Intracranial black-blood vessel wall magnetic resonance imaging: Initial clinical experience in a single-center study

Objective: To assess the adjunct value of high-resolution black-blood vessel wall MR (VW-MR) imaging in the context of ischemic stroke and other vascular diseases in the clinical practice. Methods: All patients with vascular abnormalities underwent MR on a 3T system. In addition to the conventional clinical scans, VW-MR imaging was performed by the volume isotropic turbo spin-echo acquisition (VISTA). Typical imaging parameters were: isotropic voxel size 0.35 × 0.35 × 0.35 mm³. VW-MR findings in adjunction to MR angiography were reviewed by two neuroradiologists and presented as case series to compare with the final diagnosis based on the clinical data. Results: 14 patients were recruited within 12 months, among which 12 completed MR scans. The final diagnoses included 6 cases of atherosclerotic plaque, 4 cases of aneurysm, 1 case of Takayasu vasculitis, and 1 case dissection. In general, VW-MR imaging before and after gadolinium allowed successful detection of vasculitis with circumferential smooth and thick enhancement, as well as active plaque with eccentric enhancement. Reasonable interpretation could be made for clot and thrombus with careful inspection of the clinical context. Signal void artifact could be observed in post coiling and stent placement arteries. Dark signal was also demonstrated in heavily calcified aneurysmal wall. Conclusion: Despite relatively small sample size, our preliminary study has demonstrated the useful adjunct information provided by VW-MR imaging for diagnosis and characterization of intracranial vascular diseases in the clinical practice. Pitfalls should be aware in certain cases and large cohort clinical studies are warranted to further evaluate its clinical value.