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Guo A, Zhang Z, Dong GH, Su L, Gao C, Zhang M, Shi X, Wang H, Zhang X, Lu DH, Fu Y, Jing J, Shi FD, Tian DC. Cortical Microhemorrhage Presentation of Small Vessel Primary Angiitis of the Central Nervous System. Ann Neurol 2024; 96:194-203. [PMID: 38661030 DOI: 10.1002/ana.26940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/29/2024] [Accepted: 03/31/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE Primary angiitis of the central nervous system (PACNS) is a rare vasculitis restricted to the brain, spinal cord, and leptomeninges. This study aimed to describe the imaging characteristics of patients with small vessel PACNS (SV-PACNS) using 7 T magnetic resonance imaging (MRI). METHODS This ongoing prospective observational cohort study included patients who met the Calabrese and Mallek criteria and underwent 7 T MRI scan. The MRI protocol includes T1-weighted magnetization-prepared rapid gradient echo imaging, T2 star weighted imaging, and susceptibility-weighted imaging. Two experienced readers independently reviewed the neuroimages. Clinical data were extracted from the electronic patient records. The findings were then applied to a cohort of patients with large vessel central nervous system (CNS) vasculitis. RESULTS We included 21 patients with SV-PACNS from December 2021 to November 2023. Of these, 12 (57.14%) had cerebral cortical microhemorrhages with atrophy. The pattern with microhemorrhages was described in detail based on the gradient echo sequence, leading to the identification of what we have termed the "coral-like sign." The onset age of patients with coral-like sign (33.83 ± 9.93 years) appeared younger than that of patients without coral-like sign (42.11 ± 14.18 years) (P = 0.131). Furthermore, the cerebral lesions in patients with cortical microhemorrhagic SV-PACNS showed greater propensity toward bilateral lesions (P = 0.03). The coral-like sign was not observed in patients with large vessel CNS vasculitis. INTERPRETATION The key characteristics of the coral-like sign represent cerebral cortical diffuse microhemorrhages with atrophy, which may be an important MRI pattern of SV-PACNS. ANN NEUROL 2024;96:194-203.
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Affiliation(s)
- Ai Guo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhe Zhang
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ge-Hong Dong
- Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lei Su
- Department of Neurology, Tianjin General Hospital, Tianjin, China
| | - Chenyang Gao
- Department of Neurology, Tianjin General Hospital, Tianjin, China
| | - Mengting Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoyu Shi
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huabing Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xinghu Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - De-Hong Lu
- Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying Fu
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fu-Dong Shi
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Tianjin General Hospital, Tianjin, China
| | - De-Cai Tian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Alzein MM, Patel A, Abdalla RN, Cantrell DR, Shaibani A, Ansari SA. MR Vessel Wall Imaging for Atherosclerosis and Vasculitis. Neuroimaging Clin N Am 2024; 34:251-260. [PMID: 38604709 DOI: 10.1016/j.nic.2024.02.001] [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] [Indexed: 04/13/2024]
Abstract
Conventional imaging modalities, such as computed tomography angiography, MR angiography, transcranial Doppler ultrasonography, and digital subtraction angiography, are utilized in evaluating intraluminal or intravascular pathology of the intracranial vessels. Limitations of luminal imaging techniques can lead to inaccurate diagnosis, evaluation, and risk stratification, as many cerebrovascular pathologies contain an extrinsic vessel wall component. Furthermore, vessel wall imaging can provide information regarding extent, treatment response, and biopsy targets for vasculitis cases. Overall, while vessel wall imaging can provide robust data regarding intracranial pathologies, further prospective, multicenter studies are required to improve diagnostic application and accuracy.
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Affiliation(s)
- Mohamad M Alzein
- Department of Radiology, Northwestern University, Feinberg School of Medicine
| | - Abhinav Patel
- Department of Radiology, Northwestern University, Feinberg School of Medicine
| | - Ramez N Abdalla
- Department of Radiology, Northwestern University, Feinberg School of Medicine; Department of Radiology, Lurie Children's Hospital; Department of Radiology, Ain Shams University, Faculty of Medicine
| | - Donald R Cantrell
- Department of Radiology, Northwestern University, Feinberg School of Medicine; Department of Radiology, Lurie Children's Hospital
| | - Ali Shaibani
- Department of Radiology, Northwestern University, Feinberg School of Medicine; Department of Radiology, Lurie Children's Hospital; Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine
| | - Sameer A Ansari
- Department of Radiology, Northwestern University, Feinberg School of Medicine; Department of Radiology, Lurie Children's Hospital; Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine; Department of Neurology, Northwestern University, Feinberg School of Medicine.
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Kang DW, Kim DY, Kim J, Baik SH, Jung C, Singh N, Song JW, Bae HJ, Kim BJ. Emerging Concept of Intracranial Arterial Diseases: The Role of High Resolution Vessel Wall MRI. J Stroke 2024; 26:26-40. [PMID: 38326705 PMCID: PMC10850450 DOI: 10.5853/jos.2023.02481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/27/2023] [Accepted: 12/04/2023] [Indexed: 02/09/2024] Open
Abstract
Intracranial arterial disease (ICAD) is a heterogeneous condition characterized by distinct pathologies, including atherosclerosis. Advances in magnetic resonance technology have enabled the visualization of intracranial arteries using high-resolution vessel wall imaging (HR-VWI). This review summarizes the anatomical, embryological, and histological differences between the intracranial and extracranial arteries. Next, we review the heterogeneous pathophysiology of ICAD, including atherosclerosis, moyamoya or RNF213 spectrum disease, intracranial dissection, and vasculitis. We also discuss how advances in HR-VWI can be used to differentiate ICAD etiologies. We emphasize that one should consider clinical presentation and timing of imaging in the absence of pathology-radiology correlation data. Future research should focus on understanding the temporal profile of HR-VWI findings and developing quantitative interpretative approaches to improve the decision-making and management of ICAD.
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Affiliation(s)
- Dong-Wan Kang
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
- Headquarters for Public Health Care, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Neurology, Gyeonggi Provincial Medical Center, Icheon Hospital, Icheon, Korea
| | - Do Yeon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
- Headquarters for Public Health Care, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Neurology, Gyeonggi Provincial Medical Center, Icheon Hospital, Icheon, Korea
| | - Jonguk Kim
- Department of Neurology, Inha University Hospital, Incheon, Korea
| | - Sung Hyun Baik
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Cheolkyu Jung
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Nishita Singh
- Department of Internal Medicine-Neurology Division, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jae W. Song
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
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