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Imaging of the Neurovasculitides

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Neurovascular Imaging

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Abstract

Neurovasculitis is a term used to describe a diverse spectrum of diseases characterized by inflammation of the blood vessels that may progress to ischemic injury of the central or peripheral nervous system. The overlapping clinical and radiographic features and the complex pathophysiology make it difficult to quickly or clearly identify neurovasculitis as the etiology of a patient’s symptoms. Nonetheless, simple yet comprehensive categorization schemes established by consensus meetings and based upon the anatomy, pathophysiology, and imaging findings help to clarify the situation. For both the radiologist and the treating clinician, a systemic approach considering the triad of organ systems involved, laboratory results, and vessel size and type affected simplifies the situation. Vessel size is particularly important for the radiologist to consider as it broadly categorizes the neurovasculitides within the differential diagnosis. Imaging plays an essential role in the diagnosis of these diseases and may be divided into those studies that investigate the vessel lumen, the vessel wall, and the parenchyma. Demonstration of the vessel wall or perivascular inflammatory change is a specific and compelling finding, which should be specifically pursued by the radiologist. All imaging modalities contribute to the analysis; conventional catheter angiography is no longer the preeminent diagnostic standard. Despite the uncommon occurrence of neurovasculitis, it is important to be familiar with these diseases. They play a particularly important role in the differential diagnosis of stroke in young and middle-aged adults and typically have devastating clinical consequences. If diagnosed early, they may be effectively treated, relieving symptoms and avoiding permanent central and peripheral neurologic damage.

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Abbreviations

ACA:

Anterior cerebral artery

CA:

Catheter angiography

CT:

Computed tomography

CTA:

Computed tomography angiography

FDG-PET:

18F-fluorodeoxyglucose positron emission tomography

GCA:

Giant cell arteritis

ICA:

Internal carotid artery

MCA:

Middle cerebral artery

MRA:

Magnetic resonance angiography

MRI:

Magnetic resonance imaging

PACNS:

Primary angiitis of the central nervous system

PCA:

Posterior cerebral artery

RCVS:

Reversible cerebral vasoconstrictive syndrome

SLE:

Systemic lupus erythematosus

TA:

Takayasu arteritis

US:

Ultrasound

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Authors and Affiliations

  1. Neuroradiology, Department of Radiology, NYU Langone Medical Center, New York, NY, USA

    Adam J. Davis

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  1. Adam J. Davis
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Correspondence to Adam J. Davis .

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Editors and Affiliations

  1. Department of Radiology, AOU of Cagliari, Monserrato, Cagliari, Italy

    Luca Saba

  2. Neurointerventional Radiology Section, Department of Radiology, NYU Langone Medical Center, New York, NY, USA

    Eytan Raz

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Davis, A.J. (2016). Imaging of the Neurovasculitides. In: Saba, L., Raz, E. (eds) Neurovascular Imaging. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-9029-6_22

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  • DOI: https://doi.org/10.1007/978-1-4614-9029-6_22

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