Abstract
Cerebrovascular diseases are a leading cause of disability and death worldwide. The definition of stroke etiology is mandatory to predict outcome and guide therapeutic decisions. The diagnosis of pathological processes involving intracranial arteries is especially challenging, and the visualization of intracranial arteries’ vessel walls is not possible with routine imaging techniques. Vessel wall magnetic resonance imaging (VW-MRI) uses high-resolution, multiparametric MRI sequences to directly visualize intracranial arteries walls and their pathological alterations, allowing a better characterization of their pathology. VW-MRI demonstrated a wide range of clinical applications in acute cerebrovascular disease. Above all, it can be of great utility in the differential diagnosis of atherosclerotic and non-atherosclerotic intracranial vasculopathies. Additionally, it can be useful in the risk stratification of intracranial atherosclerotic lesions and to assess the risk of rupture of intracranial aneurysms. Recent advances in MRI technology made it more available, but larger studies are still needed to maximize its use in daily clinical practice.
Highlights
Cerebrovascular diseases are a leading cause of disability and death worldwide
Vessel wall magnetic resonance imaging (VW-MRI) has demonstrated its utility in a wide range of clinical situations, including differential diagnosis of intracranial vasculopathies, identification and evaluation of intracranial atherosclerotic disease and risk stratification in patients with intracranial aneurysms [7,8]
VW-MRI has become a valuable aid in investigating patients with acute cerebrovascular disease and shows a wide range of clinical applications
Summary
Cerebrovascular diseases are a leading cause of disability and death worldwide. The definition of stroke etiology is mandatory to predict the prognosis and recurrence risk and guide therapeutic decisions [1,2]. The pathogenesis of cerebrovascular diseases often originates inside the vessel walls, standard luminal based imaging modalities lack the capability to visualize these pathological processes, unless they are associated with significant luminal changes [3]. This is true for intracranial arteries, which have smaller diameter and thinner vessel walls, that are beyond the resolution of standard diagnostic techniques [4]. When applied to patients with cryptogenic stroke, it allows for the definition of the stroke etiology in a significant percentage of them, often revealing findings compatible with vasculitis or complicated atherosclerotic disease [9]. In this paper we will review the technical basis and the main clinical application of VW-MRI in cerebrovascular disease
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