Abstract
Background
Primary angiitis of the central nervous system is an uncommon single-organ vasculitis that is still poorly understood, and its diagnosis can be quite challenging. Traditional vascular imaging techniques could only show the abnormality of vessel lumen, while primary angiitis of the central nervous system as well as atherosclerosis or other mimics could show similar patterns, like tapering of the vessel lumen or multiple stenosis. Vessel wall magnetic resonance imaging can directly visualize the abnormality of the vessel wall, therefore has become a valuable approach for vasculopathy evaluation. However, 2D vessel wall magnetic resonance imaging can only be restricted to one fixed angle for one scanning process, while vasculitis tends to involve multiple vessels. With the development of 3D isotropic vessel wall imaging sequence, it can achieve a thorough view of the whole brain vasculature in shorter time and apply reconstruction in any angle. Reasonably, 3D isotropic vessel wall imaging could help with the diagnosis, evaluation and follow-up of primary angiitis of the central nervous system more effectively.
Case presentation
We present five cases of primary angiitis of the central nervous system that underwent 3D isotropic vessel wall imaging, along with follow-up. The diagnosis of primary angiitis of the central nervous system was made by classic diagnosis criteria. The youngest patient was 21 years old, while the oldest one was 49 years old. As for disease onset, one patient presented with headache, while other four patients presented with ischemic stroke. Both anterior circulation and posterior circulation of the five patients were involved, regardless of the responsible vessel. They were given steroids, immunosuppressor or parahormone for management. On follow-up vessel imaging, one patient displayed gradual vessel occlusion in 12 months, one patient showed partial resolution, other three patients presented with vasculopathy persistence.
Conclusions
3D isotropic vessel wall imaging could evaluate the specific responsible vessel as well as the whole brain vasculature in one-time scan, providing detailed information in detection, diagnosis, evaluation and follow-up. Moreover, primary angiitis of the central nervous system tend to be multi-vessel involving, so the 3D isotropic vessel wall imaging could be more applicable.
High-resolution vessel wall imaging in primary angiitis of central nervous system
