Investigation of childhood central nervous system vasculitis: magnetic resonance angiography versus catheter cerebral angiography.
OBJECTIVE
We compared the clinical utility of magnetic resonance angiography (MRA) to catheter cerebral angiography (CA) in the investigation of children with suspected central nervous system (CNS) vasculitis.


METHODS
Single-centre retrospective review of children with a suspected diagnosis of CNS vasculitis studied with both MRA and CA. MRA and CA-detected abnormalities (location, multiplicity, and morphology) were compared; sensitivity and specificity were calculated on a per lesion and per patient basis for MRA, with CA as the reference standard.


RESULTS
Findings in fourteen patients (median age at presentation of 5 y 10 mo [range 1 y 5 mo-14 y 5 mo]; eight males, six females) relating to sixteen paired studies of MRA and CA were reviewed. CA-detected lesions were commonly bilateral (13/16 studies, p<0.05), and likely to be proximally distributed (15/16 studies, p<0.05).The sensitivity and specificity of MRA for CA lesion detection was 63% (95% confidence interval [CI] 48-78) and 89% (95% CI 81-93), respectively with moderate agreement between the two modalities (kappa=0.51, 95% CI 0.37-0.66). The majority of the false negative observations involved the posterior circulation (9/14). The overall sensitivity for MRA diagnosis of vasculitis per patient was 94% (95% CI 67-99).


CONCLUSIONS
MRA failed to identify all lesions detected on CA, particularly those in the posterior circulation. MRA is a reasonable initial modality in the investigation of suspected CNS vasculitis but in cases of abnormal parenchymal MRI and normal MRA, CA should be considered.
Department of Paediatric Rheumatology, Institute of Child Health, London, UK. d.eleftheriou@ich.ucl.ac.uk
Despina
D
Eleftheriou
Tim
T
Cox
Dawn
D
Saunders
Nigel J
NJ
Klein
Paul A
PA
Brogan
Vijeya
V
Ganesan
D000293:Adolescent; D001921:Brain / Q000098:blood supply / Q000473:pathology; D002404:Catheterization; D002533:Cerebral Angiography / Q000295:instrumentation / Q000379:methods*; D002560:Cerebrovascular Circulation; D002648:Child; D002675:Child, Preschool; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007223:Infant; D018810:Magnetic Resonance Angiography; D008297:Male; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D020293:Vasculitis, Central Nervous System / Q000175:diagnosis* / Q000473:pathology