Rule Out (R/O) Vasculitis

Steven Thibodeau1, Ellen Grant1, Pamela W. Schaefer1

1 Massachusetts General Hospital, Boston, Massachusetts
Publication Name:  Current Protocols in Magnetic Resonance Imaging
Unit Number:  Unit A1.6
DOI:  10.1002/0471142719.mia0106s13
Online Posting Date:  May, 2005
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When imaging patients for vasculitis, the goals are: (1) to determine if there is evidence of acute or subacute cerebral injury and (2) to assess the contour of the major intracranial arteries. An additional but still experimental goal is (3) to determine if there are areas of altered perfusion that suggest active small vessel disease. Standard MR images and diffusion‐weighted imaging are used to detect and determine the age of parenchymal lesions. The 3‐D TOF MRA helps evaluate the large and medium vessels. Perfusion‐weighted imaging may detect regions of altered relative blood flow and blood volume. This unit contains a basic protocol for the evaluation of stable patients as well as an alternative protocol for unstable patients.

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Table of Contents

  • Basic Protocol 1: Standard Imaging for Vasculitis
  • Alternate Protocol 1: Rapid Assessment for Altered Perfusion and Acute Ischemic Injury
  • Commentary
  • Literature Cited
  • Tables
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Basic Protocol 1: Standard Imaging for Vasculitis

  • Gadolinium‐DTPA contrast agent (e.g., Manevist, Omniscan, Prohance)
  • Normal saline (0.9% NaCl), sterile
  • Injection pump
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Literature Cited

Literature Cited
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   Duna, G.F. and Calabrese, L.H. 1995. Limitations of invasive modalities in the diagnosis of primary angiitis of the central nervous system. J. Rheumatol. 22:662‐667.
   Greenan, T.J., Grossman, R.I., and Goldberg, H.I. 1992. Cerebral vasculitis: MR imaging and angiographic correlation. Radiology 182:65‐72.
   Harris, K.G., Tran, D.D., Sickels, W.J., Cornell, S.H., and Yuh, W.T. 1994. Diagnosing intracranial vasculitis: The roles of MR and angiography. A.J.N.R. Am. J. Neuroradiol. 15:317‐330.
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   Joelson, E., Ruthrauff, B., Ali, F., Lindeman, N., and Sharp, F.R. 2000. Multifocal dural enhancement associated with temporal arteritis. Arch. Neurol. 57:119‐122.
   Pomper, M.G., Miller, T.J., Stone, J.H., Tidmore, W.C., and Hellmann, D.B. 1999. CNS vasculitis in autoimmune disease: MR imaging findings and correlation with angiography. A.J.N.R. Am. J. Neuroradiol. 20:75‐85.
   Shellock, F.G. 1996. Pocket Guide to MR Procedures and Metallic Objects. Lippincott‐Raven, Philadelphia.
   Yuh, W.T., Ueda, T., Maley, J.E., Quets, J.P., White, M., Hahn, P.Y., and Otake, S. 1999a. Diagnosis of microvasculopathy in CNS vasculitis: Value of perfusion and diffusion imaging. J. Magn. Reson. Imaging 10:310‐313.
   Yuh, W.T., Ueda, T., and Maley, J.E. 1999b. Perfusion and diffusion imaging: A potential tool for improved diagnosis of CNS vasculitis. A.J.N.R. Am. J. Neuroradiol. 20:87‐89.
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