Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · Feb 2024
ReviewUsefulness of Different Imaging Methods in the Diagnosis of Cerebral Vasculopathy.
Assessment of cerebral vasculopathies is challenging and requires understanding the utility of different imaging methods. Various techniques are available to image the vessel lumen, each with unique advantages and disadvantages. ⋯ Digital subtraction angiography remains the gold standard but is invasive, while VW-MRI provides a non-invasive way of assessing vessel wall pathology. Conventional brain MRI has high sensitivity in the diagnosis of vasculitis but findings are nonspecific.
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Illicit and recreational drugs, such as cocaine, heroin, amphetamines, and marijuana, can result in drug-related vasculitis or vasculopathy. Similarly, the use of certain antithyroid, oncologic, and immunosuppressive medications for therapeutic purposes can lead to vasculopathy. ⋯ MR imaging, Vessel Wall imaging, and CT/CTA are valuable imaging tools for the evaluation of patients with suspected drug-induced vasculopathy or vasculitis. This article reviews the pathomechanism, clinical presentation, and imaging findings of vasculopathy related to drug abuse and prescribed medications.
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Vasculitides are characterized by inflammation of the vessel wall, with their categorization relying on clinical and paraclinical manifestations, vessel type, size, distribution, histological attributes, and associated conditions. This review delves into the salient neuroimaging hallmarks of central nervous system vasculitis associated with the most prevalent systemic diseases and highlightings potential pitfalls and diagnostic confounders.
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Cerebral amyloid angiopathy (CAA) is a cerebrovascular disorder marked by the accumulation of amyloid-beta peptide (Aβ) within the leptomeninges and smaller blood vessels of the brain. CAA can be both noninflammatory and inflammatory, and the inflammatory version includes Aβ-related angiitis (ABRA). ABRA is a vasculitis of the central nervous system related to an inflammatory response to Aβ in the vascular walls, which necessitates differentiating ABRA from noninflammatory CAA, as ABRA may require immunosuppressive treatment. MR imaging is typically the most effective imaging modality of choice to screen for these conditions, and they should be obtained at varying time points to track disease progression.