The Value Of HR-MRI In The Diagnosis,Efficacy And Prognosis Of Central Nervous System Vasculitis

Objective:(1)To explore the HR-MRI image characteristics of central nervous system(CNS)vasculitis;(2)to explore the value of HR-MRI in the treatment effect and prognosis evaluation of CNS vasculitis.Methods:(1)from January 2018 to January 2020,50 patients with intracranial artery stenosis and unclear etiology found by 3D-TOF MRA in the imaging department of our hospital or clinically suspected of CNS vasculitis were selected for 3.0T HR-MRI plain scan and enhanced scan.(2)The age,gender,laboratory test results and HR-MRI findings of 24 patients with CNS vasculitis were recorded.The follow-up was carried out.The treatment response of the patients was evaluated according to the clinical and imaging characteristics and the results of each follow-up were recorded.Result:1.The mean age of 24 patients with CNS vasculitis was 32.5 years,the median age was 32.5 years.Among them,there were 16 males(67.0%)with an average age of 32.6 years(23-46 years).The average age was 32.4 years(15-43 years).2.24 patients with CNS vasculitis showed diffuse homogeneous centripetal thickening on HR-MRI,5 patients(20.8%)involved single arterial segment,19 patients(79.2%)involved multi-arterial segment,involving 99 arterial segments in total.Seven(7.1%)segments were enhanced at level 1 and 92(92.9%)segments were enhanced at level 2.30(30.3%)had mild stenosis,43(43.4%)had moderate stenosis,21(21.2%)had severe stenosis occlusion,and 5(5.1%)had no obvious stenosis.3.In 24 cases of CNS vasculitis,except one case involving basilar artery at the same time,the other 23 cases involved only anterior circulation vessels in varying degrees,mainly internal carotid artery(ICA)and / or middle cerebral artery(MCA).24 cases were treated with cerebrovascular events,8 cases(33.3%)were bilateral multiple cerebral infarction,8 cases(33.3%)were unilateral multiple cerebral infarction,3 cases(12.5%)were single cerebral infarction,5 cases(20.8%)were TIA4.The median follow-up time of 24 patients with CNS vasculitis was 9 months(9-12 months),19 patients in hormone therapy group,11 patients in 9 months(5 patients with enhancement and reduction / disappearance of stenosis degree of lumen,6 patients with reduction of stenosis degree of lumen,no change of enhancement of lumen),4 patients with recurrence and 4 patients without response.There were 5 patients in the control group,4 patients with no response and 1 patient with recurrence after 9 months of treatment.There was a significant difference in the remission rate between the two groups(P = 0.041).5.Among 19 cases of CNS vasculitis treated with hormone,4 cases recurred.They were divided into recurrent and non recurrent subgroups.The difference of single,bilateral and involved vessels(only involving MCA,only involving ICA,MCA and ICA)between the two groups was analyzed to find out whether there was any effect on recurrence(P > 0.05).The average number of vascular segments involved in recurrent group was 6.5(3-11),and the average number of vascular segments involved in non recurrent group was 3.5(1-8).The correlation between the number of vascular segments involved and recurrence was analyzed.The results were statistically significant(P = 0.039),indicating that the more the number of vascular segments involved in CNS vasculitis,the more prone to recurrence.Conclusion:1.The incidence of CNS vasculitis is higher in young patients than in women.When young patients without cerebrovascular risk factors have ischemic stroke,CNS vasculitis should be included in the differential diagnosis of etiology.2.HR-MRI of CNS vasculitis often shows the image characteristics of multi vessel and multi-arterial segment involvement.The wall of the involved vessel is uniformly thickened to the heart,and the vessel wall is often accompanied with grade 2 enhancement,a few grade 1 enhancement.3.CNS vasculitis is more likely to involve anterior circulation vessels,especially internal carotid artery and middle cerebral artery.4.hormone is effective in the treatment of CNS vasculitis,and HR-MRI is helpful to evaluate the effect.5.The number of involved vascular segments(6.4 arterial segments on average)in the recurrent group was higher than that in the non recurrent group(3.6 arterial segments on average),suggesting that the more vascular segments involved,the more likely to relapse after hormone therapy.