Vessel Wall MRI for Targeting Biopsies of Intracranial Vasculitis

High-resolution vessel wall MR imaging protocol for identifying a surgical target in a 33-year-old man with suspected intracranial vasculitis. A coronal reconstruction of a 3D-VWMRI sequence (acquired resolution, 0.5 mm isotropic, A) shows evidence of vasculitis, including circumferential enhancement and thickening of the wall of a small branch of the right MCA (white arrowhead) and of small cortical veins (arrow). The right frontal cortical vein (white arrow), confirmed to be a vein on the venous phase of the contrast-enhanced MRA (B), was selected as the target. Note that the vessel is identified on the 3D echo-spoiled gradient-echo sequence (C, arrow) acquired for surgical navigation but does not appear abnormal (D and E). Hematoxylin-eosin-stained biopsy section shows significant transmural inflammation (arrows) of the blood vessel wall. The lumen is indicated by asterisks.