ARRS 2022 Abstracts


E1428. A Review of Current Clinical Applications of Intracranial Vessel Wall MR Imaging
  1. Jose Saucedo; Perelman School of Medicine at the Hospital of Pennsylvania
  2. Raghav Mattay; Hospital of the University of Pennsylvania
  3. Vance Lehman; Department of Radiology, Mayo Clinic
  4. Jiayu Xiao; Department of Radiology, Keck School of Medicine, University of Southern California
  5. Emmanuel Obusez; Department of Radiology, Cleveland Clinic
  6. Zhaoyang Fan; Department of Radiology, Keck School of Medicine, University of Southern California
  7. Jae Song; Hospital of the University of Pennsylvania
Over the last 2 decades, there has been an exponential increase in the number of publications highlighting potential clinical applications for vessel wall MRI (VWI). Therefore, an update incorporating this recent knowledge would be useful for review and clinical interpretation. Intracranial VWI has been applied to many different types of intracranial vasculopathies ranging from aneurysms to steno-occlusive vasculopathies. VWI has allowed us to investigate disease mechanisms by enabling us to directly visualize the site of pathology in the vessel walls. The diagnostic advantage of VWI to visualize vessel wall injury contrasts with conventional angiographic techniques, such as CTA , MRA, and digital subtraction angiography (DSA), which provide luminal information only. Luminal changes such as stenosis and dilatation are often consequences of vessel wall pathology and thus may be less sensitive for detecting the etiology of a vasculopathy. As reviewed by the American Society of Neuroradiology (ASNR) Vessel Wall Imaging study group, intracranial VWI may be useful diagnostically as an adjunct imaging tool to conventional luminal techniques. Intracranial VWI has utility in disease diagnosis or assessment of disease activity. Use of VWI is so far more firmly established for diagnostic purposes, in particular for steno-occlusive diseases. Common clinical indications include evaluating patients with stroke of undetermined etiology, further characterizing angiographically detected stenosis, and, in some centers, evaluating cerebral aneurysms. In this review, we provide an overview of intracranial VWI techniques and highlight technical considerations for specific types of vasculopathies. We also share illustrative VWI cases for common clinical indications and review imaging features that may aid image interpretation.

Educational Goals / Teaching Points
The goals of this exhibit are to provide an updated review on intracranial VWI protocols and image interpretation; review VWI technical considerations and describe common VWI imaging features of different intracranial vasculopathies and show illustrative cases; review the role of VWI for differentiating among steno-occlusive vasculopathies, such as intracranial atherosclerotic plaque, dissections, and moyamoya disease; and highlight how VWI may be used for the diagnostic work-up and surveillance of patients with vasculitis of the CNS and cerebral aneurysms.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The exhibit covers VWI, , moyamoya intracranial atherosclerosis (ICAS), aneurysm, dissection, vasculitis, and reversible cerebral vasoconstriction syndrome (RCVS).

Intracranial VWI has a wide array of potential clinical applications. As technical innovations improve our ability to image small intracranial vessel walls and our scientific understanding of imaging appearances of intracranial vasculopathies expand, VWI will likely take an important role as part of the diagnostic work-up of patients with cerebrovascular diseases.