Vessel wall MR imaging for the detection of intracranial inflammatory vasculopathies

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 highresolution 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.

Morphological variables associated with ruptured basilar tip aneurysms

“…However, this would be more reflective of actual clinical practice. Assessment of these morphological variables in the clinical setting, possibly in combination with other imaging modalities such as vessel wall MRI, could contribute to the risk evaluation in these patients [44][45][46][47][48] . Finally, smoking status was obtained via medical records review and may not be completely accurate.…”

Young Woman with Sudden-Onset Neck Pain and Quadriplegia: a Case Report

“…Given the sudden onset of neck pain, the possibility of a vascular dissection should be considered, and we thought vertebral artery dissection was the most possible diagnosis when she was transferred. MRI is also good diagnostic tool for vascular disease [10,11].…”

Vessel-wall MRI in thunderclap headache: A useful tool to answer the riddle?

“…13 In fact, High Resolution Vessel Wall MRI sequences (HRVW-MRI) have been proposed as a valuable tool in case of negative or inconclusive previous neuroradiological examinations. These sequences, in conjunction with others, permit to differentiate various pathological processes, ranging from RCVS and vasculitis to aneurysmal subarachnoid haemorrhage (SAH) thanks to the different shapes and pattern of enhancement of cerebral arteries 14–16 (Table 1).…”

“…In both cases of vasculitis and RCVS, the HRVW demonstrated arterial thickening, but differently from vasculitis in the RCVS, the wall did not enhance. 14–17 This could be explained by the different etiology, because in the case of vasculitis there is a strong wall permeability, while in RCVS the thickening is attributed to the shortening of the muscle cells, with lack of inflammation 14–17 (Table 1).…”