Arnett Nathan, Pavlou Athanasios, Burke Morgan P, Cucchiara Brett L, Rhee Rennie L, Song Jae W
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Neuroradiology. 2022 Jan;64(1):43-58. doi: 10.1007/s00234-021-02724-9. Epub 2021 May 3.
Beyond vessel wall enhancement, little is understood about vessel wall MR imaging (VW-MRI) features of vasculitis affecting the central nervous system (CNS). We reviewed vessel wall MR imaging patterns of inflammatory versus infectious vasculitis and also compared imaging patterns for intracranial versus extracranial arteries of the head and neck.
Studies reporting vasculitis of the CNS/head and neck and included MR imaging descriptions of vessel wall features were identified by searching PubMed, Scopus, Cochrane, Web of Science, and EMBASE up to June 10, 2020. From 6065 publications, 115 met the inclusion criteria. Data on study characteristics, vasculitis type, MR details, and VW-MRI descriptions were extracted.
Studies used VW-MRI for inflammatory (64%), infectious (17%), or both inflammatory and infectious vasculitides (19%). Vasculitis affecting intracranial versus extracranial arteries were reported in 58% and 39% of studies, respectively. Commonly reported VW-MRI features were vessel wall enhancement (89%), thickening (72%), edema (10%), and perivascular enhancement (16%). Inflammatory vasculitides affecting the intracranial arteries were less frequently reported to have vessel wall thickening (p = 0.006) and perivascular enhancement (p = 0.001) than extracranial arteries. Varicella zoster/herpes simplex vasculitis (VZV/HSV, 45%) and primary angiitis of the CNS (PACNS, 22%) were the most commonly reported CNS infectious and inflammatory vasculitides, respectively. Patients with VZV/HSV vasculitis more frequently showed decreased or resolution of vessel wall enhancement after therapy compared to PACNS (89% versus 59%).
To establish imaging biomarkers of vessel wall inflammation in the CNS, VW-MRI features of vasculitis accounting for disease mechanism and anatomy should be better understood.
除血管壁强化外，对于影响中枢神经系统（CNS）的血管炎的血管壁磁共振成像（VW-MRI）特征了解甚少。我们回顾了炎症性与感染性血管炎的血管壁MRI表现，并比较了头颈部颅内与颅外动脉的成像表现。
通过检索截至2020年6月10日的PubMed、Scopus、Cochrane、科学网和EMBASE，确定了报告CNS/头颈部血管炎并包含血管壁特征MRI描述的研究。从6065篇出版物中，115篇符合纳入标准。提取了关于研究特征、血管炎类型、MRI细节和VW-MRI描述的数据。
研究使用VW-MRI评估炎症性血管炎（64%）、感染性血管炎（17%）或炎症性和感染性血管炎（19%）。分别有58%和39%的研究报告了影响颅内与颅外动脉的血管炎。常见的VW-MRI特征包括血管壁强化（89%）、增厚（72%）、水肿（10%）和血管周围强化（16%）。与颅外动脉相比，影响颅内动脉的炎症性血管炎较少出现血管壁增厚（p = 0.006）和血管周围强化（p = 0.001）。水痘带状疱疹/单纯疱疹病毒血管炎（VZV/HSV，45%）和中枢神经系统原发性血管炎（PACNS，22%）分别是最常报告的CNS感染性和炎症性血管炎。与PACNS相比，VZV/HSV血管炎患者治疗后血管壁强化更常出现减轻或消退（89%对59%）。
为了建立CNS血管壁炎症的成像生物标志物，应更好地了解考虑疾病机制和解剖结构的血管炎的VW-MRI特征。
