Learning objectives
Our goal is to demonstrate typical aspects of vasculitis imaging with emphasis on a 3D- darkblood.
The 3D T1-weighted dark-blood sequence (3D-darkblood) enables the suppression of the flow inside the vascular lumen, what allows the study of its wall.
Vasculopathies are characterized by intense inflammatory activity in the vascular wall. Conventional arterial 3D time-of-flight (TOF) MR angiography is limited in the demonstration of the inflamed vascular wall.
In the case of vasculitis, there are areas of concentric thickening and avid enhancement by the contrast agent...
Background
- Vessel wall imaging enables differentiation between inflammatory and non-inflammatory vascular disorders, assessing the differential diagnosis of the cerebral vasculitides.
- Vessel wall enhancement on MRI is related to inflammatory activity, which is found mainly in vasculitides and in some cases of atherosclerosis.
- Absence of vessel wall enhancement on MRI is related to noninflammatory conditions, like vasoconstriction syndromes and moyamoya.
- Pre-gadolinium hypersignal in vessel wall imaging is related to dissection or intraplaque hemorrhage in atheromatosis.
- Absence of vessel wall enhancement on MRI...
Findings and procedure details
Introduction:
Vasculitides area heterogeneous group of diseases presenting with inflammation and necrosis of the vessel wall.
Strokes and hematic foci in multiple vascular distributions are common.
The etiological diagnosis can be corroborated by clinical and laboratorial data as well as imaging. Biopsy needs to be considered in undefined cases.
Atherosclerotic vasculopathy and cerebral vasoconstriction syndromes are the main differential diagnoses in imaging.
Etiology:
-Primary angiitis of the CNS:
- Primary systemic vasculitides:giant cell arteritis, Takayassu, polyarteritis nodosa, Kawasaki, Wegener, Churg-Strauss.
- Secondary systemic vasculitides:
-...
Conclusion
Vessel wall imagingenables differentiation between inflammatory and non-inflammatory vascular disorders by demonstrating enhancement of the vascular wall.
Temporalarteritisaffects branches of the external carotid artery (especially the temporal artery), with contrast enhancement being noted in the study of the vascular wall.
Atheromatosis and vasoconstrictionsyndromesare important differential diagnoses of vasculitis.
Atheromatosis: irregular thickening of the vascular wall that can enhance.
Vasoconstriction syndromes: multifocal stenosis, usually without contrast enhancement.
Moyamoya and dissectionare other differential diagnoses when studying the vascular wall.
Moyamoyashows noninflammatory stenosis/occlusions of the internal carotid arteries...
Personal information and conflict of interest
V. T. Salzani; Rio de Janeiro, RIO DE JANEIRO/BR - nothing to disclose P. N. Paiva de Castro; Rio de Janeiro, RIO DE JANEIRO/BR - nothing to disclose E. M. Lima; Rio de Janeiro, RIO DE JANEIRO/BR - nothing to disclose R. Queiroz Dos Santos; Rio De Janeiro/BR - nothing to disclose D. Carvalho Machado; Rio de Janeiro/BR - nothing to disclose L. E. D. Siqueira Pinto; RIO DE JANEIRO/BR - nothing to disclose R. Cruz Bezerra; Rio de Janeiro/BR - nothing to disclose C....
References
1. Pinho MC, Hall JT, Cross JC; Shang T, Madhuranthakam AJ, Moore WA. Intracranial Vessel Wall MRI in Clinical Practice: Technical Considerations, Current and Emerging Applications, and Clinical Pearls and Pitfalls. Radiographics. 2018; 8 (2): 97-118. https://doi.org/10.3174/ng.9170237.
2. Mandell DM, Mossa-Basha M, Qiao Y. Intracranial vessel wall MRI: Principles and expert consensus recommendations of the American Society of Neuroradiology. AJNR Am J Neuroradiol. 2017; 38:218–29. https://doi.org/10.3174/ajnr.A4893.
3. Miller TR, Shivashankar R, Mossa-Basha M, Gandhi D. Reversible Cerebral Vasoconstriction Syndrome, Part 2: Diagnostic Work-Up, Imaging Evaluation,...
