Benjamin, Laura A;
Lim, Emma;
Sokolska, Magdalena;
Markus, Julia;
Zaletel, Tjasa;
Aggarwal, Veena;
Luder, Robert;
... Jäger, Hans Rolf; + view all
(2022)
Vessel wall magnetic resonance and arterial spin labelling imaging in the management of presumed inflammatory intracranial arterial vasculopathy.
Brain Communications
, Article fcac157. 10.1093/braincomms/fcac157.
(In press).
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Abstract
Optimal criteria for diagnosing and monitoring response to treatment for infectious and inflammatory medium-large vessel intracranial vasculitis presenting with stroke are lacking. We integrated intracranial vessel wall MRI with arterial spin labelling into our routine clinical stroke pathway to detect presumed inflammatory intracranial arterial vasculopathy, and monitor disease activity, in patients with clinical stroke syndromes. We used predefined standardised radiological criteria to define vessel wall enhancement, and all imaging findings were rated blinded to clinical details. Between 2017-2018, stroke or Transient Ischemic Attack patients were first screened in our vascular radiology meeting and followed up in a dedicated specialist stroke clinic if a diagnosis of medium-large inflammatory intracranial arterial vasculopathy was radiologically confirmed. Treatment was determined and monitored by a multi-disciplinary team. In this case series, eleven patients were managed in this period from the cohort of young stroke presenters (<55 years). The median age was 36-years (Interquartile range:33,50), 8/11 (73%) were female. Two out of 11 (18%) had herpesvirus infection confirmed by viral nucleic acid in the cerebrospinal fluid. We showed improvement in cerebral perfusion at 1-year using an arterial spin labelling sequence in patients taking immunosuppressive therapy for >4-weeks compared to those not receiving therapy (6 [100%] versus 2 [40%] p = 0.026). Our findings demonstrate the potential utility of vessel wall magnetic resonance with arterial spin labelling imaging in detecting and monitoring medium-large inflammatory intracranial arterial vasculopathy activity for patients presenting with stroke symptoms; limiting the need to progress to brain biopsy. Further systematic studies in unselected populations of stroke patients are needed to confirm our findings and establish the prevalence of medium-large artery wall inflammation.
| Type: | Article |
|---|---|
| Title: | Vessel wall magnetic resonance and arterial spin labelling imaging in the management of presumed inflammatory intracranial arterial vasculopathy |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1093/braincomms/fcac157 |
| Publisher version: | https://doi.org/10.1093/braincomms/fcac157 |
| Language: | English |
| Additional information: | © The Author(s) 2022. Published by Oxford University Press on behalf of the Guarantors of Brain. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
| Keywords: | Cerebral vasculitis, neuroinflammation, Stroke, Vessel Wall MR, ASL |
| UCL classification: | UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > Lab for Molecular Cell Bio MRC-UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10151019 |
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