The contribution of vessel wall magnetic resonance imaging to the diagnosis of primary and secondary central nervous system vasculitis

D'Aniello, Serena; Rustici, Arianna; Gramegna, Laura Ludovica; Godi, Claudia; Piccolo, Laura; Gentile, Mauro; Zini, Andrea; Carrozzi, Alessandro; Lodi, Raffaele; Tonon, Caterina; Dall'Olio, Massimo; Simonetti, Luigi; Chieffo, Raffaella; Anzalone, Nicoletta; Cirillo, Luigi

doi:http://dx.doi.org/10.3390/diagnostics14090927

The contribution of vessel wall magnetic resonance imaging to the diagnosis of primary and secondary central nervous system vasculitis

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D'Aniello S, Rustici A, Gramegna LL, Godi C, Piccolo L, Gentile M, et al. The contribution of vessel wall magnetic resonance imaging to the diagnosis of primary and secondary central nervous system vasculitis. Diagnostics (Basel). 2024 Apr 29;14(9):927. DOI: 10.3390/diagnostics14090927

Abstract

Background: To describe high-resolution brain vessel wall MRI (VW-MRI) patterns and morphological brain findings in central nervous system (CNS) vasculitis patients. Methods: Fourteen patients with confirmed CNS Vasculitis from two tertiary centers underwent VW-MRI using a 3T scanner. The images were reviewed by two neuroradiologists to assess vessel wall enhancement characteristics and locations. Results: Fourteen patients were included (six females; average age 48 ± 19 years). Diagnoses included primary CNS vasculitis (PCNSV) in six patients and secondary CNS vasculitis (SCNSV) in eight, half of which were infection-related. Thirteen patients showed vessel wall enhancement, which was intense in eleven patients (84.6%) and concentric in twelve (92.3%), affecting the anterior circulation in nine patients (69.2%), posterior in two patients (15.4%), and both circulations in two patients (15.4%). The enhancement patterns were similar across different CNS vasculitis types. DWI changes corresponded with areas of vessel wall enhancement in 77% of patients. Conclusions: CNS vasculitis is often associated with intense, concentric vessel wall enhancement in VW-MRI, especially in the anterior circulation. The consistent presence of DWI alterations in affected territories suggests a possible link to microembolization or hypoperfusion. These imaging findings complement parenchymal brain MRI and MRA/DSA data, potentially increasing the possibility of a clinical diagnosis of CNS vasculitis.