Vessel wall contrast enhancement: a diagnostic sign of cerebral vasculitis.
OBJECTIVE
Inflammatory stenoses of cerebral arteries cause stroke in patients with florid vasculitis. However, diagnosis is often difficult even with digital subtraction angiography (DSA) and biopsy. The purpose of this study was to establish the value of contrast-enhanced MRI, proven to be sensitive to extradural arteritis, for the identification of intracranial vessel wall inflammation.


METHODS
Twenty-seven patients with a diagnosis of cerebral vasculitis affecting large brain vessels were retrieved from the files: 8 children (2-10 years, 7 female, 1 male) and 19 adults (16-76 years, 10 female, 9 male). Diagnosis was based on histological or serological proof of vasculitis or on clinical and imaging criteria. All MRI examinations included diffusion-weighted imaging, time-of-flight magnetic resonance angiography (TOF-MRA) and contrast-enhanced scans. MRI scans were assessed for the presence of ischemic brain lesions, arterial stenoses, vessel wall thickening and contrast uptake.


RESULTS
Ischemic changes of the brain tissue were seen in 24/27 patients and restricted diffusion suggestive of recent ischemia in 17/27; 25/27 patients had uni- or multifocal stenoses of intracranial arteries on TOF-MRA and 5/6 had stenoses on DSA. Vessel wall thickening was identified in 25/27, wall enhancement in 23/27 patients.


CONCLUSIONS
Wall thickening and intramural contrast uptake are frequent findings in patients with active cerebral vasculitis affecting large brain arteries. Further prospective studies are required to determine the specificity of this finding.
Department of Neuroradiology, University of Oxford, John Radcliffe Hospital, Oxford, UK. Wilhelm.Kuker@ndm.ox.ac.uk
Wilhelm
W
Küker
Susanne
S
Gaertner
Thomas
T
Nagele
Christian
C
Dopfer
Martin
M
Schoning
Jens
J
Fiehler
Peter M
PM
Rothwell
Ulrich
U
Herrlinger
D000293:Adolescent; D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000473:pathology; D002539:Cerebral Arterial Diseases / Q000473:pathology; D002536:Cerebral Arteries / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D020293:Vasculitis, Central Nervous System / Q000473:pathology*
D003287:Contrast Media