Department of Radiology, Sureyyapasa Chest Diseases and Thoracic Surgery Training Hospital, Başıbüyük Mah. Hastane Yolu Cad, 34844, Istanbul, Turkey.
Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpasa, Istanbul, Turkey.
Neuroradiology. 2021 Oct;63(10):1635-1644. doi: 10.1007/s00234-021-02686-y. Epub 2021 Mar 8.
The aim of this study is to demonstrate the diagnostic effect of VWI in differentiating PACNS from other vasculopathies and its role in post-treatment follow-up in PACNS patients in this study.
In this prospective study, we included patients with clinical suspicion of PACNS who presented with new-onset ischemic events and had significant intracranial large vessel stenosis on DSA or MRA. VWI was performed on all patients. The imaging findings and final diagnoses were recorded. Control VWI was performed on patients with PACNS diagnosis after at least 3 months of treatment, and the change in findings was also evaluated.
Twenty-three patients were included in the study had a median age of 40 (range 12-58). The most common clinical manifestations were focal neurologic deficits. According to the initial clinical evaluation, 10 patients (43.5%) were classified as PACNS and 13 patients (56.5%) as indeterminate for PACNS. After incorporating the VWI findings, the diagnosis of PACNS was confirmed in all clinically diagnosed PACNS patients. Concentric wall thickening and contrast enhancement were statistically significant in the PACNS group (p <0.001). According to concentric thickening and VWE features, sensitivity and specificity in distinguishing PACNS and other vasculopathies were 95.2%, 75% and 95.2%, 68.8%, respectively. Vessel wall enhancement regressed in 7 of 9 patients during a median follow-up period of 8 months (range 5.5-11.5) in PACNS patients who followed up.
VWI seems a new and useful imaging method in the differential diagnosis of PACNS and might be a useful adjunct for post-treatment follow-up.
本研究旨在展示 VWI 在鉴别 PACNS 与其他血管病变中的诊断效果，并在本研究中探讨其在 PACNS 患者治疗后随访中的作用。
在这项前瞻性研究中，我们纳入了临床怀疑为 PACNS 的患者，这些患者表现为新发缺血性事件，且 DSA 或 MRA 显示存在明显的颅内大血管狭窄。对所有患者进行 VWI 检查。记录影像学表现和最终诊断。对诊断为 PACNS 的患者在治疗至少 3 个月后进行对照 VWI 检查，并评估其检查结果的变化。
本研究共纳入 23 例患者，平均年龄为 40 岁（范围 12-58 岁）。最常见的临床表现为局灶性神经功能缺损。根据初始临床评估，10 例患者（43.5%）被归类为 PACNS，13 例患者（56.5%）为 PACNS 不确定。纳入 VWI 检查结果后，所有临床诊断为 PACNS 的患者均得到了明确诊断。PACNS 组的同心壁增厚和对比增强具有统计学意义（p <0.001）。根据同心增厚和 VWE 特征，鉴别 PACNS 和其他血管病变的敏感性和特异性分别为 95.2%、75%和 95.2%、68.8%。在中位随访 8 个月（范围 5.5-11.5）期间，PACNS 患者中有 7 例患者的血管壁强化消退。
VWI 似乎是一种新的有用的鉴别诊断 PACNS 的影像学方法，并且可能是治疗后随访的有用辅助手段。
