Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Rio de Janeiro, RJ, Brazil; Department of Radiology, Federal Fluminense University, Niterói, RJ, Brazil.
Department of Neuroradiology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Department of Radiology, DASA, São Paulo, SP, Brazil.
Clin Imaging. 2023 Jun;98:26-35. doi: 10.1016/j.clinimag.2023.03.014. Epub 2023 Mar 29.
Vasculitis is a complication of several infectious diseases affecting the central nervous system, which may result in ischemic and/or hemorrhagic stroke, transient ischemic attack, and aneurysm formation. The infectious agent may directly infect the endothelium, causing vasculitis, or indirectly affect the vessel wall through an immunological mechanism. The clinical manifestations of these complications usually overlap with those of non-infectious vascular diseases, making diagnosis challenging. Intracranial vessel wall magnetic resonance imaging (VWI) enables the evaluation of the vessel wall and the diseases that affect it, providing diagnostic data beyond luminal changes and enabling the identification of inflammatory changes in cerebral vasculitis. This technique demonstrates concentric vessel wall thickening and gadolinium enhancement, associated or not with adjacent brain parenchymal enhancement, in patients with vasculitis of any origin. It permits the detection of early alterations, even before a stenosis occurs. In this article, we review the intracranial vessel wall imaging features of infectious vasculitis of bacterial, viral, and fungal etiologies.
血管炎是几种影响中枢神经系统的传染病的并发症，可能导致缺血性和/或出血性脑卒中、短暂性脑缺血发作和动脉瘤形成。感染因子可能直接感染血管内皮，导致血管炎，或通过免疫机制间接影响血管壁。这些并发症的临床表现通常与非传染性血管疾病重叠，使得诊断具有挑战性。颅内血管壁磁共振成像（VWI）能够评估血管壁及其受影响的疾病，提供超越管腔变化的诊断数据，并能够识别脑血管炎的炎症变化。该技术显示出任何病因的血管炎患者的血管壁同心性增厚和钆增强，伴有或不伴有相邻脑实质增强。它可以检测到早期改变，甚至在发生狭窄之前。在本文中，我们回顾了细菌性、病毒性和真菌性病因引起的颅内血管炎的血管壁影像学特征。
