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We're going to continue our talk

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about vessel wall imaging.

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This is a case of vasculitis.

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This is an 81-year-old male who had

0:09

known vasculitis from a previous biopsy.

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He came in with a seizure and you can

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see on these FLAIR images that there's

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some leptomeningeal FLAIR hyperintensity

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in the parietal lobe,

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and there's some leptomeningeal

0:25

enhancement on the gadolinium enhanced images.

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And again, we're just looking at that

0:28

sulcal FLAIR hyperintensity.

0:32

Some gadolinium enhancement and you can

0:34

see the same phenomenon along the left temporal lobe

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and the bilateral occipital lobes,

0:40

with some associated enhancement.

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Let me show you this SWI images.

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The patient also has some little peripheral

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foci of susceptibility that are just

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micro-hemorrhages, some larger areas

0:55

here in the right frontal lobe,

0:59

few in the right temporal lobe.

1:02

You can see additional foci.

1:03

So, some peripheral micro-hemorrhages and

1:07

this leptomeningeal process

1:09

which had previously been biopsied

1:12

and proven to be vasculitis.

1:14

So, the patient got better with steroids

1:17

and then came in several months later

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with some right-sided visual changes.

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And he had these images.

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You can see there's a right PCA infarction.

1:32

That's DWI, hyperintense,

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ADC, hypointense,

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FLAIR, hyperintense.

1:35

There's a little swelling,

1:36

so it's kind of subacute at this point.

1:39

Also involvement of the splenium of the corpus callosum

1:41

and the thalamus,

1:42

and then there's a lesion in the posterior

1:45

right corona radiata.

1:47

His previously seen leptomeningeal

1:50

process have resolved.

1:51

And again, you can see on the SWI,

1:54

you can see multiple peripheral

1:56

micro-hemorrhages that hadn't really

1:58

changed too much from the previous exam.

2:01

There were no new micro-hemorrhages.

2:03

So, we got an MRA.

2:08

You can see on the MRA that there's

2:11

cut off of the right PCA.

2:13

You can see there's some stenosis

2:15

in the left PCA.

2:16

There's some stenosis in the right MCA.

2:19

Some stenosis in the right internal

2:21

carotid artery. And that was the MRA.

2:25

Let me just show you,

2:28

clip it in the other direction,

2:30

again, the cutoff of a PCA.

2:31

So now on the right MCA,

2:33

some narrowing of the left P1 segment.

2:37

So, we got vessel wall imaging in this patient.

2:42

This is the vessel wall imaging.

2:45

So you'll note,

2:46

in the right vertebral artery,

2:48

there's concentric enhancement

2:49

completely surrounding the vessel.

2:53

And then as we go up,

2:55

that's all the way up the whole right vertebral artery,

2:58

and then...

2:59

And the supraclinoid internal carotid arteries,

3:02

there appears to be concentric enhancement.

3:03

It's a little bit hard to see in this plane,

3:07

so we can look at the coronal images.

3:09

And you can see there's concentric

3:12

enhancement of that right

3:14

internal carotid artery.

3:15

And to a lesser extent of the left

3:17

internal carotid artery.

3:18

So, those were the major findings and this

3:23

is consistent with concentric wall enhancement,

3:26

secondary to CNS vasculitis,

3:28

and obviously has a subacute PCA infarction.

3:35

I just wanted to show you the right PCA

3:37

is just diffusely enhancing just

3:39

because there's very slow flow

3:42

because of the clot in that location.