Diagnosis
Serial vessel wall enhancement pattern on high-resolution vessel wall magnetic resonance imaging and clinical implications in patients with central nervous system vasculitis
T. Shimoyama1, K. Uchino2, L.H. Calabrese3, R.A. Hajj-Ali4
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
- Department of Rheumatic and Immunologic Disease, Orthopaedic and Rheumatology Institute, Cleveland Clinic, Cleveland, OH, USA.
- Department of Rheumatic and Immunologic Disease, Orthopaedic and Rheumatology Institute, Cleveland Clinic, Cleveland, OH, USA. hajjalr@ccf.org
CER15550
2022 Vol.40, N°4
PI 0811, PF 0818
Diagnosis
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PMID: 35522543 [PubMed]
Received: 01/02/2022
Accepted : 30/03/2022
In Press: 04/05/2022
Published: 04/05/2022
Abstract
OBJECTIVES:
High-resolution vessel wall imaging (HR-VWI) often demonstrates strong and concentric vessel wall enhancement (VWE) in patients with central nervous system vasculitis (CNS-V). However, little is known about follow-up VWE characteristics and monitoring the response to treatments. The aim of this study was to investigate serial VWE patterns and its clinical practice through the management of CNS-V.
METHODS:
We extracted 9 patients with diagnosed of CNS-V who underwent serial HR-VWI (baseline, 1st follow-up, and 2nd follow-up) from Cleveland Clinic CNS vasculopathy registry. VWE were analysed in 17 intracranial artery segments. VWE was graded on a 3-point scale (0; none, 1; mild/eccentric, and 2; strong/concentric). VWE grade for each arterial segment was summed to create a total VWE score. We investigated the relationship between serial VWE patterns and clinical course.
RESULTS:
In unique 153 intracranial arterial segments, 39 arteries (25.5%) had strong/concentric VWE on baseline HR-VWI. The positive rates of concentric VWE have decreased to 12.4% (19/153) at 1st follow-up and (10/153) 6.5% at 2nd follow-up, respectively (p<0.001). Mean total VWE scores have significantly decreased over time courses (p=0.034). Two patients had relapse at 1st follow-up image. In relapse cases, mean total VWE scores have worsened at 1st follow-up (baseline:2.0 to 1st follow-up: 6.0). After intensive immunosuppressive treatment, mean VWE scores have improved at 2nd follow-up (1st follow-up: 6.0 to 2nd follow-up: 2.0).
CONCLUSIONS:
Decreasing contrast VWE at follow-up images may indicate good response to treatment in CNS-V. By contrast, relapse patients might have temporal VWE worsening during the clinical course.
