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Neuroradiologic Characteristics of Primary Angiitis of the Central Nervous System According to the Affected Vessel Size

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Abstract

Introduction

Magnetic resonance imaging (MRI) has an important impact in diagnosing primary angiitis of the central nervous system (PACNS). However, neuroradiologic findings may vary immensely, making an easy and definite diagnosis challenging.

Methods

In this retrospective, single center study, we analyzed neuroradiologic findings of patients with PACNS diagnosed at our hospital between 2009 and 2014. Furthermore, we classified patients according to the affected vessel size and compared imaging characteristics between the subgroups.

Results

Thirty-three patients were included (mean age 43 [±15.3] years, 17 females) in this study. Patients with positive angiographic findings were classified as either medium or large vessel PACNS and presented more ischemic lesions (p < 0.001) and vessel wall enhancement (p = 0.017) compared to patients with small vessel PACNS. No significant differences were detected for the distribution of contrast-enhancing lesions (parenchymal or leptomeningeal), hemorrhages, or lesions with mass effect. Twenty-five patients underwent brain biopsy. Patients with medium or large vessel PACNS were less likely to have positive biopsy results.

Discussion

It is essential to differentiate between small and medium/large vessel PACNS since results in MRI, digital subtraction angiography and brain biopsy may differ immensely. Since image quality of MR scanners improves gradually and brain biopsy may often be nonspecific or negative, our results emphasize the importance of MRI/MRA in the diagnosis process of PACNS.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Christian Thaler, Ann-Katrin Kaufmann-Bühler, Jens Fiehler & Susanne Siemonsen

  2. Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Simon Schuster, Henrike Bachmann, Götz Thomalla & Tim Magnus

  3. Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Jakob Matschke

  4. Mongolian Academy of Sciences, Oyun Onosh Medical Center, Ulaanbaatar, Mongolia

    Tserenchunt Gansukh & Amarjargal Gansukh

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  1. Christian Thaler
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  2. Ann-Katrin Kaufmann-Bühler
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  3. Tserenchunt Gansukh
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  4. Amarjargal Gansukh
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Corresponding author

Correspondence to Christian Thaler.

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Conflict of interest

C. Thaler, A.-K. Kaufmann-Bühler, T. Gansukh, A. Gansukh, S. Schuster, H. Bachmann, G. Thomalla, T. Magnus, J. Matschke, J. Fiehler and S. Siemonsen declare that they have no competing interests.

Additional information

Christian Thaler and Ann-Katrin Kaufmann-Bühler contributed equally to this work.

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Thaler, C., Kaufmann-Bühler, AK., Gansukh, T. et al. Neuroradiologic Characteristics of Primary Angiitis of the Central Nervous System According to the Affected Vessel Size. Clin Neuroradiol 29, 37–44 (2019). https://doi.org/10.1007/s00062-017-0622-8

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  • DOI: https://doi.org/10.1007/s00062-017-0622-8

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