Vessel wall MR imaging in neuroradiology

Abstract

Vessel wall MR imaging (VW-MRI) has been introduced into clinical practice and applied to a variety of diseases, and its usefulness has been reported. High-resolution VW-MRI is essential in the diagnostic workup and provides more information than other routine MR imaging protocols. VW-MRI is useful in assessing lesion location, morphology, and severity. Additional information, such as vessel wall enhancement, which is useful in the differential diagnosis of atherosclerotic disease and vasculitis could be assessed by this special imaging technique. This review describes the VW-MRI technique and its clinical applications in arterial disease, venous disease, vasculitis, and leptomeningeal disease.

Keywords: 3D MRI; Delay alternating with nutation for tailored excitation; MR angiography; Magnetization transfer; Vessel wall MR imaging; Vessel wall enhancement.

Fig. 1

A 75-year-old male with right ICA stenosis. a TOF-MRA shows stenosis of the proximal part of right ICA (arrow). b Axial MPR section of DANTE T1-SPACE shows hyperintensity plaque at the right ICA (arrow). c Coronal MPR section of DANTE T1-SPACE shows hyperintensity plaque at the right ICA (arrow)

Fig. 2

A 75-year-old male with acute onset left hemiparesis. a DWI shows hyperintensity in the right internal capsule (black arrow). b TOF-MRA shows no apparent inflow inside the right ICA (arrowheads). (c, d, e) 3D T1-SPACE shows intermediated signal inside the right ICA with slight hyperintense structure along the ICA wall (white arrows). Ultrasound shows mobile thrombus or oscillating thrombus in the right ICA (data not shown)

Fig. 3

A 45-year-old male with right ICA dissection. The images of 40 days after the onset (a, c), and 90 days (b, d) are shown: DANTE T1-SPACE (a, b) and TOF-MRA (c, d). a DANTE T1-SPACE shows hyperintensity in the false lumen, which represents the intramural thrombosis. b DANTE T1-SPACE obtained at 90 days after the onset showed that hyperintensity in the false lumen had regressed. c TOF-MRA showed inflow only in the true lumen. d The size of true lumen returned to normal at 90 days after the onset

Fig. 4

A 55-year-old female with temporal right hemiparesis. a DWI showed hyperintensity in the medial part of right frontal lobe (arrow). DWI also showed widespread hyperintensity in the medial aspect of right frontal lobe (data not shown). b MIP image of TOF-MRA shows discontinuous flow in the right ACA (arrowheads). c DANTE T1-SPACE showed high intensity spot at the right ACA indicating the thrombosis in the false lumen (arrow). d Source image of TOF-MRA showed a slow flow in the true lumen of right ACA (arrow). Acute stroke associated with dissection of right ACA was diagnosed. RCVS was also suspected because of thunderclap headache at onset. However, the stenosis of the right ACA did not improve over time

Fig. 5

A male in his 50 years without any risk factor of atherosclerosis. He suffered from recurrent multiple small brain infarcts in the ipsilateral hemisphere. a CE-CTA shows the defect at the proximal part of right ICA (arrow). Carotid web was diagnosed. b Non-enhanced MRA shows no apparent abnormality (arrow). c Non-enhanced DANTE T1-SPACE showed intermediate signal at right ICA (arrow). d Contrast-enhanced DANTE T1-SPACE showed a thin septum projecting into the lumen of right ICA

Fig. 6

A 35-year-old male with venous infarction associated with the venous thrombosis of superficial cerebral vein and the vein of Labbé. (a, b) DANTE T1-SPACE showed hyperintensity in the thrombosed venous structures (arrowheads) as well as the venous hemorrhagic infarction in right temporal lobe (arrow). c A thin slice maximum intensity projection image of DANTE T1-SPACE clearly visualized thrombosed vein

Fig. 7

A 60-year-old male with right facial nerve palsy and neuralgia. CE DANTE T1-SPACE (a, c) and CE GRE T1WI (b, d) are shown. He was diagnosed as Ramsay-Hunt syndrome, and CSF analysis demonstrated varicella zoster meningitis. (a, c) CE DANTE T1-SPACE showed enhancement of right facial nerve and geniculate ganglion (arrows). (b, d) CE GRE T1WI showed less pronounced enhancement in the facial nerve (arrows). Note that non-specific mild enhancement is often seen in geniculate ganglion, but the enhancement is more pronounced in this case

Fig. 8

A 10-year-old girl with CNS dissemination of acute lymphocytic leukemia. CE DANTE T1-SPACE showed enhancement of bilateral vestibular nerves (white arrows), abducens nerves (white arrowheads) a, trigeminal nerves (black arrows) b, and oculomotor nerves (white double arrows) c. CE DANTE T1-SPACE showed leptomeningeal enhancement at the left occipital lobe (black arrowheads) (a, b)