Progressive confluent white matter lesions, cortical and subcortical T2 lesions, multiple microhemorrhages, large single or multiple enhancing mass lesions, and enhancing small vessels/perivascular spaces are also seen [105]. Although parenchymal abnormalities on MRI have considerable overlap with other CNS diseases, sensitivity of a normal MRI for CNS vasculitis approaches 100% [99,101]. Recent advances in MRI intracranial vessel wall imaging shows promise in helping to differentiate CNS vasculitis from other cerebrovascular diseases as inflammatory changes of the vessel wall differ between conditions, whereas luminal stenoses and dilations can overlap [99,107-109]. In a recent retrospective study, the addition of contrast- enhanced MRI vessel wall imaging to luminal imaging (DSA, CTA, or MRA) increased radiological diagnostic accuracy to 89% when compared with 36% in luminal imaging alone in differentiating among nonocclusive cerebrovascular diseases. In this study the reference standard was the clinical diagnosis, so it remains to be determined whether these findings have any clinical value [107]. MRV Head There is no relevant literature to support the use of MRV head in the initial imaging for suspected CNS vasculitis. US Duplex Doppler Carotid Artery There is no relevant literature to support the use of carotid artery US duplex Doppler in the initial imaging for suspected CNS vasculitis. US Duplex Doppler Transcranial There is no relevant literature to support the use of TCD in the initial imaging for suspected CNS vasculitis. CVD-Aneurysm, Vascular Malformation, and SAH Supporting Documents The evidence table, literature search, and appendix for this topic are available at https://acsearch. acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation.
Cerebrovascular Diseases Aneurysm Vascular Malformation and Subarachnoid Hemorrhage PCAs. Progressive confluent white matter lesions, cortical and subcortical T2 lesions, multiple microhemorrhages, large single or multiple enhancing mass lesions, and enhancing small vessels/perivascular spaces are also seen [105]. Although parenchymal abnormalities on MRI have considerable overlap with other CNS diseases, sensitivity of a normal MRI for CNS vasculitis approaches 100% [99,101]. Recent advances in MRI intracranial vessel wall imaging shows promise in helping to differentiate CNS vasculitis from other cerebrovascular diseases as inflammatory changes of the vessel wall differ between conditions, whereas luminal stenoses and dilations can overlap [99,107-109]. In a recent retrospective study, the addition of contrast- enhanced MRI vessel wall imaging to luminal imaging (DSA, CTA, or MRA) increased radiological diagnostic accuracy to 89% when compared with 36% in luminal imaging alone in differentiating among nonocclusive cerebrovascular diseases. In this study the reference standard was the clinical diagnosis, so it remains to be determined whether these findings have any clinical value [107]. MRV Head There is no relevant literature to support the use of MRV head in the initial imaging for suspected CNS vasculitis. US Duplex Doppler Carotid Artery There is no relevant literature to support the use of carotid artery US duplex Doppler in the initial imaging for suspected CNS vasculitis. US Duplex Doppler Transcranial There is no relevant literature to support the use of TCD in the initial imaging for suspected CNS vasculitis. CVD-Aneurysm, Vascular Malformation, and SAH Supporting Documents The evidence table, literature search, and appendix for this topic are available at https://acsearch. acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation.