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High-Resolution Vessel Wall Imaging in Pediatric Mycoplasma Pneumoniae-Associated Central Nervous System Vasculitis
Mengyao Zhang1, Xinju Li2, Yanfeng Zhang1
1Children's Medical Center, Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun City, Jlin Province, China; Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun City, Jlin Province, China.
Background:
To evaluate the clinical and imaging features, particularly the characteristics of high-resolution vessel wall imaging, in pediatric cases of Mycoplasma pneumoniae-associated central nervous system vasculitis (MP-CNSV).
Methods:
The retrospective study enrolled five pediatric patients diagnosed with MP-CNSV (January 2022 to December 2024). Clinical symptoms, laboratory findings, and imaging results were analyzed.
Results:
All five patients exhibited acute neurological deficits, with preceding respiratory infections confirmed as MP infection. Magnetic resonance imaging (MRI) revealed acute ischemic infarctions in all cases, with all lesions localized to anterior circulation vessels. Magnetic resonance angiography and high-resolution vessel wall imaging assessments indicated that 11 out of 55 large and medium vessels were affected, with anterior circulation involvement in all patients. Four out of five cases exhibited multiple segmental foci and three out of five cases displayed long-segment involvement along the internal carotid artery. All patients exhibited grade 3-4 stenosis and concentric enhancement. Clinical follow-up showed remission in all patients. On vessel wall imaging follow-up, one patient showed progression of vascular stenosis at 3 months, which stabilized by 9 months; two patients exhibited reduced vessel wall enhancement and/or stenosis.
Conclusions:
Predominant anterior circulation involvement is a characteristic of childhood MP-CNSV cases in this cohort. A long-segment lesion of the internal carotid artery is also a hallmark of this case series. Moreover, all cases in our study demonstrated a monophasic disease course, which provides valuable insights for the formulation of immunosuppressive treatment strategies.
Insights
Pediatric Mycoplasma pneumoniae-associated central nervous system vasculitis (MP-CNSV) predominantly affects anterior circulation vessels. High-resolution vessel wall imaging reveals characteristic long-segment internal carotid artery lesions and concentric enhancement in these cases.
Area of Science:
- Neurology
- Pediatrics
- Radiology
Background:
- Mycoplasma pneumoniae-associated central nervous system vasculitis (MP-CNSV) is a rare but serious condition in children.
- Understanding its clinical and imaging features is crucial for diagnosis and management.
Purpose of the Study:
- To evaluate the clinical and imaging features of pediatric MP-CNSV.
- To specifically assess the role of high-resolution vessel wall imaging in characterizing the disease.
Main Methods:
- Retrospective analysis of five pediatric patients diagnosed with MP-CNSV between January 2022 and December 2024.
- Comprehensive review of clinical symptoms, laboratory findings, and detailed analysis of MRI, MRA, and high-resolution vessel wall imaging.
Main Results:
- All patients presented with acute neurological deficits following respiratory infections due to MP.
- MRI showed ischemic infarctions in the anterior circulation in all cases.
- High-resolution vessel wall imaging revealed segmental and long-segment involvement of the internal carotid artery with grade 3-4 stenosis and concentric enhancement in most cases.
Conclusions:
- Childhood MP-CNSV characteristically involves the anterior circulation and internal carotid artery with long-segment lesions.
- High-resolution vessel wall imaging provides detailed insights into vessel wall inflammation and stenosis.
- The observed monophasic disease course aids in guiding immunosuppressive treatment strategies.
