0:00

We're going to talk a little bit about

0:01

vessel wall imaging today.

0:03

These are images of a 64-year-old male

0:07

who had long standing hypertension

0:09

and multiple strokes.

0:11

And currently, this is the diffusion-weighted image

0:14

and this is the ADC map, FLAIR image,

0:18

SWI image,

0:19

and we're just going to go through the images.

0:20

And on the diffusion,

0:21

you can see there's a small little subacute infarct

0:25

in the right splenium of the corpus callosum,

0:28

and there's no other acute infarct,

0:31

but as you go through these other images,

0:32

he's got chronic infarcts in multiple

0:35

vascular territories.

0:36

He's got this chronic left ACA infarction,

0:40

and he's got chronic thalamic infarctions

0:46

and had multiple chronic infarctions.

0:49

And then if you look on the SWI,

0:51

he has these multiple foci of hemorrhage

0:55

in the thalami and one in the medial temporal lobe,

1:01

but predominantly in the thalami and basal ganglia.

1:05

So, it kind of looks like a hypertensive picture

1:08

with all these deep gray nuclei hemorrhages,

1:12

and a lot of white matter disease.

1:15

But anyway, so next we'll look at the MRA.

1:20

And on the MRA images,

1:23

you can see that there are multifocal stenosis

1:25

in the bilateral anterior cerebral arteries,

1:28

and a little bit in the right M1.

1:32

And you can see in the bilateral posterior

1:33

cerebral arteries, there are areas of narrowing.

1:36

There are areas of irregularity in the MCAs.

1:38

So, he's got multifocal intracranial vascular stenoses.

1:43

And we'll show it in another projection, too.

1:46

Again, you can see these severe stenoses

1:49

in the anterior cerebral arteries,

1:50

some in the posterior cerebral arteries.

1:53

So the question is,

1:55

is this atherosclerotic or is this vasculitis

2:01

or some other process?

2:03

So these are the vessel wall images.

2:07

And again,

2:08

they're high resolution T1 weighted images.

2:11

These are post contrast.

2:13

And we're just going to take a look at

2:14

some of the vessels.

2:15

The vertebral arteries,

2:16

they always enhance a little bit proximally.

2:20

Basilar artery is kind of small here.

2:22

It's a little hard to tell,

2:23

but when we start to look at the

2:26

supraclinoid internal carotid arteries

2:28

and the middle cerebral arteries,

2:30

you can see there's some eccentric enhancement.

2:32

Here you can see along the anterior wall

2:33

but not the posterior wall.

2:35

You can see the same thing on the other side

2:38

of the right MCA,

2:40

where you have this kind of multifocal

2:42

eccentric enhancement.

2:44

The posterior communicating artery has some

2:47

enhancement on the inferior aspect,

2:49

but not the superior aspect.

2:51

So, areas of multifocal enhancement

2:55

that appear asymmetric.

2:57

You can see it again in the

2:59

left anterior cerebral artery,

3:00

a little enhancement along the posterior wall,

3:02

but not the anterior wall.

3:04

Some of these vessels are just diffusely enhancing

3:06

because there's very slow flow.

3:08

Here's another ACA branch

3:10

that has eccentric enhancements.

3:11

So, this was thought to be intracranial

3:15

atherosclerotic disease

3:17

due to long standing hypertension.