Although angiographic diagnosis continues to be accepted by some authors [104], other authors have proposed diagnostic criteria that do not accept diagnosis based on angiography and require histology from biopsy or autopsy [105]. With a strong clinical suspicion, brain imaging is important for supporting the diagnostic process and directing biopsy [99,106]. Imaging examinations with CNS vasculitis demonstrate numerous nonspecific findings, such as infarcts, white matter injury, mass lesions, meningeal enhancement, or hemorrhage. Characteristic vessel imaging findings, though not always present on histologically proven cases, include multifocal stenosis and dilatation of the intracranial vasculature as well as characteristic pattern of vessel wall inflammation [107]. Many of the imaging features overlap with other cerebrovascular diseases, such as reversible cerebral vasoconstriction syndrome or atherosclerotic disease. Arteriography Cervicocerebral Cerebral arteriography has long been the standard in imaging diagnosis of CNS vasculitis due to its submillimeter resolution. However, cerebral angiography has low specificity for vasculitis given significant overlap of findings with other cerebrovascular diseases, such as atherosclerosis or reversible cerebral vasoconstriction syndrome, and limited sensitivity as the degree of vascular involvement can be below angiography resolution [99,107]. CT Head Perfusion There is no relevant literature to support the use of CT head perfusion in the initial imaging for suspected CNS vasculitis. CT Head There is no relevant literature to support the use of CT head in the initial imaging for suspected CNS vasculitis. CTA Head CTA head can characterize intracranial vessel luminal characteristics with limited resolution and evaluation of the distal small arteries.
Cerebrovascular Diseases Aneurysm Vascular Malformation and Subarachnoid Hemorrhage PCAs. Although angiographic diagnosis continues to be accepted by some authors [104], other authors have proposed diagnostic criteria that do not accept diagnosis based on angiography and require histology from biopsy or autopsy [105]. With a strong clinical suspicion, brain imaging is important for supporting the diagnostic process and directing biopsy [99,106]. Imaging examinations with CNS vasculitis demonstrate numerous nonspecific findings, such as infarcts, white matter injury, mass lesions, meningeal enhancement, or hemorrhage. Characteristic vessel imaging findings, though not always present on histologically proven cases, include multifocal stenosis and dilatation of the intracranial vasculature as well as characteristic pattern of vessel wall inflammation [107]. Many of the imaging features overlap with other cerebrovascular diseases, such as reversible cerebral vasoconstriction syndrome or atherosclerotic disease. Arteriography Cervicocerebral Cerebral arteriography has long been the standard in imaging diagnosis of CNS vasculitis due to its submillimeter resolution. However, cerebral angiography has low specificity for vasculitis given significant overlap of findings with other cerebrovascular diseases, such as atherosclerosis or reversible cerebral vasoconstriction syndrome, and limited sensitivity as the degree of vascular involvement can be below angiography resolution [99,107]. CT Head Perfusion There is no relevant literature to support the use of CT head perfusion in the initial imaging for suspected CNS vasculitis. CT Head There is no relevant literature to support the use of CT head in the initial imaging for suspected CNS vasculitis. CTA Head CTA head can characterize intracranial vessel luminal characteristics with limited resolution and evaluation of the distal small arteries.