The Role of Imaging in the Diagnosis of Central Nervous System Vasculitis
Tóm tắt
Cerebral vasculitis is diagnosed with difficulty. Its presentation with heterogeneous symptoms and signs often delays diagnosis. In this context, imaging plays an important role in advancing the diagnosis. Digital subtraction cerebral angiography, MRI, and MRA, the most useful examinations for vasculitis, provide supportive, but not pathognomonic, evidence of cerebral vasculitis. On MRI, multiple infarcts in different vascular territories and of different ages are suggestive of vasculitis. On digital subtraction cerebral angiography, areas of stenosis, dilatation, and occlusion are suggestive of vasculitis. Small vessel vasculitis is currently best demonstrated by changes seen in brain parenchyma on MRI, but high field strength (7 T) magnetic resonance angiography offers the possibility of directly evaluating small vessel vasculitis. Ultrasound and high-resolution contrast MRI are excellent modalities for evaluating the superficial extracranial circulation.
Tài liệu tham khảo
•• Scolding N: Central nervous system vasculitis. Semin Immunopathol 2009, 31:527–536. This is an excellent review of the current pathology, clinical features, and diagnosis of CNS vasculitis.
Jennette JC, Falk RJ, Andrassy K, et al.: The proposal of an international consensus conference. Arthritis Rheum 1994, 37:187–192.
Hunder GG, Arend WP, Bloch DA, et al.: The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum 1990, 33:1065–1067.
•• Kuker W: Cerebral vasculitis: imaging signs revisited. Neuroradiology 2007, 49:471–479. This is an excellent review of the imaging in cerebral vasculitis. A modified approach to the Chapel Hill classification is proposed.
Kaufmann TJ, Kallmes DF: Diagnostic cerebral angiography: archaic and complication-prone or here to stay for another 80 years? AJR Am J Roentgenol 2008, 1:1435–1437.
Nishikawa M, Sakamoto H, Katsuyama J, et al.: Multiple appearing and vanishing aneurysms: primary angiitis of the central nervous system. J Neurosurg 1998, 88:133–137.
Willinsky RA, Taylor SM, TerBrugge K, et al.: Neurologic complications of cerebral angiography: prospective analysis of 2,899 procedures and review of the literature. Radiology 2003, 227:522–528.
Yahyavi-Firouz-Abadi N, Wynn BL, Rybicki FJ, et al.: Steroid-responsive large vessel vasculitis: application of whole-brain 320-detector row dynamic volume CT angiography and perfusion. AJNR Am J Neuroradiol 2009, 30:1409–1411.
Blockmans D, Bley T, Schmidt W: Imaging for large-vessel vasculitis. Curr Opin Rheumatol 2009, 21:19–28.
Kraemer M, Berlit P: Systemic, secondary and infectious causes for cerebral vasculitis: clinical experience with 16 new European cases. Rheumatol Int 2009 Oct 13 (Epub ahead of print).
Harris KG, Tran DD, Sickels WJ, et al.: Diagnosing intracranial vasculitis: the roles of MR and angiography. AJNR Am J Neuroradiol 1994, 15:317–330.
Calabrese LH, Duna GF, Lie JT: Vasculitis in the central nervous system. Arthritis Rheum 1997, 40:1189–1201.
Aviv RI, Benseler SM, Silverman ED, et al.: MR imaging and angiography of primary CNS vasculitis of childhood. AJNR Am J Neuroradiol 2006, 27:192–199.
Wasserman BA, Stone JH, Hellmann DB, Pomper MG: Reliability of normal findings on MR imaging for excluding the diagnosis of vasculitis of the central nervous system. AJR Am J Roentgenol 2001, 177:455–459.
Cloft HJ, Phillips CD, Dix JE, et al.: Correlation of angiography and MR imaging in cerebral vasculitis. Acta Radiol 1999, 40:83–87.
Deibler AR, Pollock JM, Kraft RA, et al.: Arterial spin-labeling in routine clinical practice, part 2: hypoperfusion patterns. AJNR Am J Neuroradiol 2008, 29:1235–1241.
White ML, Hadley WL, Zhang Y, Dogar MA: Analysis of central nervous system vasculitis with diffusion-weighted imaging and apparent diffusion coefficient mapping of the normal-appearing brain. AJNR Am J Neuroradiol 2007, 28:933–937.
Scolding N: Can diffusion weighted imaging improve the diagnosis of CNS vasculitis? Nat Clin Pract Neurol 2007, 3:608–609.
Sundgren PC, Jennings J, Attwood JT, et al.: MRI and 2D-CSI MR spectroscopy of the brain in the evaluation of patients with acute onset of neuropsychiatric systemic lupus erythematosus. Neuroradiology 2005, 47:576–585.
Appenzeller S, Li LM, Costallat LT, Cendes F: Neurometabolic changes in normal white matter may predict appearance of hyperintense lesions in systemic lupus erythematosus. Lupus 2007, 16:963–971.
Minagar A, Fowler M, Harris MK, Jaffe SL: Neurologic presentations of systemic vasculitides. Neurol Clin 2010, 28:171–184.
Bongartz TM: Large-vessel involvement in giant cell arteritis. Curr Opin Rheumatol 2006, 18:7–10.
Schmidt WA, Kraft HE, Vorpahl K, et al.: Color duplex ultrasonography in the diagnosis of temporal arteritis. N Engl J Med 1997, 337:1336–1342.
Karassa FB, Matsagas MI, Schmidt WA, Ioannidis JP: Meta-analysis: test performance of ultrasonography for giant-cell arteritis. Ann Intern Med 2005, 142:359–369.
Pipitone N, Salvarani C: Role of imaging in vasculitis and connective tissue diseases. Best Pract Res Clin Rheumatol 2008, 22:1075–1091.
Bley TA, Uhl M, Carew J, et al.: Diagnostic value of high-resolution MR imaging in giant cell arteritis. AJNR Am J Neuroradiol 2007, 28:1722–1727.
Geiger J, Ness T, Uhl M, et al.: Involvement of the ophthalmic artery in giant cell arteritis visualized by 3 T MRI. Rheumatology 2009, 48:537–541.
Bley TA, Geiger J, Jacobsen S, et al.: High-resolution MRI for assessment of middle meningeal artery involvement in giant cell arteritis. Ann Rheum Dis 2009, 68:1369–1370.
Andrews J, Mason JC: Takayasu’s arteritis—recent advances in imaging offer promise. Rheumatology 2007, 46:6–15.
Desai MY, Stone JH, Foo TKF, et al.: Delayed contrast-enhanced MRI of the aortic wall in Takayasu’s arteritis: initial experience. AJR Am J Roentgenol 2005, 184:1427–1431.
Webb M, Chambers A, Al-Nahhas A, et al.: The role of FDG PET in characterising disease activity in Takayasu arteritis. Eur J Nucl Med Mol Imaging 2004, 31:627–634.
Schmidley J, ed: Central Nervous System Angiitis. Boston, MA: Butterworth-Heinemann; 2000.
Birnbaum J, Hellmann DB: Primary angiitis of the central nervous system. Arch Neurol 2009, 66:704–709.
Molloy ES, Singhal AB, Calabrese LH: Tumour-like mass lesion: an under-recognised presentation of primary angiitis of the central nervous system. Ann Rheum Dis 2008, 67:1732–1735.
Tong KA, Ashwal S, Obenaus A, et al.: Susceptibility-weighted MR imaging: a review of clinical applications in children. AJNR Am J Neuroradiol 2008, 29:9–17.
Lee Y, Kim J-H, Kim E, et al.: Tumor-mimicking primary angiitis of the central nervous system: initial and follow-up MR features. Neuroradiology 2009, 51:651–659.
Von Morze C, Purcell D, Banerjee S, et al.: High resolution intracranial MRA at 7 T using autocalibrating parallel imaging: initial experience in vascular disease patients. Magn Reson Imaging 2008, 26:1329–1333.
Woolfenden AR, Hukin J, Poskitt KJ, Connolly MB: Encephalopathy complicating Henoch-Schonlein purpura: reversible MRI changes. Pediatr Neurol 1998, 19:74–77.
Berlit P: Diagnosis and treatment of cerebral vasculitis. Ther Adv Neurol Disord 2009, 28:1–14.
Jacobi C, Wildemann B, Wengenroth M: Imaging of cerebral vasculitis. In Inflammatory Disease of the Brain, edn 1. Edited by Hahnel S. Berlin: Springer-Verlag; 2009:26–50
Matsushima M, Yaguchi H, Niino M, et al.: MRI and pathological findings of rheumatoid meningitis. J Clin Neurosci 2010, 17:129–132.
Jones SE, Belsley NA, McLoud TC, Mullins ME: Rheumatoid meningitis: radiological and pathological correlation. AJR Am J Roentgenol 2006, 186:1181–1183.
Abe K: MRI of central nervous system vasculitis. Curr Med Imaging Rev 2006, 2:425–434.
Citron BP, Halpern M, McCarron M, et al.: Necrotizing angiitis associated with drug abuse. N Engl J Med 1970, 283:1003–1011.
Geibprasert S, Gallucci M, Krings T: Addictive illegal drugs: structural neuroimaging. AJNR Am J Neuroradiol 2009 Oct 29 (Epub ahead of print).
Wynne PJ, Younger DS, Khandji A, Silver AJ: Radiographic features of central nervous system vasculitis. Neurol Clin 1997, 15:779–804.
Hajj-Ali RA, Calabrese LH: Central nervous system vasculitis. Curr Opin Rheumatol 2009, 21:10–18.
Ducros A, Boukobza M, Porcher R, et al.: The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome. A prospective series of 67 patients. Brain 2007, 130:3091–3101.
Hankey G: Isolated angiitis/angiopathy of the CNS. Prospective diagnostic and therapeutic experience. Cerebrovasc Dis 1991, 1:2–15.