Abstract TP130: The Clinical Value of Magnetic Resonance Vessel Wall Maging in Patients With Central Nervous System Vasculitis

Abstract

Background and Purpose: Prompt and accurate diagnosis of central nervous system (CNS) vasculitis is essential for treatment decision making and prevention of irreversible brain damage. However, diagnosis is often challenging even with digital subtraction angiography and biopsy. The purpose of this study was to investigate the value of magnetic resonance vessel wall imaging (MR-VWI) in diagnosis and management of CNS vasculitis. Methods: We retrospectively reviewed 13 patients with clinically defined CNS vasculitis who underwent intracranial MR-VWI. Two patients had imaging follow-up after treatment. The imaging protocol included conventional T1/T2 brain MR, diffusion-weighted imaging, MRA, and pre- and post-contrast T1-weighted whole-brain MR-VWI. An experienced neuroradiologist reviewed MR-VWI images to characterize vessel wall characteristics (lumen narrowing, pattern of wall thickening, and grade of contrast enhancement) at major intracranial arterial segments. Additionally, the changes in the brain parenchyma and meninges were evaluated. Results: Of these 13 patients (6 men, age 28-70 years), 4 had acute infarction. Six patients had intracranial artery stenosis on MRA, but 11 patients showed vessel wall abnormality on MR-VWI. Eleven patients showed multiple, smooth, wall thickening and pronounced contrast enhancement, which were concentric in 9 and eccentric in 2. Two of these 11 patients had follow-up imaging after treatment; imaging findings remained stable in one and the degree of wall thickening and enhancement reduced in the other. In 2 of 13 patients, meningeal enhancement was observed in the absence of vascular wall thickening. Conclusions: MR-VWI depicts CNS vasculitis with characteristic multiple, smooth, vessel wall thickening and contrast enhancement, with most of cases being of concentric pattern. These features may provide useful information for early and accurate diagnosis as well as for tracking treatment response.