Mahmud Mossa-Basha MD, Presenter: Nothing to Disclose

William D. Hwang MD, Abstract Co-Author: Nothing to Disclose

Tom Hatsukami, Abstract Co-Author: Research Grant, Koninklijke Philips NV

Adam de Havenon MD, Abstract Co-Author: Nothing to Disclose

David Tirschwell MD, MSc, Abstract Co-Author: Nothing to Disclose

Yoshimi Anzai MD, Abstract Co-Author: Nothing to Disclose

Niranjan Balu PhD, Abstract Co-Author: Nothing to Disclose

Daniel S. Hippe MS, Abstract Co-Author: Research Grant, Koninklijke Philips NV Research Grant, General Electric Company

Chun Yuan PhD, Abstract Co-Author: Research Grant, Koninklijke Philips NV Consultant, Bristol-Myers Squibb Company Consultant, Koninklijke Philips NV

To assess the contribution of high-resolution T2-weighted vessel wall MR (VWI) sequences for differential diagnosis of intracranial vasculopathies.

Consecutive patients with intracranial arterial stenosis who had undergone 3T high-resolutioin MR VWI were retrospectively selected.  2D T2-weighted sequences (.4 x .4 mm in-plane resolution, 1 mm thick slices) were scanned and assessed in both axial plane and a plane perpendicular to the artery lumen.  Relative vessel wall thickness, eccentricity of disease and signal characteristics were assessed in areas of arterial stenosis or irregularity as seen on luminal imaging by a double blinded rater.  Classification of patients was based on the following clinical and imaging criteria:  atherosclerosis (>2 atherosclerosis risk factors without evidence of systemic or CSF inflammation or clinical evidence of vasospastic process/reversibility), vasculitis (clinical evidence of CSF infection/inflammation and/or systemic inflammatory disease without atherosclerosis risk factors or clinical evidence of vasospastic process) and reversible cerebral vasoconstriction syndrome (RCVS) (classic clinical presentation, with reversibility of the imaging findings and no evidence of systemic or CNS inflammatory disease).

There were 21 atherosclerosis cases with 45 plaques, 4 vasculitis cases (VZV, PACNS, TB and Behcet vasculitis) with 14 stenoses and 4 RCVS cases with 19 stenoses that could adequately be assessed on T2-weighted VWI.  A linear T2 hyperintense band along the intimal surface (presumed to represent fibrous cap) was seen in 36/45 atherosclerotic, 0/14 vasculitic and 0/19 RCVS lesions.  All of the atherosclerotic lesions showed appreciable wall thickening, as compared to 11/14 vasculitis and 4/19 RCVS lesions. 42/45 atherosclerotic plaques, 2/14 vasculitis and 2/19 RCVS lesions showed eccentric wall thickening.

High resolution T2-weighted VWI can complement T1 and PD pre and post-contrast VWI for the differentiation of intracranial stenosing vasculopathy, based on disease eccentricity, presence of a T2 hyperintense intimal band and appreciable wall thickening.

High-resolution T2 VWI should be incorporated into intracranial VWI protocols, as this technique can provide complementary information to T1 and PD-weighted techniques.

Mossa-Basha, M, Hwang, W, Hatsukami, T, de Havenon, A, Tirschwell, D, Anzai, Y, Balu, N, Hippe, D, Yuan, C, The Value of High-Resolution T2-Weighted Vessel Wall MR Imaging for the Differentiation of Intracranial Vasculopathies.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14016929.html