Vessel Wall Magnetic Resonance Imaging in Cerebrovascular Diseases

Abstract

Cerebrovascular diseases are a leading cause of disability and death worldwide. The definition of stroke etiology is mandatory to predict outcome and guide therapeutic decisions. The diagnosis of pathological processes involving intracranial arteries is especially challenging, and the visualization of intracranial arteries’ vessel walls is not possible with routine imaging techniques. Vessel wall magnetic resonance imaging (VW-MRI) uses high-resolution, multiparametric MRI sequences to directly visualize intracranial arteries walls and their pathological alterations, allowing a better characterization of their pathology. VW-MRI demonstrated a wide range of clinical applications in acute cerebrovascular disease. Above all, it can be of great utility in the differential diagnosis of atherosclerotic and non-atherosclerotic intracranial vasculopathies. Additionally, it can be useful in the risk stratification of intracranial atherosclerotic lesions and to assess the risk of rupture of intracranial aneurysms. Recent advances in MRI technology made it more available, but larger studies are still needed to maximize its use in daily clinical practice.

Vessel wall MR imaging in neuroradiology

“…VW-MRI revealed a concentric contrast enhancement of arterial walls, localized in multiple vascular territories in patient with PACNS [ 102 , 103 ]. According to the systematic review of CNS vasculitis, features of VW-MRI for vasculitis affecting the intracranial and extracranial arteries included vessel wall enhancement (89%), vessel wall thickening (72%), vessel wall edema (10%), or perivascular enhancement (16%) [ 104 ].…”

Application and interpretation of vessel wall magnetic resonance imaging for intracranial atherosclerosis: a narrative review

“…VFA/FSE has been used for T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), proton density-weighted imaging (PDWI), and gadolinium-based contrast enhancement T1WI (15). Other 3D techniques include flow-dephasing-prepared fast spoiled gradient recalled echo (16).…”

Vessel wall MR imaging of aortic arch, cervical carotid and intracranial arteries in patients with embolic stroke of undetermined source: A narrative review

“…CT is the gold standard for detecting intracranial calcifications. Detecting calcifications on MRI can be difficult as signal intensities may vary ( 84 , 85 ), though most often are described to be hypointense on 3D TOF, T1W, T2W, proton density sequences and non-enhancing on gadolinium-enhanced T1W sequence ( 86 ). Although CT may be best for calcification detection, distinguishing the type of vascular calcification may be a challenge.…”