Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Neuroradiology. 2022 May;64(5):915-924. doi: 10.1007/s00234-021-02831-7. Epub 2021 Oct 16.
Vascular complications can be seen in various viral CNS infections. Variable neuro-imaging findings have been described in the literature elucidating the parenchymal changes with vascular involvement. Vessel wall imaging (VWI) can help to detect these vascular involvements. We aimed to describe the role and usefulness of VWI in the evaluation of various viral CNS infections.
In this prospective study, we included 15 cases of various diagnosed viral CNS infections (varicella, HIV encephalopathy, HSV encephalitis, Japanese encephalitis, dengue, COVID-19). VWI and time-of-flight MR angiography (TOF MRA) were included in imaging protocol. All cases were evaluated for the presence of cerebral parenchymal changes, vascular enhancement, and vascular stenosis.
We found infarctions in all 5 cases of varicella, 1 case of HIV encephalopathy, and 1 case of COVID-19 encephalopathy. All these cases also showed vascular enhancement and stenosis on VWI. The rest of the cases, including 1 case of HIV encephalopathy, 3 cases of herpes encephalitis, 2 cases of dengue, and 2 cases of Japanese encephalitis did not have any vascular complication, and also did not show vascular enhancement or stenosis.
VWI can be useful in the detection of vascular involvement in various viral infections of CNS which show a relatively higher cerebrovascular complication rate like varicella, HIV encephalopathy, and COVID-19. However, VWI may not be useful in the routine evaluation of other viral infections like herpes, dengue, and Japanese encephalitis, which have a very low rate of cerebrovascular complication rate.
血管并发症可见于各种中枢神经系统病毒感染。文献中已经描述了可变的神经影像学表现，阐明了伴有血管受累的实质变化。血管壁成像（VWI）可以帮助检测这些血管受累。我们旨在描述 VWI 在评估各种病毒性中枢神经系统感染中的作用和实用性。
在这项前瞻性研究中，我们纳入了 15 例各种诊断明确的病毒性中枢神经系统感染（水痘、HIV 脑炎、单纯疱疹病毒性脑炎、乙型脑炎、登革热、COVID-19）。影像学方案包括 VWI 和时间飞越磁共振血管造影（TOF MRA）。所有病例均评估脑实质变化、血管强化和血管狭窄的存在情况。
我们发现 5 例水痘、1 例 HIV 脑炎和 1 例 COVID-19 脑炎患者均存在梗死。所有这些病例的 VWI 也显示了血管强化和狭窄。其余病例，包括 1 例 HIV 脑炎、3 例疱疹性脑炎、2 例登革热和 2 例乙型脑炎，均无血管并发症，也未显示血管强化或狭窄。
VWI 可用于检测中枢神经系统各种病毒感染中的血管受累，这些感染的脑血管并发症发生率相对较高，如水痘、HIV 脑炎和 COVID-19。然而，VWI 在其他病毒感染（如疱疹、登革热和乙型脑炎）的常规评估中可能没有用处，因为这些感染的脑血管并发症发生率非常低。
