High-resolution MRI vessel wall imaging in varicella zoster virus vasculopathy

Abstract

Contrast-enhanced vessel wall imaging high-resolution MRI (HRMR) has revealed vessel wall thickening and enhancement in multiple intracranial vasculopathies, including varicella zoster virus (VZV) vasculopathy. We retrospectively reviewed a database of patients with virologically-verified VZV vasculopathy, who underwent initial and follow-up HRMR between April 2011 and May 2014. Six patients were identified. Baseline demographic and clinical characteristics were collected, including stroke risk factors, history of VZV-related disorders, neurological presentation, course and antiviral treatment. Initial HRMR in patients with VZV vasculopathy demonstrated various patterns of stenosis, vessel wall thickening and enhancement, predominantly in terminal internal carotid artery segments and the M1 segment of the middle cerebral arteries. Follow-up HRMR showed improvement of stenosis, with reduced vessel wall thickening and enhancement at multiple times after treatment. HRMR has the potential to assist in diagnosis and treatment of VZV vasculopathy.

Keywords: Angiography; High-resolution; MRI; Treatment; Varicella zoster virus; Vasculopathy.

Fig. 1

Contrast-enhanced high-resolution MRI (HRMR) over time in Patient 1. Axial HRMR at presentation demonstrates stenosis and vessel wall enhancement of the terminal segment of the right ICA and proximal right MCA (a), minimal improvement of stenosis and enhancement 3 months later (b), with resolution of stenosis and vessel wall enhancement at 21 months (c).

Fig. 2

Contrast-enhanced high-resolution MRI (HRMR) over time in Patient 2. At presentation, coronal (a) and axial (b) HRMR reveal vessel wall thickening and enhancement of both terminal ICA segments; 3 months later, coronal (c) and axial (d) HRMR demonstrate resolution of thickening and enhancement.

Fig. 3

Contrast-enhanced high-resolution MRI (HRMR) over time in Patient 4. At presentation, coronal (a), axial (b) and oblique magnified views (c) demonstrate stenosis, with post-stenotic dilatation of the M1 segment of the left MCA and vessel wall enhancement of the terminal segment of the left ICA and proximal left MCA; 4 months later, coronal (d), axial (e) and oblique magnified views (f) reveal stable stenosis with moderate improvement of the vessel wall enhancement.

Fig. 4

Contrast-enhanced high-resolution MRI (HRMR) over time in Patient 5. At presentation, coronal views demonstrate vessel wall enhancement of the terminal segment of both ICAs and in the lentiform nucleus and head of the caudate nucleus (a), while axial views show enhancement of the M1 segment of the left MCA (b); 4 months later, coronal views reveal resolution of enhancement of the terminal segment of both ICAs with reduced enhancement of the lentiform nucleus and head of the caudate nucleus (c), and axial views demonstrate resolution of enhancement of the M1 segment of the left MCA (d).

Fig. 5

Contrast-enhanced high-resolution MRI (HRMR) over time in Patient 6. At presentation, coronal (a) and axial (b) views demonstrate stenosis, thickening and vessel wall enhancement of the terminal segments of both ICAs; 5 months later, coronal (c) and axial (d) views reveal persistent stenosis, thickening and vessel wall enhancement.