Black blood MRI in suspected large artery primary angiitis of the central nervous system

J Neuroimaging. 2013 Jul;23(3):379-83. doi: 10.1111/j.1552-6569.2012.00743.x. Epub 2012 Aug 28.


Objectives: Single case reports suggest that black blood MRI (T1-weighted fat and blood suppressed sequences with and without contrast injection; BB-MRI) may visualize intracranial vessel wall contrast enhancement (CE) in primary angiitis of the central nervous system (PACNS). In this single-center observational pilot study we prospectively investigated the value of BB-MRI in the diagnosis of large artery PACNS.

Methods: Patients with suspected large artery PACNS received a standardized diagnostic program including BB-MRI. Vessel wall CE was graded (grade 0-2) by two experienced readers blinded to clinical data and correlated to the final diagnosis.

Results: Four of 12 included patients received a final diagnosis of PACNS. All of them showed moderate (grade 1) to strong (grade 2) vessel wall CE at the sites of stenosis. A moderate (grade 1) vessel wall CE grade was also observed in 6 of the remaining 8 patients in whom alternative diagnoses were made: arteriosclerotic disease (n = 4), intracranial dissection (n = 1), and Moyamoya disease (n = 1).

Conclusions: Our pilot study demonstrates that vessel wall CE is a frequent finding in PACNS and its mimics. Larger trials will be necessary to evaluate the utility of BB-MRI in the diagnostic workup of PACNS.

Keywords: Infarction; MRI; inflammation; vasculitis.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Algorithms*
  • Female
  • Humans
  • Image Enhancement / methods*
  • Image Interpretation, Computer-Assisted / methods*
  • Magnetic Resonance Angiography / methods*
  • Male
  • Middle Aged
  • Observer Variation
  • Pilot Projects
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Single-Blind Method
  • Vasculitis, Central Nervous System / pathology*