When the Wall is the Problem: Supraaortic arteriopathies.

This poster is published under an open license. Please read the disclaimer for further details.

Congress:

ECR 2015

Poster Number:

C-1412

Type:

Educational Exhibit

Keywords:

Dysplasias, Dissection, Arteriosclerosis, Contrast agent-intravenous, Ultrasound, MR-Angiography, CT-Angiography, Vascular, Head and neck, CNS

Authors:

I. Etxegoien Juaristi, C. Biurrun Mancisidor, J. A. Vega, E. Pardo Zudaire, G. Vega-Hazas Porrúa, F. J. Borja Consigliere, A. Borja Consigliere; San Sebastian/ES

DOI:

10.1594/ecr2015/C-1412

DOI-Link:

https://dx.doi.org/10.1594/ecr2015/C-1412

Fig. 18: 41 year old female with clinical diagnosis of carotidynia. RMI:right CCA wall...

Fig. 19: US follow up imaging a week later after treatment with corticoids shows...

Fig. 8: 50 year old male with severe "thunderclap" headache. NECT:frontal convexal HSA....

Fig. 9: Arteriography (right and left ICA injection): multifocal vasoespasm in all...

Learning objectives

To review the etiology, pathophysiology and treatment of the arteriophaties affecting the wall of supraaortic trunks and intracranial arteries by different diagnosticimaging tecniques: ultrasonography (US), CT/CTA, MRI/MRA and arteriography.

Background

They represent a heterogeneous group of diseases that affect the wall of supraaortic arteriopathies and intracranial arteries. - CLASSIFICATION: 1. Non-Inflammatory: 1.1. Atherosclerosis: Atheroma is an accumulation of cells, lipids, extracelular matrix and necrotic debris within the intima. Diffuse intimal thickening can result on outward and constrictive remodeling of the vessel wall. 1.2. Arterial dissection/intramural hematoma: break in the arterial wall causes blood to accumulate in a false lumen (located within the media). imaging findings: long segment stenosis in true lumen, high T1 signal from...

Findings and procedure details

Thickened vessel walls may be visualized by MRI, which help to distinguish between non inflammatory and inflammatory (edema, contrast enhacement of vesselwall) origin. NECT and T1 sequence will help us distinguish between atheromatous plaque and intramural hematoma. Arteriography is the gold standard for diagnosisof reversible vasoconstriction syndrome, fibromuscular dysplasia ("string of beads" sign), and Moya-Moya disease or syndrome ("Puff of smoke" sign). * CASES: 1. Atherosclerosis. Fig. 1 Fig. 2 Fig. 3 Fig. 4 2.Arterial disección/Intramural hematoma. Fig. 5 Fig. 6 3.Fibromuscular dysplasia. Fig. 7...

Conclusion

Several diseases affecting the wall of supra-aortic trunks and intracranial arteries can have similar appereances on luminal imaging. CT/CTA, MRI/MRA and arteriographycan help distinguish among these diagnostic possibilities limiting the number of invasive procedures and improving the treatment.

Personal information

References

-Craniocervical ArterialDissection: Spectrum of Imaging Findings and Differential Diagnosis.Mathieu H. Rodallec. Radiographics, Oct 2008, Vol. 28. - Clinical and angiographic features and stroke types in adult moyamoya disease.D.-k. Jang. AJNR 2014 vol 35. - Multimodal imaging of reversible cerebral vasoconstriction syndrome:a series of 6 cases. C.P.Marder. AJNR 2012 vol 33. - MDCT Detection of fibromuscular dysplasia of the carotid artery. Cécile de Monyé. AJR April 2007, vol 188 number 4. - Imaging spectrum of CNS vasculitis. Ahmed Abdel Khalek Abdel Razek.Radiographics, Jul 2014, vol.34. -...