Assessment of central nervous system vasculitis in children based on high-resolution vascular wall imaging

Abstract

Objectives Central nervous system vasculitis (CNSV) is a rare disease. High-resolution vessel wall imaging (HR-VWI) enables the identification of inflammatory changes within the vessel wall. Few studies have applied HR-VWI to assess CNSV in children. This study delves into the utility of High-Resolution Vascular Wall Imaging (HR-VWI) for diagnosing and treating CNSV in children, with the aim of enhancing clinical diagnosis and efficacy evaluation. Methods Imaging data were acquired from children who underwent HR-VWI examinations. The study meticulously analyzed clinical data and laboratory tests to discern the characteristics and distribution patterns of diverse vasculitis forms. Results Of the 36 CNSV patients included in this study. In children, CNSV mainly involves medium-sized vessels, with grade "1" and "2" stenosis, and grade "4" stenosis is rare, and the imaging features generally show centripetal and moderate enhancement, suggesting that this feature is specific for the diagnosis of CNSV. High grade stenosis, concentric enhancement, and strong enhancement of vascular indicate more severe disease activity. Remarkably, HR-VWI proved to be significantly more sensitive than MRA in detecting CNSV. Among the 13 cases subjected to imaging review, 8 demonstrated a reduction or resolution of vessel wall inflammation. In contrast, 5 patients exhibited worsening inflammation in the vessel wall. HR-VWI demonstrated that changes in vessel wall inflammation were closely correlated with changes in brain parenchymal lesions and symptoms. Conclusion This study underscores the diagnostic value of HR-VWI in children CNSV assessment and treatment monitoring, offering a quantitative evaluation of CNSV in children.