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NEUROLOGY 2009;72:627-634
© 2009 American Academy of Neurology

Intracranial arterial wall imaging using high-resolution 3-tesla contrast-enhanced MRI

R. H. Swartz, MD, PhD, S. S. Bhuta, MD, R. I. Farb, MD, R. Agid, MD, R. A. Willinsky, MD, K. G. terBrugge, MD, J. Butany, MD, B. A. Wasserman, MD, D. M. Johnstone, RTR, RTMR, F. L. Silver, MD and D. J. Mikulis, MD

From the Departments of Neurology (R.H.S.), Neuroradiology (S.S.B., R.I.F., R.A., R.A.W., K.G.t.B., F.L.S., D.J.M.), Medical Imaging (D.M.J.), and Pathology (J.B.), Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada; and Russell H. Morgan Department of Radiology and Radiological Sciences (B.A.W.), Johns Hopkins Hospital, Baltimore, MD.

Address correspondence and reprint requests to Dr. David Mikulis, Division of Neuroradiology, Department of Medical Imaging, New East Wing, Toronto Western Hospital, University Health Network, 399 Bathurst St., Toronto, Ontario, Canada M5T 2S8 mikulis{at}uhnres.utoronto.ca

Background: Conventional arterial imaging focuses on the vessel lumen but lacks specificity because different pathologies produce similar luminal defects. Wall imaging can characterize extracranial arterial pathology, but imaging intracranial walls has been limited by resolution and signal constraints. Higher-field scanners may improve visualization of these smaller vessels.

Methods: Three-tesla contrast-enhanced MRI was used to study the intracranial arteries from a consecutive series of patients at a tertiary stroke center.

Results: Multiplanar T2-weighted fast spin echo and multiplanar T1 fluid-attenuated inversion recovery precontrast and postcontrast images were acquired in 37 patients with focal neurologic deficits. Clinical diagnoses included atherosclerotic disease (13), CNS inflammatory disease (3), dissections (3), aneurysms (3), moyamoya syndrome (2), cavernous angioma (1), extracranial source of stroke (5), and no definitive clinical diagnosis (7). Twelve of 13 with atherosclerotic disease had focal, eccentric vessel wall enhancement, 10 of whom had enhancement only in the vessel supplying the area of ischemic injury. Two of 3 with inflammatory diseases had diffuse, concentric vessel wall enhancement. Three of 3 with dissection showed bright signal on T1, and 2 had irregular wall enhancement with a flap and dual lumen.

Conclusions: Three-tesla contrast-enhanced MRI can be used to study the wall of intracranial blood vessels. T2 and precontrast and postcontrast T1 fluid-attenuated inversion recovery images at 3 tesla may be able to differentiate enhancement patterns of intracranial atherosclerotic plaques (eccentric), inflammation (concentric), and other wall pathologies. Prospective studies are required to determine the sensitivity and specificity of arterial wall imaging for distinguishing the range of pathologic conditions affecting cerebral vasculature.

Abbreviations: CTA = computed tomographic angiography; DSA = digital subtraction angiography; FIESTA = fast imaging employing steady state acquisition; FLAIR = fluid-attenuated inversion recovery; FRFSE = fast recovery fast spin echo; ICA = internal carotid artery; MCA = middle cerebral artery; MR = magnetic resonance; MRA = magnetic resonance angiography; TE = echo time; TI = inversion time; TR = recovery time.

Supplemental data at www.neurology.org

Disclosure: The authors report no disclosures.

Received February 15, 2008. Accepted in final form November 14, 2008.