High-resolution vessel wall imaging in primary angiitis of central nervous system

• Published in: Annals of the Indian Academy of Neurology Vol. 24; no. 4; pp. 524 - 530
• Main Authors: Sundaram, Soumya, Kumar, P, Sharma, Dev, Kesavadas, Chandrasekharan, Sreedharan, Sapna, Prasad, B, Sylaja, P
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01.07.2021; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer - Medknow; Wolters Kluwer Medknow Publications
• Subjects: Carotid artery; Central nervous system; Diagnosis; hrvwi; Magnetic resonance imaging; Nervous system; Neuroimaging; Original; pacns; primary angiitis of cns; Stents; Vasculitis; vessel wall enhancement; vessel wall imaging; vessel wall thickening; PACNS; HRVWI; primary angiitis of CNS; vessel wall imaging; vessel wall enhancement; vessel wall thickening
• ISSN: 0972-2327; 1998-3549
• DOI: 10.4103/aian.AIAN_106_21

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.