High-Resolution Vessel Wall Imaging in Primary Angiitis of Central Nervous System

Abstract

Background: High-resolution vessel wall imaging (HRVWI) can aid in differentiating the various intracranial vasculopathies, but has been sparingly used in the diagnosis of primary angiitis of central nervous system (PACNS). This study is aimed to describe the vessel wall imaging characteristics of PACNS. Materials and Methods: Patients with confirmed diagnosis of PACNS according to the Calabrese and Mallek criteria who had abnormal HRVWI were included in this retrospective descriptive study. Magnetic resonance image of brain, conventional four-vessel cerebral digital subtraction angiogram, and HRVWI were read by a neuroradiologist. The vessel wall parameters assessed were T1W and T2W appearances, pattern of wall thickening and contrast enhancement, and remodeling index. Results: HRVWI done in 21 patients with PACNS yielded abnormality in 20 (95.2%) who were included in the analysis. The mean age at presentation was 42.55 ± 9.48 years and 14 (70%) were males. The median number of vessels involved were four (range 2–12). The commonest vessels affected were proximal middle cerebral artery (70%) and internal carotid artery (55%). Vessel wall thickening was concentric, eccentric, and absent in 12 (60%), 1 (5%), and 7 (35%) patients, respectively. Vessel wall enhancement was diffuse in 17 (85%), eccentric in 1 (5%), and absent in 2 (10%) patients. One patient had T2W hyperintense stenotic lesion. Remodeling index was negative in 11 (55%) patients. Conclusion: Distinctive vessel wall appearances were observed by HRVWI in PACNS, concentric vessel wall thickening and enhancement being more frequent. Hence, HRVWI can be considered as an additional noninvasive imaging modality in the diagnosis of PACNS.

Primary Angiitis of the CNS

“…It was useful in the detection of medium vessel vasculitis subtype, distinguishing PACNS from mimics, 13 and is another tool that could be used in patients in whom biopsy was not performed or negative. 14 The distinction between small and medium/large vessel vasculitis is not always mutually exclusive but rather represents different ends of a spectrum because the disease process may affect all vessels. Similar patients were also reported by a German cohort.…”

Modern Concepts on the Clinic and Diagnosis of Primary Vasculitis of the Central Nervous System

“…Более того, тяжесть заболевания и скорость прогрессирования могут сильно различаться среди пациентов, что увеличивает неспецифичность клинических проявлений. У большинства пациентов отмечались одновременно несколько симптомов и синдромов [8,21,[28][29][30][31].…”

“…В свою очередь, практическое применение МРА и КТА при поражении мелких сосудов невозможно из-за отсутствия изменений на ангиограммах. Поэтому данные методы имеют низкую специфичность, чем использование традиционной контрастной церебральной ангиографии [8,30,42].…”

“…Главным отличительным признаком при ПВЦНС является гладкое, концентрическое и сегментарное утолщение сосудистой стенки с происходящим накоплением контраста и периваскулярным отеком [8,15,29,42]. Noh H. et al ( 2016) отметили, что накопление контрастного вещества позволяет диагностировать ПВЦНС на ранней стадии развития патологического процесса, когда контрастная церебральная ангиография неэффективна [30]. Кроме этого, этот феномен позволяет провести дифференциальную диагностику между атеросклерозом, так в отличие от ПВЦНС атеросклеротическая бляшка располагается эксцентрично, наблюдается локальное утолщение сосудистой стенки без признаков периваскулярного отека, а контраст накапливается в зависимости от ее состава (от умеренной до высокой интенсивности) [8, 12-13, 15-18, 35, 42].…”

Neuroimaging Scoring Tools to Differentiate Inflammatory Central Nervous System Small-Vessel Vasculitis: A Need for Artificial Intelligence/Machine Learning?—A Scoping Review

“…Sundaram et al found that HRVWI was able to detect distinctive vessel wall appearances, specifically concentric vessel wall thickening and enhancement, yielding abnormalities in 95.2% of the patients in the study. Consequently, this suggested that HRVWI may be considered in the future as a non-invasive diagnostic modality for PACNS and possibly other SVDs [43].…”