title: Multicontrast high-resolution vessel wall magnetic resonance imaging and its value in differentiating intracranial vasculopathic processes.
abstract: OBJECTIVE
  Although studies have attempted to differentiate intracranial vascular disease using vessel wall magnetic resonance imaging (VWI), none have incorporated multicontrast imaging. This study uses T1- and T2-weighted VWI to differentiate intracranial vasculopathies.
  
  
  METHODS
  We retrospectively reviewed patients with clinically defined intracranial vasculopathies causing luminal stenosis/irregularity who underwent VWI studies. Two blinded experts evaluated T1 precontrast and postcontrast and T2-weighted VWI characteristics, including the pattern of wall thickening; presence, pattern, and intensity of postcontrast enhancement; and T2 signal characteristics.
  
  
  RESULTS
  Twenty-one cases of atherosclerosis (intracranial atherosclerotic disease [ICAD]), 4 of reversible cerebral vasoconstriction syndrome, and 4 of vasculitis were identified, with a total of 118 stenotic lesions (81 ICAD, 22 reversible cerebral vasoconstriction syndrome, and 15 vasculitic lesions). There was substantial to excellent inter-reader agreement for the assessment of lesional T2 hyperintensity (κ=0.80), pattern of wall thickening (κ=0.87), presence (κ=0.90), pattern (κ=0.73), and intensity (κ=0.77) of enhancement. ICAD lesions were significantly more likely to have eccentric wall involvement (90.1%) than reversible cerebral vasoconstriction syndrome (8.2%; P<0.001) and vasculitic lesions (6.7%; P<0.001) and were also more likely to have T2 hyperintensity present than the other 2 vasculopathies (79% versus 0%; P<0.001). There were also significant differences in the presence, intensity, and pattern of enhancement between all lesion types. Combining T1 and T2 VWI increased the sensitivity of VWI in differentiating ICAD from other vasculopathies from 90.1% to 96.3%.
  
  
  CONCLUSIONS
  Multicontrast VWI can be a complementary tool for intracranial vasculopathy differentiation, which often leads to more invasive workups when reversible cerebral vasoconstriction syndrome and vasculitis are in the differential diagnosis.
authors.affiliation: From the Departments of Radiology (M.M.-B., W.D.H., D.H., N.B., Y.A., C.Y.) Neurology (K.J.B., D.T.T.), and Vascular Surgery (T.H.), University of Washington, Seattle; Department of Neurology, University of Utah, Salt Lake City (A.D.H.). mmossab@uw.edu.
authors.forename: Mahmud
authors.initials: M
authors.lastname: Mossa-Basha
authors.affiliation: From the Departments of Radiology (M.M.-B., W.D.H., D.H., N.B., Y.A., C.Y.) Neurology (K.J.B., D.T.T.), and Vascular Surgery (T.H.), University of Washington, Seattle; Department of Neurology, University of Utah, Salt Lake City (A.D.H.).
authors.forename: William D
authors.initials: WD
authors.lastname: Hwang
authors.affiliation: From the Departments of Radiology (M.M.-B., W.D.H., D.H., N.B., Y.A., C.Y.) Neurology (K.J.B., D.T.T.), and Vascular Surgery (T.H.), University of Washington, Seattle; Department of Neurology, University of Utah, Salt Lake City (A.D.H.).
authors.forename: Adam
authors.initials: A
authors.lastname: De Havenon
authors.affiliation: From the Departments of Radiology (M.M.-B., W.D.H., D.H., N.B., Y.A., C.Y.) Neurology (K.J.B., D.T.T.), and Vascular Surgery (T.H.), University of Washington, Seattle; Department of Neurology, University of Utah, Salt Lake City (A.D.H.).
authors.forename: Daniel
authors.initials: D
authors.lastname: Hippe
authors.affiliation: From the Departments of Radiology (M.M.-B., W.D.H., D.H., N.B., Y.A., C.Y.) Neurology (K.J.B., D.T.T.), and Vascular Surgery (T.H.), University of Washington, Seattle; Department of Neurology, University of Utah, Salt Lake City (A.D.H.).
authors.forename: Niranjan
authors.initials: N
authors.lastname: Balu
authors.affiliation: From the Departments of Radiology (M.M.-B., W.D.H., D.H., N.B., Y.A., C.Y.) Neurology (K.J.B., D.T.T.), and Vascular Surgery (T.H.), University of Washington, Seattle; Department of Neurology, University of Utah, Salt Lake City (A.D.H.).
authors.forename: Kyra J
authors.initials: KJ
authors.lastname: Becker
authors.affiliation: From the Departments of Radiology (M.M.-B., W.D.H., D.H., N.B., Y.A., C.Y.) Neurology (K.J.B., D.T.T.), and Vascular Surgery (T.H.), University of Washington, Seattle; Department of Neurology, University of Utah, Salt Lake City (A.D.H.).
authors.forename: David T
authors.initials: DT
authors.lastname: Tirschwell
authors.affiliation: From the Departments of Radiology (M.M.-B., W.D.H., D.H., N.B., Y.A., C.Y.) Neurology (K.J.B., D.T.T.), and Vascular Surgery (T.H.), University of Washington, Seattle; Department of Neurology, University of Utah, Salt Lake City (A.D.H.).
authors.forename: Thomas
authors.initials: T
authors.lastname: Hatsukami
authors.affiliation: From the Departments of Radiology (M.M.-B., W.D.H., D.H., N.B., Y.A., C.Y.) Neurology (K.J.B., D.T.T.), and Vascular Surgery (T.H.), University of Washington, Seattle; Department of Neurology, University of Utah, Salt Lake City (A.D.H.).
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Anzai
authors.affiliation: From the Departments of Radiology (M.M.-B., W.D.H., D.H., N.B., Y.A., C.Y.) Neurology (K.J.B., D.T.T.), and Vascular Surgery (T.H.), University of Washington, Seattle; Department of Neurology, University of Utah, Salt Lake City (A.D.H.).
authors.forename: Chun
authors.initials: C
authors.lastname: Yuan
mesh_terms: D000368:Aged; D002533:Cerebral Angiography / Q000379:methods*; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged
keywords: intracranial vasculopathy; magnetic resonance imaging; vascular diseases