Vessel wall MR imaging for the detection of intracranial inflammatory vasculopathies

Myriam Edjlali, Ye Qiao, Gregoire Boulouis, Nicolas Menjot, Luca Saba, Bruce Alan Wasserman, Javier M. Romero

Research output: Contribution to journalReview articlepeer-review

Abstract

Intracranial vasculopathies are routinely investigated by lumen-based modalities such as magnetic resonance angiography (MRA), computed tomography angiography (CTA), and digital subtraction angiography (DSA). These techniques are useful to analyze the vessel lumen, allowing to detect vessel stenosis or occlusion. However, the primum movins of the disease, i.e., an abnormal thickening of the vessel wall, remains within the arterial wall. The vasculopathy can moreover be present without always narrowing the lumen or modifying its regularity. Hence, there is a need to detect directly and analyze vessel wall abnormalities. Development of 3D high-resolution black blood sequences for intracranial vessel wall MR imaging (VW-MRI) enabled routine clinical applications not only vasculitis, but also of intracranial atherosclerotic disease (ICAD), intracranial dissections, reversible intracranial dissections, reversible cerebral vasoconstriction syndrome (RCVS), Moyamoya disease, and intracranial aneurysms. This high-resolution intracranial VW- MRI approach is increasingly used on a clinical basis at many centers to solve diagnostic problems, especially in patients with ischemic stroke or intracranial hemorrhage. An expert consensus Guideline from the American Society of Neuroradiology provides recommendations for clinical implementation of intracranial vessel wall MRI. There are several technical aspects needed to be considered when implementing VW-MRI in intracranial vessels, including flow suppression, both in blood and cerebrospinal fluid (CSF), spatial resolution and signal-to-noise ratio (SNR). In this article, we review the technical aspects of VW-MRI, and recommend applications for vascular diseases including non-occlusive intracranial vasculopathies, Moyamoya disease, and identifying culprit plaques. We also give a focus on the utility of VW-MRI for determining stroke etiology in adults and in children and young adults.

Original languageEnglish (US)
Pages (from-to)1108-1119
Number of pages12
JournalCardiovascular Diagnosis and Therapy
Volume10
Issue number4
DOIs
StatePublished - Aug 2020

Keywords

  • Intracranial atherosclerotic disease (ICAD)
  • Intracranial vasculopathy
  • Stenosis
  • Vessel wall MR imaging (VW-MRI)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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