High-resolution MRI vessel wall imaging: spatial and temporal patterns of reversible cerebral vasoconstriction syndrome and central nervous system vasculitis.
OBJECTIVE
High-resolution MR imaging is an emerging tool for evaluating intracranial artery disease. It has an advantage of defining vessel wall characteristics of intracranial vascular diseases. We investigated high-resolution MR imaging arterial wall characteristics of CNS vasculitis and reversible cerebral vasoconstriction syndrome to determine wall pattern changes during a follow-up period.


METHODS
We retrospectively reviewed 3T-high-resolution MR imaging vessel wall studies performed on 26 patients with a confirmed diagnosis of CNS vasculitis and reversible cerebral vasoconstriction syndrome during a follow-up period. Vessel wall imaging protocol included black-blood contrast-enhanced T1-weighted sequences with fat suppression and a saturation band, and time-of-flight MRA of the circle of Willis. Vessel wall characteristics including enhancement, wall thickening, and lumen narrowing were collected.


RESULTS
Thirteen patients with CNS vasculitis and 13 patients with reversible cerebral vasoconstriction syndrome were included. In the CNS vasculitis group, 9 patients showed smooth, concentric wall enhancement and thickening; 3 patients had smooth, eccentric wall enhancement and thickening; and 1 patient was without wall enhancement and thickening. Six of 13 patients had follow-up imaging; 4 patients showed stable smooth, concentric enhancement and thickening; and 2 patients had resoluton of initial imaging findings. In the reversible cerebral vasoconstriction syndrome group, 10 patients showed diffuse, uniform wall thickening with negligible-to-mild enhancement. Nine patients had follow-up imaging, with 8 patients showing complete resolution of the initial findings.


CONCLUSIONS
Postgadolinium 3T-high-resolution MR imaging appears to be a feasible tool in differentiating vessel wall patterns of CNS vasculitis and reversible cerebral vasoconstriction syndrome changes during a follow-up period.
From the Department of Diagnostic Radiology (E.C.O., S.E.J.), Imaging Institute.
E C
EC
Obusez
Cerebrovascular Center (F.H.).
F
F
Hui
Department of Neurology (R.A.H., R.C.), Neurological Institute.
R A
RA
Hajj-Ali
Department of Neurology (R.A.H., R.C.), Neurological Institute.
R
R
Cerejo
Department of Rheumatology (L.H.C., T.H.), Orthopaedic and Rheumatology Institute, Cleveland Clinic, Cleveland, Ohio.
L H
LH
Calabrese
Department of Rheumatology (L.H.C., T.H.), Orthopaedic and Rheumatology Institute, Cleveland Clinic, Cleveland, Ohio.
T
T
Hammad
From the Department of Diagnostic Radiology (E.C.O., S.E.J.), Imaging Institute joness19@ccf.org.
S E
SE
Jones
D000328:Adult; D000368:Aged; D002561:Cerebrovascular Disorders / Q000473:pathology*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D020293:Vasculitis, Central Nervous System / Q000473:pathology*; D014661:Vasoconstriction