Beyond Venous Inflammation: Vessel Wall Imaging of Intracranial Arteries in Neuro-Behçet's Syndrome

Neuro-Behçet syndrome (NBS) is a heterogeneous inflammatory disorder in which venous involvement is well recognized, while intracranial arterial pathology remains insufficiently characterized. Conventional luminal imaging methods are limited in detecting early or isolated arterial wall abnormalities. Vessel wall imaging (VWI) may provide additional insights into arterial involvement in NBS.

Thirty-nine NBS patients (27 men, 12 women; mean age 38.52 ± 9.54 years) underwent intracranial VWI; 16 were imaged during the attack period and 23 during the attack-free period. A total of 1170 artery segments were systematically evaluated for wall thickening patterns and contrast enhancement. VWI findings were analyzed in relation to imaging timing, radiological subtype, MR angiography findings, and EDSS.

Vessel wall involvement was found in 16 patients (41%), mainly in the posterior circulation (81%). Concentric wall thickening without enhancement was the most common pattern (80.48%). Vessel wall involvement was significantly more frequent in patients imaged during the attack period compared with those imaged in the attack-free period (68.8% vs. 21.7%; p = 0.007). Vessel wall enhancement was present only in the attack period (p = 0.022). Notably, higher EDSS scores were significantly associated with multisegmental posterior circulation involvement, particularly when ≥ 3 segments were affected (p = 0.015; p = 0.024).

Intracranial arterial wall involvement is detectable by VWI in a substantial proportion of NBS patients, predominantly in the posterior circulation with a concentric thickening pattern. These findings suggest that arterial wall pathology may be more common than previously recognized and that VWI provides complementary diagnostic information beyond conventional luminal imaging.