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Wagner F, Almeida GG, Willems EP, Weber J, Geiss J, Hundsberger T, Mordasini P, Wildermuth S, Leschka S, Waelti S, Dietrich TJ, Fischer TS. Temporal evolution of primary angiitis of the central nervous system (PACNS) on MRI following immunosuppressant treatment. Insights Imaging 2024; 15:140. [PMID: 38853223 PMCID: PMC11162979 DOI: 10.1186/s13244-024-01710-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/26/2024] [Indexed: 06/11/2024] Open
Abstract
PURPOSE To systematically analyse the time course of vessel wall enhancement and associated stenosis in patients with primary angiitis of the central nervous system (PACNS) following immunosuppressive therapy. MATERIAL AND METHODS Two neuroradiologists retrospectively analysed MRIs of patients with PACNS seen at the Bern University Hospital and the St. Gallen Cantonal Hospital between 2015 and 2020. MRIs were examined for the presence of vessel wall enhancement, length of vessel wall enhancement (mm), circumferential extent of enhancement (degree) and degree of stenosis (%). Descriptive statistics and measurements of interobserver reliability were obtained. To investigate the temporal profiles of the variables following the commencement of immunosuppressant treatment, four series of Bayesian generalised multi-level models were generated. RESULTS A total of 23 patients with 43 affected vessels identified from 209 MRI exams were evaluated (mean follow-up: 715 days, standard deviation ± 487 days), leading to a complete dataset of 402 entries. Vessel wall enhancement and circumferential extent of enhancement decreased for approximately 1 year after the initiation of immunosuppressant therapy. Changes were more pronounced in younger patients. Disappearance of vessel wall enhancement (in at least one vessel) was seen in about half of patients after a median of 172 days interquartile range 113-244, minimum 54 days, maximum 627 days. CONCLUSIONS This study evaluated the typical time course of vessel wall enhancement in patients with PACNS. Our results could be a useful reference for radiologists and clinicians interpreting follow-up imaging in patients with PACNS. CRITICAL RELEVANCE STATEMENT Routine clinical exams can be interpreted with more confidence when radiologists are aware of the typical temporal evolution of vessel wall enhancement in patients with primary angiitis of the central nervous system after initiation of immunosuppressive therapy. KEY POINTS Few data exist for vessel wall imaging of primary angiitis of the central nervous system. Following immunosuppressant therapy, vessel wall enhancement decreases for approximately one year. These results may serve as a reference for radiologists performing follow-up imaging.
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Affiliation(s)
- Franca Wagner
- Bern University Hospital, University of Bern, Bern, Switzerland
- University of Bern, Bern, Switzerland
| | - Gonçalo G Almeida
- University of Bern, Bern, Switzerland
- Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Erik P Willems
- Clinical Trials Unit, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Johannes Weber
- Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Medical School St. Gallen, St. Gallen, Switzerland
| | - Johannes Geiss
- Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Medical School St. Gallen, St. Gallen, Switzerland
| | - Thomas Hundsberger
- Department of Neurology and Oncology, Cantonal Hospital St. Gallen, Medical School St. Gallen, St. Gallen, Switzerland
| | - Pasquale Mordasini
- Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Medical School St. Gallen, St. Gallen, Switzerland
| | - Simon Wildermuth
- Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Medical School St. Gallen, St. Gallen, Switzerland
| | - Sebastian Leschka
- Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Medical School St. Gallen, St. Gallen, Switzerland
| | - Stephan Waelti
- Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Medical School St. Gallen, St. Gallen, Switzerland
| | - Tobias Johannes Dietrich
- Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Medical School St. Gallen, St. Gallen, Switzerland
| | - Tim Steffen Fischer
- Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Medical School St. Gallen, St. Gallen, Switzerland.
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Agarwal S, Sebastian LJD, Gaikwad S, Srivastava MVP, Sharma MC, Singh M, Bhatia R, Agarwal A, Sharma J, Dash D, Goyal V, Srivastava AK, Tripathi M, Suri V, Singh MB, Sarkar C, Suri A, Singh RK, Vibha D, Pandit AK, Rajan R, Gupta A, Elavarasi A, Radhakrishnan DM, Das A, Tandon V, Doddamani R, Upadhyay A, Vishnu VY, Garg A. The role of susceptibility-weighted imaging & contrast-enhanced MRI in the diagnosis of primary CNS vasculitis: a large case series. Sci Rep 2024; 14:4718. [PMID: 38413676 PMCID: PMC10899183 DOI: 10.1038/s41598-024-55222-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/21/2024] [Indexed: 02/29/2024] Open
Abstract
Primary CNS Vasculitis (PCNSV) is a rare, diverse, and polymorphic CNS blood vessel inflammatory condition. Due to its rarity, clinical variability, heterogeneous imaging results, and lack of definitive laboratory markers, PCNSV diagnosis is challenging. This retrospective cohort analysis identified patients with histological diagnosis of PCNSV. Demographic data, clinical presentation, neuroimaging studies, and histopathologic findings were recorded. We enrolled 56 patients with a positive biopsy of CNS vasculitis. Most patients had cerebral hemisphere or brainstem symptoms. Most brain MRI lesions were bilateral, diffuse discrete to confluent white matter lesions. Frontal lobe lesions predominated, followed by inferior cerebellar lesions. Susceptibility-weighted imaging (SWI) hemorrhages in 96.4% (54/56) of patients, either solitary microhemorrhages or a combination of micro and macrohemorrhages. Contrast-enhanced T1-WIs revealed parenchymal enhancement in 96.3% (52/54 patients). The most prevalent pattern of enhancement observed was dot-linear (87%), followed by nodular (61.1%), perivascular (25.9%), and patchy (16.7%). Venulitis was found in 19 of 20 individuals in cerebral DSA. Hemorrhages in SWI and dot-linear enhancement pattern should be incorporated as MINOR diagnostic criteria to diagnose PCNSV accurately within an appropriate clinical context. Microhemorrhages in SWI and venulitis in DSA, should be regarded as a potential marker for PCNSV.
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Affiliation(s)
- Sushant Agarwal
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India.
| | | | - Shailesh Gaikwad
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - M C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Jyoti Sharma
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepa Dash
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Vinay Goyal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Achal K Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Vaishali Suri
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta B Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Chitra Sarkar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Suri
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh K Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Vibha
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Awadh K Pandit
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Anu Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - A Elavarasi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Animesh Das
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Tandon
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Doddamani
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Upadhyay
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Venugopalan Y Vishnu
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
| | - Ajay Garg
- Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India.
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Zedde M, Napoli M, Moratti C, Pezzella FR, Seiffge DJ, Tsivgoulis G, Caputi L, Salvarani C, Toni D, Valzania F, Pascarella R. The Hemorrhagic Side of Primary Angiitis of the Central Nervous System (PACNS). Biomedicines 2024; 12:459. [PMID: 38398061 PMCID: PMC10886751 DOI: 10.3390/biomedicines12020459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/29/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024] Open
Abstract
Primary Angiitis of the Central Nervous System (PACNS) is a rare cerebrovascular disease involving the arteries of the leptomeninges, brain and spinal cord. Its diagnosis can be challenging, and the current diagnostic criteria show several limitations. Among the clinical and neuroimaging manifestations of PACNS, intracranial bleeding, particularly intracerebral hemorrhage (ICH), is poorly described in the available literature, and it is considered infrequent. This review aims to summarize the available data addressing this issue with a dedicated focus on the clinical, neuroradiological and neuropathological perspectives. Moreover, the limitations of the actual data and the unanswered questions about hemorrhagic PACNS are addressed from a double point of view (PACNS subtyping and ICH etiology). Fewer than 20% of patients diagnosed as PACNS had an ICH during the course of the disease, and in cases where ICH was reported, it usually did not occur at presentation. As trigger factors, both sympathomimetic drugs and illicit drugs have been proposed, under the hypothesis of an inflammatory response due to vasoconstriction in the distal cerebral arteries. Most neuroradiological descriptions documented a lobar location, and both the large-vessel PACNS (LV-PACNS) and small-vessel PACNS (SV-PACNS) subtypes might be the underlying associated phenotypes. Surprisingly, amyloid beta deposition was not associated with ICH when histopathology was available. Moreover, PACNS is not explicitly included in the etiological classification of spontaneous ICH. This issue has received little attention in the past, and it could be addressed in future prospective studies.
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Affiliation(s)
- Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Manuela Napoli
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123 Reggio Emilia, Italy; (M.N.); (R.P.)
| | - Claudio Moratti
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123 Reggio Emilia, Italy; (M.N.); (R.P.)
| | | | - David Julian Seiffge
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Georgios Tsivgoulis
- Second Department of Neurology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece
| | - Luigi Caputi
- Neurology Unit, Department of Cardio-Cerebrovascular Diseases, Maggiore Hospital ASST-Crema, 26013 Crema, Italy;
| | - Carlo Salvarani
- Rheumatology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Danilo Toni
- Emergency Department Stroke Unit, Policlinico Umberto I, University La Sapienza, 00189 Rome, Italy;
| | - Franco Valzania
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Rosario Pascarella
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123 Reggio Emilia, Italy; (M.N.); (R.P.)
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4
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Pascarella R, Antonenko K, Boulouis G, De Boysson H, Giannini C, Heldner MR, Kargiotis O, Nguyen TN, Rice CM, Salvarani C, Schmidt-Pogoda A, Strbian D, Hussain S, Zedde M. European Stroke Organisation (ESO) guidelines on Primary Angiitis of the Central Nervous System (PACNS). Eur Stroke J 2023; 8:842-879. [PMID: 37903069 PMCID: PMC10683718 DOI: 10.1177/23969873231190431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/11/2023] [Indexed: 11/01/2023] Open
Abstract
The European Stroke Organisation (ESO) guideline on Primary Angiitis of the Central Nervous System (PACNS), developed according to ESO standard operating procedures (SOP) and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, was elaborated to assist clinicians in the diagnostic and treatment pathway of patients with PACNS in their decision making. A working group involving vascular neurologists, neuroradiologists, rheumatologists, a neuropathologist and a methodologist identified 17 relevant clinical questions; these were addressed according to the patient/population, intervention, comparison and outcomes (PICO) framework and systematic literature reviews were performed. Notably, each PICO was addressed with respect to large vessel (LV)-PACNS and small vessel (SV)-PACNS. Data to answer many questions were scarce or lacking and the quality of evidence was very low overall, so, for some PICOs, the recommendations reflect the ongoing uncertainty. When the absence of sufficient evidence precluded recommendations, Expert Consensus Statements were formulated. In some cases, this applied to interventions in the diagnosis and treatment of PACNS which are embedded widely in clinical practice, for example patterns of cerebrospinal fluid (CSF) and Magnetic Resonance Imaging (MRI) abnormalities. CSF analysis for hyperproteinorrachia and pleocytosis does not have evidence supporting their use as diagnostic tools. The working group recommended that caution is employed in the interpretation of non-invasive vascular imaging due to lack of validation and the different sensitivities in comparison with digital subtraction angiography (DSA) and histopathological analyses. Moreover, there is not a neuroimaging pattern specific for PACNS and neurovascular issues are largely underreported in PACNS patients. The group's recommendations on induction and maintenance of treatment and for primary or secondary prevention of vascular events also reflect uncertainty due to lack of evidence. Being uncertain the role and practical usefulness of current diagnostic criteria and being not comparable the main treatment strategies, it is suggested to have a multidisciplinary team approach in an expert center during both work up and management of patients with suspected PACNS. Highlighting the limitations of the currently accepted diagnostic criteria, we hope to facilitate the design of multicenter, prospective clinical studies and trials. A standardization of neuroimaging techniques and reporting to improve the level of evidence underpinning interventions employed in the diagnosis and management of PACNS. We anticipate that this guideline, the first comprehensive European guideline on PACNS management using GRADE methodology, will assist clinicians to choose the most effective management strategy for PACNS.
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Affiliation(s)
- Rosario Pascarella
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Katherina Antonenko
- Department of Neurology, University Hospital and University of Bern, Bern, Switzerland
| | - Grégoire Boulouis
- Neuroradiology - Diagnostic and Interventional Neuroradiology, CIC-IT 1415, INSERM 1253 iBrain, Tours University Hospital, Centre Val de Loire Region, France
| | - Hubert De Boysson
- Service de Médecine Interne, CHU de Caen, Avenue de la Côte de Nacre, Caen, France; Université Caen Normandie, Caen, France
| | - Caterina Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Mirjam R Heldner
- Department of Neurology, University Hospital and University of Bern, Bern, Switzerland
| | - Odysseas Kargiotis
- Stroke Unit, Metropolitan Hospital, Ethnarchou Makariou 9, Piraeus, Greece
| | - Thanh N Nguyen
- Neurology, Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Claire M Rice
- Neurology, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Neurology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Carlo Salvarani
- Rheumatology, Rheumatology Unit, Azienda Ospedaliera-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy
| | - Antje Schmidt-Pogoda
- Department of Neurology with Institute of Translational Neurology, Münster University Hospital, Albert-Schweitzer-Campus 1, Münster, Germany
| | - Daniel Strbian
- Department of Neurology, Helsinki University Central Hospital HUCH, Helsinki, Finland
| | | | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Campos ADC, Sarmento S, Narciso M, Fonseca T. Primary Central Nervous System Vasculitis: A Rare Cause of Stroke. Cureus 2023; 15:e39541. [PMID: 37366459 PMCID: PMC10290904 DOI: 10.7759/cureus.39541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Primary central nervous system vasculitis (PCNSV) is a rare cause of ischemic stroke and is considered idiopathic in most cases. PCNSV can present with a wide variety of neurological manifestations and should be considered in the differential diagnosis of ischemic stroke, particularly if the neurological deficit cannot be explained by the affected vascular area or when it is multifocal. The diagnosis of PCNSV is relevant because the required therapy differs from the treatments commonly used for frequent ischemic strokes. We report the case of a 64-year-old woman admitted for an ischemic stroke with a right frontal cortico-subcortical ischemic lesion. The etiological investigation documented multiple intracranial arterial stenoses. Secondary causes of central nervous system vasculitis were excluded. The patient refused a brain biopsy, and corticosteroid therapy was initiated due to high suspicion of PCNSV, supported by findings from transcranial Doppler ultrasound and brain magnetic resonance angiography. The patient had a positive clinical outcome and did not have any recurrences while under therapy. This case raises awareness of the importance of considering PCNSV in the differential diagnosis of ischemic stroke. It emphasizes the importance of promptly initiating therapy to minimize PCNSV-associated complications.
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Affiliation(s)
- Ana de Carmo Campos
- Pulido Valente Hospital, North Lisbon University Hospital Centre, Lisbon, PRT
- Department of Health Promotion and Prevention of Non-communicable Disease, National Health Institute Doutor Ricardo Jorge, Lisbon, PRT
| | - Sara Sarmento
- Pulido Valente Hospital, North Lisbon University Hospital Centre, Lisbon, PRT
- Faculty of Medicine, University of Lisbon, Lisbon, PRT
| | - Marco Narciso
- Pulido Valente Hospital, North Lisbon University Hospital Centre, Lisbon, PRT
| | - Teresa Fonseca
- Pulido Valente Hospital, North Lisbon University Hospital Centre, Lisbon, PRT
- Faculty of Medicine, University of Lisbon, Lisbon, PRT
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Diagnosis and follow-up evaluation of central nervous system vasculitis: an evaluation of vessel-wall MRI findings. J Neurol 2021; 269:982-996. [PMID: 34236502 PMCID: PMC8264821 DOI: 10.1007/s00415-021-10683-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 01/14/2023]
Abstract
Objective To approach the clinical value of MRI with vessel wall imaging (VWI) in patients with central nervous system vasculitis (CNSV), we analyzed patterns of VWI findings both at the time of initial presentation and during follow-up. Methods Stenoocclusive lesions, vessel-wall contrast enhancement (VW-CE) and diffusion-restricted lesions were analyzed in patients with a diagnosis of CNSV. On available VWI follow-up, progression, regression or stability of VW-CE were evaluated and correlated with the clinical status. Results Of the 45 patients included, 28 exhibited stenoses visible on MR angiography (MRA-positive) while 17 had no stenosis (MRA-negative). VW-CE was found in 2/17 MRA-negative and all MRA-positive patients (p < 0.05). 79.1% (53/67) of stenoses showed VW-CE. VW-CE was concentric in 88.3% and eccentric in 11.7% of cases. Diffusion-restricted lesions were found more frequently in relation to stenoses with VW-CE than without VW-CE (p < 0.05). 48 VW-CE lesions in 23 patients were followed over a median time of 239.5 days. 13 VW-CE lesions (27.1%) resolved completely, 14 (29.2%) showed partial regression, 17 (35.4%) remained stable and 4 (8.3%) progressed. 22/23 patients received immunosuppressive therapy for the duration of follow-up. Patients with stable or progressive VW-CE were more likely (p < 0.05) to have a relapse (14/30 cases) than patients with partial or complete regression of VW-CE (5/25 cases). Conclusion Concentric VW-CE is a common finding in medium/large-sized vessel CNSV. VW-CE might represent active inflammation in certain situations. However, follow-up VWI findings proved ambiguous as persisting VW-CE despite immunosuppressive therapy and clinical remission was a frequent finding. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10683-7.
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Su X, Han L, Li M, Wang Z, Gao J, Tian Y, Du C. Novel method using DW-MRI and ADC images to guide stereotactic biopsy for the diagnosis small primary angiitis of the central nervous system: a case report. Eur J Med Res 2021; 26:58. [PMID: 34162432 PMCID: PMC8220829 DOI: 10.1186/s40001-021-00529-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/03/2021] [Indexed: 11/10/2022] Open
Abstract
Objective To determine the role of diffusion-weighted magnetic resonance imaging (DW-MRI) and apparent diffusion coefficient (ADC) imaging to guide stereotactic biopsy for the diagnosis of intracranial angiitis. Case presentation In a 28-year-old woman who had experienced inactive headache and right limbs numbness for 4 days, preoperative magnetic resonance (MR) scanning, enhanced scanning, diffusion tensor imaging, magnetic resonance spectroscopy, diffusion-weighted imaging (DWI), and ADC image scanning were performed. Stereotactic biopsy was performed in one target where the area of edema detected with MR FLAIR, and two targets where the area shown as a high-value and a lower value area in the DWI/ADC image. Pathological examinations together with computed tomographic and enhanced MRI scans were conducted after surgery. A preoperative enhanced MRI scan showed a uniform low-intensity lesion in the patient’s left centrum semiovale, with a volume of 3.1 cm3. The DWI and ADC images showed uneven high-intensity signals and different ADC values in the lesion area, respectively. During surgery, tissues around the lesion and the lesion center were sampled at the three selected targets. The postoperative pathological diagnosis was primary angiitis of the central nervous system, and the patient was given anti-inflammatory medication and hormone therapy. The 3-year follow-up confirmed that the patient had recovered well, with a Glasgow Outcome Scale score of five. Conclusion DW-MRI and ADC images can be reliably used to determine the location of small intracranial lesions, and guide stereotactic biopsy to facilitate the diagnosis of primary vasculitis of the central nervous system.
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Affiliation(s)
- Xu Su
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, 130033, China
| | - Liang Han
- Department of Pathology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Mengxing Li
- Beijing Neurosurgical Institute , Beijing, China
| | - Zhengming Wang
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, 130033, China
| | - Jiadui Gao
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, 130033, China
| | - Yu Tian
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, 130033, China
| | - Chao Du
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, No. 126, Xiantai Street, Changchun, 130033, China.
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8
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Arnett N, Pavlou A, Burke MP, Cucchiara BL, Rhee RL, Song JW. Vessel wall MR imaging of central nervous system vasculitis: a systematic review. Neuroradiology 2021; 64:43-58. [PMID: 33938989 DOI: 10.1007/s00234-021-02724-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Beyond vessel wall enhancement, little is understood about vessel wall MR imaging (VW-MRI) features of vasculitis affecting the central nervous system (CNS). We reviewed vessel wall MR imaging patterns of inflammatory versus infectious vasculitis and also compared imaging patterns for intracranial versus extracranial arteries of the head and neck. METHODS Studies reporting vasculitis of the CNS/head and neck and included MR imaging descriptions of vessel wall features were identified by searching PubMed, Scopus, Cochrane, Web of Science, and EMBASE up to June 10, 2020. From 6065 publications, 115 met the inclusion criteria. Data on study characteristics, vasculitis type, MR details, and VW-MRI descriptions were extracted. RESULTS Studies used VW-MRI for inflammatory (64%), infectious (17%), or both inflammatory and infectious vasculitides (19%). Vasculitis affecting intracranial versus extracranial arteries were reported in 58% and 39% of studies, respectively. Commonly reported VW-MRI features were vessel wall enhancement (89%), thickening (72%), edema (10%), and perivascular enhancement (16%). Inflammatory vasculitides affecting the intracranial arteries were less frequently reported to have vessel wall thickening (p = 0.006) and perivascular enhancement (p = 0.001) than extracranial arteries. Varicella zoster/herpes simplex vasculitis (VZV/HSV, 45%) and primary angiitis of the CNS (PACNS, 22%) were the most commonly reported CNS infectious and inflammatory vasculitides, respectively. Patients with VZV/HSV vasculitis more frequently showed decreased or resolution of vessel wall enhancement after therapy compared to PACNS (89% versus 59%). CONCLUSIONS To establish imaging biomarkers of vessel wall inflammation in the CNS, VW-MRI features of vasculitis accounting for disease mechanism and anatomy should be better understood.
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Affiliation(s)
- Nathan Arnett
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Athanasios Pavlou
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Morgan P Burke
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Brett L Cucchiara
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Rennie L Rhee
- Department of Rheumatology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jae W Song
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
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Suthiphosuwan S, Bharatha A, Hsu CCT, Lin AW, Maloney JA, Munoz DG, Palmer CA, Osborn AG. Tumefactive Primary Central Nervous System Vasculitis: Imaging Findings of a Rare and Underrecognized Neuroinflammatory Disease. AJNR Am J Neuroradiol 2020; 41:2075-2081. [PMID: 32883666 DOI: 10.3174/ajnr.a6736] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/26/2020] [Indexed: 12/15/2022]
Abstract
Primary central nervous system vasculitis (PCNSV) is a poorly understood neuroinflammatory disease of the CNS affecting the intracranial vasculature. Although PCNSV classically manifests as a multifocal beaded narrowing of the intracranial vessels, some patients may not have angiographic abnormalities. A rare subset of patients with PCNSV present with masslike brain lesions mimicking a neoplasm. In this article, we retrospectively review 10 biopsy-confirmed cases of tumefactive PCNSV (t-PCNSV). All cases of t-PCNSV in our series that underwent CTA or MRA were found to have normal large and medium-sized vessels. T-PCNSV had a variable MR imaging appearance with most cases showing cortical/subcortical enhancing masslike lesion (70%), often with microhemorrhages (80%). Diffusion restriction was absent in all lesions. In summary, normal vascular imaging does not exclude the diagnosis of t-PCNSV. Advanced imaging techniques including MR perfusion and MR spectroscopy failed to demonstrate specific findings for t-PCNSV but assisted in excluding neoplasm in the differential diagnosis. Biopsy remains mandatory for definitive diagnosis.
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Affiliation(s)
- S Suthiphosuwan
- From the Department of Medical Imaging (S.S., A.B., CC-T.H., A.W.L.)
| | - A Bharatha
- From the Department of Medical Imaging (S.S., A.B., CC-T.H., A.W.L.)
- Surgery (A.B.)
| | - C C-T Hsu
- From the Department of Medical Imaging (S.S., A.B., CC-T.H., A.W.L.)
- Department of Medical Imaging (CC-T.H.), Gold Coast University Hospital, Queensland, Australia
| | - A W Lin
- From the Department of Medical Imaging (S.S., A.B., CC-T.H., A.W.L.)
| | - J A Maloney
- Department of Radiology (J.A.M.), University of Colorado, Denver, Colorado
| | - D G Munoz
- Laboratory Medicine and Pathobiology (D.G.M.), University of Toronto, Toronto, Canada
| | | | - A G Osborn
- Radiology and Imaging Sciences (A.G.O.), University of Utah, Salt Lake City, Utah
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10
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Chang HB, Gao M, Zhang JN, Cao WD, Guo SL, Wang P, Cheng G, Zhao HL. Retrospective Analysis of 28 Cases Confirmed for Primary Angiitis of the Central Nervous System by Biopsy. J Stroke Cerebrovasc Dis 2020; 29:105400. [PMID: 33096491 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/26/2020] [Accepted: 10/06/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE The present study aimed to summarize the clinical characteristics, therapeutic effects, and long-term prognosis of cases confirmed with primary angiitis of the central nervous system (PACNS) by biopsy, analyze the risk factors, and provide clinical guidance for the diagnosis and treatment of the disease. METHODS Retrospective analysis was performed on 28 cases of PACNS confirmed by biopsy, and the age, gender, pathological results, course of the disease, imaging manifestations, treatment, and prognosis of the patients were analyzed and summarized. RESULTS The cohort (age 16-60 years) comprised of 16 males. The average time from the visit to diagnosis was 6 months. The first symptom was chronic headache in 18 patients. The pathological results were accompanied by demyelination in 10 cases and glial hyperplasia in 6 cases. A total of 27 patients received treatments including glucocorticoid+cyclophosphamide; of these, 3 cases of craniotomy were improved. Among the 28 patients, 15 patients improved after the treatment, 12 patients had no significant improvement, and 1 patient was deceased. Patients with a long course of the disease before diagnosis, a Karnofsky performance status (KPS) score <60 at the time of diagnosis, a behavioral, cognitive abnormality before treatment, and a short-term relapse (0.3-1 month) have a poor outcome. CONCLUSIONS PACNS patients are prone to misdiagnosis and mistreatment, with unknown etiology and poor prognosis due to delayed treatment. Therefore, early biopsy, pathological diagnosis, and timely treatment with glucocorticoid shock are recommended, and patients with obvious mass effect should be treated by surgical resection.
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Affiliation(s)
- Hong-Bo Chang
- Department of Neurosurgery, The First Medical Center of PLA General Hospital, Beijing 100853,China.
| | - Ming Gao
- Department of Pediatrics, The seventh medical center of PLA general hospital, Beijing 100010, China.
| | - Jian-Ning Zhang
- Department of Neurosurgery, The First Medical Center of PLA General Hospital, Beijing 100853,China.
| | - Wei-Dong Cao
- Department of Neurosurgery, The First Medical Center of PLA General Hospital, Beijing 100853,China.
| | - Sheng-Li Guo
- Department of Neurosurgery, The First Medical Center of PLA General Hospital, Beijing 100853,China.
| | - Peng Wang
- Department of Neurosurgery, The First Medical Center of PLA General Hospital, Beijing 100853,China.
| | - Gang Cheng
- Department of Neurosurgery, The First Medical Center of PLA General Hospital, Beijing 100853,China.
| | - Hu-Lin Zhao
- Department of Neurosurgery, The First Medical Center of PLA General Hospital, Beijing 100853,China.
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11
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Edjlali M, Qiao Y, Boulouis G, Menjot N, Saba L, Wasserman BA, Romero JM. Vessel wall MR imaging for the detection of intracranial inflammatory vasculopathies. Cardiovasc Diagn Ther 2020; 10:1108-1119. [PMID: 32968663 DOI: 10.21037/cdt-20-324] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Intracranial vasculopathies are routinely investigated by lumen-based modalities such as magnetic resonance angiography (MRA), computed tomography angiography (CTA), and digital subtraction angiography (DSA). These techniques are useful to analyze the vessel lumen, allowing to detect vessel stenosis or occlusion. However, the primum movins of the disease, i.e., an abnormal thickening of the vessel wall, remains within the arterial wall. The vasculopathy can moreover be present without always narrowing the lumen or modifying its regularity. Hence, there is a need to detect directly and analyze vessel wall abnormalities. Development of 3D high-resolution black blood sequences for intracranial vessel wall MR imaging (VW-MRI) enabled routine clinical applications not only vasculitis, but also of intracranial atherosclerotic disease (ICAD), intracranial dissections, reversible intracranial dissections, reversible cerebral vasoconstriction syndrome (RCVS), Moyamoya disease, and intracranial aneurysms. This high-resolution intracranial VW- MRI approach is increasingly used on a clinical basis at many centers to solve diagnostic problems, especially in patients with ischemic stroke or intracranial hemorrhage. An expert consensus Guideline from the American Society of Neuroradiology provides recommendations for clinical implementation of intracranial vessel wall MRI. There are several technical aspects needed to be considered when implementing VW-MRI in intracranial vessels, including flow suppression, both in blood and cerebrospinal fluid (CSF), spatial resolution and signal-to-noise ratio (SNR). In this article, we review the technical aspects of VW-MRI, and recommend applications for vascular diseases including non-occlusive intracranial vasculopathies, Moyamoya disease, and identifying culprit plaques. We also give a focus on the utility of VW-MRI for determining stroke etiology in adults and in children and young adults.
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Affiliation(s)
- Myriam Edjlali
- Department of Neuroradiology, Université Paris-Descartes-Sorbonne-Paris-Cité, IMABRAIN-INSERM-UMR1266, DHU-Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Ye Qiao
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Gregoire Boulouis
- Department of Neuroradiology, Université Paris-Descartes-Sorbonne-Paris-Cité, IMABRAIN-INSERM-UMR1266, DHU-Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - Nicolas Menjot
- Département de Neuroradiologie, Hôpital Gui de Chauliac, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France.,Institut d'Imagerie Fonctionnelle Humaine (I2FH), Hôpital Gui de Chauliac, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France.,Département d'imagerie médicale; Centre Hospitalier Universitaire Caremeau, Nîmes, France.,Laboratoire Charles Coulomb, CNRS UMR 5221, Université de Montpellier, Montpellier, France
| | - Luca Saba
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | - Bruce Alan Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Javier M Romero
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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12
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Sloane KL, Anand P. Inflammatory Vasculitides of the Central Nervous System. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00817-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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Song JW, Moon BF, Burke MP, Kamesh Iyer S, Elliott MA, Shou H, Messé SR, Kasner SE, Loevner LA, Schnall MD, Kirsch JE, Witschey WR, Fan Z. MR Intracranial Vessel Wall Imaging: A Systematic Review. J Neuroimaging 2020; 30:428-442. [PMID: 32391979 DOI: 10.1111/jon.12719] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/22/2020] [Accepted: 04/10/2020] [Indexed: 12/22/2022] Open
Abstract
The purpose of this systematic review is to identify trends and extent of variability in intracranial vessel wall MR imaging (VWI) techniques and protocols. Although variability in selection of protocol design and pulse sequence type is known, data on what and how protocols vary are unknown. Three databases were searched to identify publications using intracranial VWI. Publications were screened by predetermined inclusion/exclusion criteria. Technical development publications were scored for completeness of reporting using a modified Nature Reporting Summary Guideline to assess reproducibility. From 2,431 articles, 122 met the inclusion criteria. Trends over the last 23 years (1995-2018) show increased use of 3-Tesla MR (P < .001) and 3D volumetric T1-weighted acquisitions (P < .001). Most (65%) clinical VWI publications report achieving a noninterpolated in-plane spatial resolution of ≤.55 mm. In the last decade, an increasing number of technical development (n = 20) and 7 Tesla (n = 12) publications have been published, focused on pulse sequence development, improving cerebrospinal fluid suppression, scan efficiency, and imaging ex vivo specimen for histologic validation. Mean Reporting Summary Score for the technical development publications was high (.87, range: .63-1.0) indicating strong scientific technical reproducibility. Innovative work continues to emerge to address implementation challenges. Gradual adoption into the research and scientific community was suggested by a shift in the name in the literature from "high-resolution MR" to "vessel wall imaging," specifying diagnostic intent. Insight into current practices and identifying the extent of technical variability in the literature will help to direct future clinical and technical efforts to address needs for implementation.
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Affiliation(s)
- Jae W Song
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | - Brianna F Moon
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA
| | - Morgan P Burke
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | | | - Mark A Elliott
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | - Haochang Shou
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Steven R Messé
- Department of Neurology, Hospital of University of Pennsylvania, Philadelphia, PA
| | - Scott E Kasner
- Department of Neurology, Hospital of University of Pennsylvania, Philadelphia, PA.,Department of Emergency Medicine, Hospital of University of Pennsylvania, Philadelphia, PA
| | - Laurie A Loevner
- Department of Radiology, University of Pennsylvania, Philadelphia, PA.,Department of Otolaryngology, Hospital of University of Pennsylvania, Philadelphia, PA
| | | | - John E Kirsch
- Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA
| | - Walter R Witschey
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | - Zhaoyang Fan
- Department of Biomedical Sciences, Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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14
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Song JW, Guiry SC, Shou H, Wang S, Witschey WR, Messé SR, Kasner SE, Loevner LA. Qualitative Assessment and Reporting Quality of Intracranial Vessel Wall MR Imaging Studies: A Systematic Review. AJNR Am J Neuroradiol 2019; 40:2025-2032. [PMID: 31727743 DOI: 10.3174/ajnr.a6317] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/24/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Over the last quarter-century, the number of publications using vessel wall MR imaging has increased. Although many narrative reviews offer insight into technique and diagnostic applications, a systematic review of publication trends and reporting quality has not been conducted to identify unmet needs and future directions. PURPOSE We aimed to identify which intracranial vasculopathies need more data and to highlight areas of strengths and weaknesses in reporting. DATA SOURCES PubMed, EMBASE, and MEDLINE databases were searched up to September 2018 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA ANALYSIS Two independent reviewers screened and extracted data from 128 articles. The Strengthening the Reporting of Observational Studies in Epidemiology guidelines were used to assess the reporting quality of analytic observational studies. DATA SYNTHESIS There has been an exponentially increasing trend in the number of vessel wall MR imaging publications during the past 24 years (P < .0001). Intracranial atherosclerosis is the most commonly studied intracranial vasculopathy (49%), followed by dissections (13%), aneurysms (8%), and vasculitis (5%). Analytic observational study designs composed 48% of the studies. Transcontinental collaborations showed nonsignificantly higher reporting quality compared with work originating from single continents (P = .20). LIMITATIONS A limitation is the heterogeneity in study designs. CONCLUSIONS Investigations on the diagnostic utility of vessel wall MR imaging in less commonly studied intracranial vasculopathies such as dissections, aneurysms, and vasculitis are warranted. More consistent adherence to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines should improve transparency and maximize effective synthesis for clinical translation. Diverse collaborative teams are encouraged to advance the understanding of intracranial vasculopathies using vessel wall MR imaging.
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Affiliation(s)
- J W Song
- From the Departments of Radiology (J.W.S., S.C.G., S.W., W.R.W., L.A.L.)
| | - S C Guiry
- From the Departments of Radiology (J.W.S., S.C.G., S.W., W.R.W., L.A.L.)
| | - H Shou
- Department of Biostatistics, Epidemiology and Informatics (H.S.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - S Wang
- From the Departments of Radiology (J.W.S., S.C.G., S.W., W.R.W., L.A.L.)
| | - W R Witschey
- From the Departments of Radiology (J.W.S., S.C.G., S.W., W.R.W., L.A.L.)
| | | | | | - L A Loevner
- From the Departments of Radiology (J.W.S., S.C.G., S.W., W.R.W., L.A.L.)
- Otolaryngology (L.A.L.)
- Neurosurgery (L.A.L.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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15
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Kalashnikova LA, Dobrynina LA, Legenko MS. [Primary central nervous system vasculitis]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:113-123. [PMID: 31626179 DOI: 10.17116/jnevro2019119081113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Primary vasculitis (angiitis) of the central nervous system (PACNS) is a rare disease targeting the vessels of the brain, spinal cord and leptomeninges without systemic involvement. The etiology is not clear enough. The authors review clinical, laboratory and radiological features of PACNS. Clinical manifestations are variable and depend on the caliber of affected vessels. The main clinical manifestations of small sized vessel vasculitis include encephalopathy (cognitive disorders, epileptic seizures), headache and transient cerebral ischemia. The main clinical presentation of vasculitis of medium/large cerebral arteries is ischemic strokes, which usually develop in different vascular territories. CSF findings in the majority of patients show modest lymphocytic pleocytosis, elevated protein level and occasionally the presence of oligoclonal bands. MRI data are not specific and include infarcts, hyperintensity (FLAIR) and sometimes tumor-like lesions. The gold standard for the verification of PACNS affected small-sized arteries is brain and leptomeningeal biopsy. Cerebral angiography allows the verification of vasculitis of medium and large cerebral arteries revealing segmental narrowings (beading). High resolution black blood MRI before and after contrast injection may visualize intracranial vessel wall contrast enhancement - the sign of inflammation in intracranial arteries. Treatment of PACNS includes corticosteroids and cyclophosphamide. In the case of patient intolerance, rituximab and blockers of tumor necrosis factor may be used.
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Affiliation(s)
| | | | - M S Legenko
- Research Center of Neurology, Moscow, Russia
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16
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Song JW, Obusez EC, Raymond SB, Rafla SD, Schaefer PW, Romero JM. Vessel Wall MRI Added to MR Angiography in the Evaluation of Suspected Vasculopathies. J Neuroimaging 2019; 29:454-457. [PMID: 30761654 DOI: 10.1111/jon.12607] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/04/2019] [Accepted: 02/06/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE We hypothesized that vessel wall MR imaging (VWI) with 3D-time-of-flight magnetic resonance imaging (3D-TOF-MRA) together increases the ability to detect abnormal intracranial vessel segments compared to 3D-TOF-MRA alone. METHODS Ninety-three consecutive subjects with a clinical history of suspected vasculopathy imaged with both VWI and 3D-TOF-MRAs were retrospectively reviewed. The 3D-TOF-MRAs were reviewed by two independent neuroradiologists classifying arterial segments as normal or abnormal based on caliber changes. Following a 2-week wash-out period, the 3D-TOF-MRAs with VWI together were re-evaluated for caliber changes and/or vessel wall enhancement. A third neuroradiologist served as consensus. Significance was assessed by McNemar's test. RESULTS Forty-two subjects with VWI and 3D-TOF-MRAs met the inclusion criteria. By 3D-TOF-MRA alone, 12.3% (95% confidence interval [CI], 10.7-15.1) of the arterial segments were identified as abnormal compared to 20.8% (95% CI, 18.2-23.4) by VWI and 3D-TOF-MRA together (P < .0001). CONCLUSIONS 3D-TOF-MRA and VWI together identifies a higher number of abnormal vessel segments than 3D-TOF-MRA alone and may provide a more accurate assessment of disease burden.
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Affiliation(s)
- Jae W Song
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Emmanuel C Obusez
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Scott B Raymond
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Samuel D Rafla
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Pamela W Schaefer
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Javier M Romero
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA
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17
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Utility of intracranial high-resolution vessel wall magnetic resonance imaging in differentiating intracranial vasculopathic diseases causing ischemic stroke. Neuroradiology 2019; 61:389-396. [PMID: 30637463 DOI: 10.1007/s00234-019-02157-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/03/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE High-resolution vessel wall imaging (HRVWI) by MRI is a novel noninvasive imaging tool which provides direct information regarding vessel wall pathologies. The utility of HRVWI in differentiating various intracranial vasculopathies among ischemic stroke is still evolving. METHODS Consecutive ischemic stroke/TIA patients within 2 weeks of symptom onset between January 2016 to December 2017, with symptomatic vessel stenosis of 50% or more/occlusion on baseline luminal imaging studies were recruited into the study. Stroke subtypes were classified as per TOAST classification initially on the basis of luminal imaging findings alone and subsequently after incorporation of HRVWI findings as well. RESULTS Forty-nine subjects were recruited into the study. The median age of the population was 42 years (range 11 to 75) with 69% being males. Incorporation of HRVWI findings classified 38.8% subjects into intracranial atherosclerotic disease (ICAD), 32.6% as stroke of other determined aetiology (ODE) (inflammatory vasculopathy [IVas] being the major subgroup [81.2%]) and 28.6% into stroke of undetermined aetiology (UE). HRVWI enabled a diagnostic reclassification in an additional 47.3% among the baseline UE category as against luminal imaging findings alone. ICAD was likelier to have eccentric vessel wall thickening, eccentric vessel wall enhancement and T2 juxtaluminal hyperintensity with surrounding hypointensity (P < 0.001), while IVas were more likely to exhibit concentric vessel wall thickening with homogenous enhancement (P < 0.001). CONCLUSION HRVWI is a useful noninvasive adjunctive tool in the diagnostic evaluation of intracranial vasculopathies, with maximum benefit in ICAD and IVas subtypes.
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