Magnetic Resonance Vessel Wall Imaging in Central Nervous System Vasculitides: A Case Series.
Magnetic Resonance Vessel Wall Imaging in Central Nervous System Vasculitides: A Case Series.
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DOI：
10.1097/nrl.0000000000000298
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发表时间：
2020-11
期刊：
影响因子：
--
通讯作者：
Dumitrascu OM
中科院分区：
文献类型：
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作者：
Padrick MM;Maya MM;Fan Z;Szumski N;Lyden PD;Song SS;Dumitrascu OM
我们的目标是报告三例中枢神经系统(CNS)血管炎，其中高分辨率磁共振血管壁成像(HR-VWI)的表现有助于诊断和治疗。病例1：女性，41岁，肥胖，吸烟，合并动脉高血压，反复发作短暂性脑缺血发作。CT血管造影显示双侧大脑中动脉(MCA)狭窄。HR-VWI显示动脉壁均匀强化增厚，提示大脑中动脉血管炎。患者报告慢性小腿皮疹，经活检发现有不明结缔组织病。接受免疫调节治疗后，患者仍无症状，6个月的HR-VWI监测显示大脑中动脉狭窄改善。例2：1例56岁男性单纯疱疹病毒1型脑炎患者经抗病毒治疗后病情好转。两个月后，脑部MRI显示新的颞顶水肿和大脑中动脉远端高信号血管。HR-VWI表现为感染后血管炎所致的大脑中动脉向心性光滑增强，在后续的HR-VWI检查中已消失。病例3：男，41岁，头痛、脑病一周。脑MRI显示点状多灶性急性缺血性脑梗塞，无增强。HR-VWI显示远端脑血管多灶性弥漫性强化。一名患者随后出现视网膜分支动脉阻塞和听力损失，并被诊断为苏萨克综合征。免疫治疗开始后未发现复发症状。在这三个病例中，HR-VWI发现了明显的血管炎症改变，这些改变对于指导病因学检查、阳性诊断、神经影像监测和靶向治疗至关重要。HR-VWI通过提供动脉壁完整性和病理学的细微差别信息，是中枢神经系统血管炎的重要诊断工具。
We aim to report three cases of central nervous system (CNS) vasculitides, in which high-resolution magnetic resonance vessel wall imaging (HR-VWI) findings were instrumental in the diagnosis and management. Case 1: A 41-year-old obese, smoker female with arterial hypertension presented with recurrent transient ischemic attacks. Computed topography angiography demonstrated bilateral middle cerebral artery (MCA) stenosis. HR-VWI revealed uniform enhancement and thickening of the arterial wall, suggestive of MCA vasculitis. The patient reported chronic calf rash that was biopsied and revealed unspecified connective tissue disease. With immunomodulation, patient remained asymptomatic and 6-month surveillance HR-VWI showed improved MCA stenoses. Case 2: A 56-year-old male with HSV1 encephalitis was treated with antiviral therapy and improved clinically. Two months later, the brain MRI revealed new temporo-parietal edema and distal MCA hyperintense vessels. HR-VWI showed MCA concentric smooth contrast enhancement, that was attributed to post-infectious vasculitis and had resolved on follow-up HR-VWI. Case 3: A 41-year-old male presented with one-week of headache and encephalopathy. Brain MRI revealed punctate multifocal acute ischemic infarcts and no contrast-enhancement. HR-VWI showed multifocal diffuse enhancement of distal cerebral vasculature. Patient subsequently developed branch retinal artery occlusion and hearing loss and was diagnosed with Susac’s Syndrome. No recurrent symptoms were noted after immunotherapy initiation. In these three cases, HR-VWI identified distinctive vascular inflammatory changes, which were crucial to guide the etiological work-up, positive diagnosis, surveillance neuroimaging, and targeted treatment. HR-VWI is an important diagnostic tool in CNS vasculitides, by providing nuanced information about arterial wall integrity and pathology.