Three-dimensional T1-weighted dark blood MRI sequencing determines suppression of the blood signal inside the vascular lumen, allowing visualization of the vascular wall. In the case of vasculitis, there is concentric thickening and avid contrast enhancement of the vascular wall11. Pinho MC, Hall JT, Cross JC, Shang T, Madhuranthakam AJ, Moore WA. Intracranial vessel wall MRI in Clinical practice: technical considerations, current and emerging applications, and clinical pearls and pitfalls. Radiographics. 2018 Apr; 8(2) 97-118. https://doi.org/10.3174/ng.9170237
https://doi.org/10.3174/ng.9170237...
,22. Mandell DM, Mossa-Basha M, Qiao Y. Intracranial vessel wall MRI: Principles and expert consensus recommendations of the American Society of Neuroradiology. AJNR Am J Neuroradiol. 2017;38:218-29. https://doi.org/10.3174/ajnr.A4893
https://doi.org/10.3174/ajnr.A4893...
.
We report on a 35-year-old man with chronic meningitis and a ventriculoperitoneal shunt, presenting with sudden right hemiplegia. Cerebrospinal fluid analysis showed lymphocytic pleocytosis. Diffusion-weighted imaging revealed a recent ischemic lesion at the left nucleus-capsular level. Vascular wall imaging showed concentric thickening and avid contrast enhancement of the left M1 wall. Additionally, cervical spine MRI showed leptomeningeal thickening (Figure). Anatomopathological analysis revealed non-caseating granulomas.
DWI (A) and ADC map (B) show ischemic insult at left nucleus-capsular level. Fat-suppressed post-contrast T1-weighted MRI (C) shows spinal leptomeningeal disease. Pre- (D) and post-gadolinium (E) 3D T1-weighted dark blood MRI reveals thickening and enhancement of left M1 wall, compatible with vasculitis.
References
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1Pinho MC, Hall JT, Cross JC, Shang T, Madhuranthakam AJ, Moore WA. Intracranial vessel wall MRI in Clinical practice: technical considerations, current and emerging applications, and clinical pearls and pitfalls. Radiographics. 2018 Apr; 8(2) 97-118. https://doi.org/10.3174/ng.9170237
» https://doi.org/10.3174/ng.9170237 -
2Mandell DM, Mossa-Basha M, Qiao Y. Intracranial vessel wall MRI: Principles and expert consensus recommendations of the American Society of Neuroradiology. AJNR Am J Neuroradiol. 2017;38:218-29. https://doi.org/10.3174/ajnr.A4893
» https://doi.org/10.3174/ajnr.A4893
Publication Dates
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Publication in this collection
15 00 2019 -
Date of issue
June 2019
History
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Received
09 Jan 2019 -
Accepted
01 Feb 2019