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### Selected Images
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**Dolichoectasia**
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*Axial CT shows fusiform dilatation and tortuosity of the basilar artery <img src='img/arrows/CS.png'/> in an octogenarian related to dolichoectasia. Fusiform dolichoectasia is a common finding in the vertebrobasilar arteries in older patients.*
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**Dolichoectasia**
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*Axial CT shows fusiform dilatation and tortuosity of the basilar artery <img src='img/arrows/CS.png'/> in an octogenarian related to dolichoectasia. Fusiform dolichoectasia is a common finding in the vertebrobasilar arteries in older patients.*
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**Dolichoectasia**
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*Axial CT shows fusiform dilatation and tortuosity of the basilar artery <img src='img/arrows/CS.png'/> in an octogenarian related to dolichoectasia. Fusiform dolichoectasia is a common finding in the vertebrobasilar arteries in older patients.*
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**Atherosclerotic Fusiform Aneurysm**
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*Coronal CTA shows fusiform dilatation <img src='img/arrows/CS.png'/> of the right supraclinoid internal carotid artery (ICA). Irregularity from atherosclerotic disease can be seen of the M1 segment of the middle cerebral artery <img src='img/arrows/CO.png'/>. No significant mural thrombus was noted in this fusiform aneurysm.*
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**Dissecting Aneurysm/Pseudoaneurysm**
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*Dissecting pseudoaneurysm in the V4 segment of the right vertebral artery seen on 3D TOF MRA <img src='img/arrows/WS.png'/>, T2 <img src='img/arrows/BS.png'/>, and T1 pre- <img src='img/arrows/CS.png'/> and post <img src='img/arrows/CO.png'/> DANTE VWI sequences shows peripheral enhancement, suggestive of instability.*
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@@ -143,7 +139,7 @@ breadcrumbs:
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**Ehlers-Danlos**
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*3D MIP MRA of the vertebrobasilar arteries in a teenage female with a history of type 4 Ehlers-Danlos shows fusiform dilatation of the vertebral artery <img src='img/arrows/CS.png'/>. The affected gene is COL3A1, and this specific type of Ehlers-Danlos has a higher risk of aneurysm and vascular rupture.*
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**Marfan Syndrome**
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*Axial MIP from CT arteriography shows fusiform dilatation of the left middle cerebral artery bifurcation <img src='img/arrows/CS.png'/> in this child with a history of Marfan syndrome.*
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@@ -151,34 +147,34 @@ breadcrumbs:
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**Familial Thoracic Aneurysm &/or Dissection**
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*Coronal MIP reformat from CT arteriography shows bilateral fusiform aneurysms of supraclinoid ICAs <img src='img/arrows/CS.png'/>. This patient also had thoracic aortic aneurysm, which is consistent with familial thoracic aortic aneurysm and dissection and is associated with a mutation of ACTA2. This gene is responsible for a component of vascular smooth muscle.*
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**HIV Infection**
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*Axial T2WI MR shows strikingly enlarged middle cerebral arteries <img src='img/arrows/CS.png'/> in this child with congenital HIV/AIDS (an uncommon but well-recognized cause of pediatric fusiform arteriopathy). The stroke-like presentations of HIV infection may relate to vasculopathies, including large-vessel aneurysmal vasculopathy.*
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**Giant Serpentine Aneurysm**
|
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*Axial NECT demonstrates a giant serpentine aneurysm in the basilar artery <img src='img/arrows/WC.png'/> with associated mural thrombus <img src='img/arrows/CC.png'/> seen on sagittal CTA.*
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### Additional Images
|
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|
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|
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**Dolichoectasia**
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*Sagittal T1WI MR shows an elongated basilar artery with a slow-flow, thickened wall <img src='img/arrows/WS.png'/>. The apex of the tortuous basilar artery indents the hypothalamus, 3rd ventricle <img src='img/arrows/WO.png'/>.*
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|
||||
|
||||
|
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**Dolichoectasia**
|
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*Axial T2WI MR shows an elongated, tortuous basilar artery with a thickened arterial wall <img src='img/arrows/BS.png'/>, typical for atherosclerosis-associated fusiform ectasia.*
|
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|
||||
|
||||
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**Atherosclerotic Fusiform Aneurysm**
|
||||
*Lateral angiography shows a large fusiform middle cerebral artery aneurysm <img src='img/arrows/BS.png'/> that extends into smaller, more distal branches <img src='img/arrows/BO.png'/>. This is an unusual example because of the location (ICA, middle cerebral artery).*
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**Nonaneurysmal Dissection**
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*Axial T1WI MR shows an enlarged right vertebral artery with high signal intensity <img src='img/arrows/WS.png'/> as well as an absent flow void of the left vertebral artery <img src='img/arrows/WC.png'/>.*
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|
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|
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|
||||
**Ehlers-Danlos Syndrome**
|
||||
*Anteroposterior oblique view of the left vertebral angiogram shows focal elongations and widening of the basilar artery <img src='img/arrows/BS.png'/> in a 6-year-old child with Ehlers-Danlos type 4.*
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@@ -186,7 +182,7 @@ breadcrumbs:
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**Giant Serpentine Aneurysm**
|
||||
*Axial MRA submentovertex view shows an unusual nonatherosclerotic giant serpentine fusiform aneurysm. The patent channel <img src='img/arrows/WS.png'/> lies within the clot in the partially thrombosed <img src='img/arrows/WO.png'/> lumen.*
|
||||
|
||||
|
||||
|
||||
**Atypical Saccular Aneurysm**
|
||||
*Lateral angiography in 30-year-old man with a subarachnoid hemorrhage shows an elongated, bizarre-appearing, multilobulated aneurysm <img src='img/arrows/BS.png'/> with long aspect ratio, tit-like projections.*
|
||||
|
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|
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+201
@@ -0,0 +1,201 @@
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||||
---
|
||||
title: "Hyperattenuating (\"Dense\") Artery"
|
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docid: "70b5e153-27a5-4871-aaf3-0942c49f02e0"
|
||||
authors:
|
||||
- key: "2bca6b86-1eca-4e93-b997-4e18913686a7"
|
||||
value: "Hediyeh Baradaran, MD, MS"
|
||||
- key: "7cc3ba75-2642-4233-b9f6-0ce69ffe28f3"
|
||||
value: "Sheri L. Harder, MD, FRCPC"
|
||||
- key: "8d5254e9-8dda-478b-8f08-bdee97a32c79"
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value: "Karen L. Salzman, MD, FACR"
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breadcrumbs:
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-
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name: "Brain"
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slug: "brain"
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treeNodeId: "6d8829f1-14d7-45af-8675-255189aa526a"
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-
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name: "Differential Diagnosis"
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slug: "differential-diagnosis"
|
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treeNodeId: "a7fdd139-664e-4bb8-8d18-400e4733ff60"
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-
|
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name: "Arteries"
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slug: "arteries"
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treeNodeId: "f5fee8ee-062f-41f2-b449-efcca9fb78f9"
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-
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name: "Modality-Specific Imaging Findings"
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slug: "modality-specific-imaging-findings"
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treeNodeId: "369f11e2-7476-4e44-89b6-0a28c866b3e9"
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-
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name: "Hyperattenuating (\"Dense\") Artery"
|
||||
slug: "hyperattenuating-dense-artery"
|
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treeNodeId: null
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category: "Brain"
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documentVersionId: "26d80075-82d0-4b92-b0c7-f1b0e5fbf5da"
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imageCount: 19
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lastUpdated: "02/07/23"
|
||||
pageDescription: "Hyperattenuating (\"Dense\") Artery"
|
||||
pageKeywords: "Brain, Differential Diagnosis, Arteries, Modality-Specific Imaging Findings, Hyperattenuating (\"Dense\") Artery"
|
||||
pageTitle: "Hyperattenuating (\"Dense\") Artery | STATdx"
|
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enhancedTitle: "Hyperattenuating ("Dense") Artery"
|
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type: "DDX"
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references: true
|
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breadcrumbs:
|
||||
- "Brain"
|
||||
- "Differential Diagnosis"
|
||||
- "Arteries"
|
||||
- "Modality-Specific Imaging Findings"
|
||||
- "Hyperattenuating (\"Dense\") Artery"
|
||||
---
|
||||
# ESSENTIAL INFORMATION
|
||||
|
||||
- ## Key Differential Diagnosis Issues
|
||||
|
||||
|
||||
- Presence, localization of focal neurologic findings important
|
||||
- High hematocrit/hemoconcentration can mimic dense middle cerebral artery (MCA) sign
|
||||
- Compare to other intracranial vessels!
|
||||
- Diffuse low-density brain (anoxia, etc.) makes all vessels appear hyperdense, mimics thrombus or subarachnoid hemorrhage
|
||||
- ## Helpful Clues for Common Diagnoses
|
||||
|
||||
|
||||
- **Physiologic****H****yperdensity**
|
||||
- Circulating blood in arteries normally slightly hyperdense to brain: Especially prominent in newborns with unmyelinated, hypodense brain
|
||||
- Diffuse cerebral edema makes vessels appear hyperdense (false dense MCA sign)
|
||||
- **Cerebral****I****schemia-Infarction, Acute**
|
||||
- Acute thrombus in affected vessel (e.g., true dense MCA sign)
|
||||
- Acute clot undergoes time-dependent decrease in density within first 5 hours after stroke onset
|
||||
- **Recent IV Contrast Administration**
|
||||
- History of prior imaging exam; more common and longer lasting in patients with renal clearance impairment
|
||||
- ## Helpful Clues for Less Common Diagnoses
|
||||
|
||||
|
||||
- **Atherosclerosis, Intracranial**
|
||||
- ASVD with microcalcifications can mimic "dense" MCA
|
||||
- **Polycythemia**
|
||||
- All vessels (arteries, veins, dural sinuses) become hyperdense in polycythemia
|
||||
- Can be physiologic (elevated hematocrit in newborns, high altitude, etc.)
|
||||
- Numerous pathologic causes (cyanotic congenital heart disease, COPD, etc.)
|
||||
- **Fusiform Aneurysm (ASVD, Non-ASVD)**
|
||||
- Vertebrobasilar > anterior circulation
|
||||
- Thickened walls may appear hyperdense
|
||||
- Non-ASVD: Younger; inherited vasculopathy, immune disorder
|
||||
- **Dissection**
|
||||
- Most posterior circulation
|
||||
- Trauma most common etiology
|
||||
- **Pseudoaneurysm**
|
||||
- Trauma most common etiology
|
||||
- ## Helpful Clues for Rare Diagnoses
|
||||
|
||||
|
||||
- **Devices and Complications**
|
||||
- Coils, balloons, stents, methacrylate, etc.
|
||||
- Embolized foreign bodies, calcified atheromata can cause hyperattenuating vessel sign
|
||||
|
||||
## References
|
||||
|
||||
# Selected References
|
||||
|
||||
1. [Figurelle ME et al: Viz.ai Implementation of stroke augmented intelligence and communications platform to improve indicators and outcomes for a comprehensive stroke center and network. AJNR Am J Neuroradiol. 44(1):47-53, 2023](http://www.ncbi.nlm.nih.gov/pubmed/?term=36574318%5Bpmid%5D)
|
||||
1. [Legrand L et al: FLAIR vascular hyperintensities as a surrogate of collaterals in acute stroke: DWI matters. AJNR Am J Neuroradiol. 44(1):26-32, 2023](http://www.ncbi.nlm.nih.gov/pubmed/?term=36521962%5Bpmid%5D)
|
||||
1. [Lu SS et al: Automated estimation of quantitative lesion water uptake as a prognostic biomarker for patients with ischemic stroke and large-vessel occlusion. AJNR Am J Neuroradiol. 44(1):33-9, 2023](http://www.ncbi.nlm.nih.gov/pubmed/?term=36549850%5Bpmid%5D)
|
||||
1. [Derraz I et al: Impact of white matter hyperintensity burden on outcome in large-vessel occlusion stroke. Radiology. 304(1):145-52, 2022](http://www.ncbi.nlm.nih.gov/pubmed/?term=35348382%5Bpmid%5D)
|
||||
1. [DiBella EVR et al: Beyond diffusion tensor MRI methods for improved characterization of the brain after ischemic stroke: a review. AJNR Am J Neuroradiol. 43(5):661-9, 2022](http://www.ncbi.nlm.nih.gov/pubmed/?term=35272983%5Bpmid%5D)
|
||||
1. [Fukutomi H et al: Location-weighted versus volume-weighted mismatch at MRI for response to mechanical thrombectomy in acute stroke. Radiology. ePub, 2022](http://www.ncbi.nlm.nih.gov/pubmed/?term=36194114%5Bpmid%5D)
|
||||
1. [Grand T et al: Benefit of mechanical thrombectomy in acute ischemic stroke related to calcified cerebral embolus. J Neuroradiol. 49(4):317-23, 2022](http://www.ncbi.nlm.nih.gov/pubmed/?term=35183595%5Bpmid%5D)
|
||||
1. [Regenhardt RW et al: Symmetric CTA Collaterals Identify Patients With Slow-progressing Stroke Likely To Benefit From Late Thrombectomy. Radiology. 302(2):400-7, 2022](http://www.ncbi.nlm.nih.gov/pubmed/?term=34726532%5Bpmid%5D)
|
||||
1. [Zhou Y et al: CT hyperdense artery sign and the effect of alteplase in endovascular thrombectomy after acute stroke. Radiology. 305(2):410-8, 2022](http://www.ncbi.nlm.nih.gov/pubmed/?term=35819327%5Bpmid%5D)
|
||||
1. [Heo JH et al: Computed tomography-based thrombus imaging for the prediction of recanalization after reperfusion therapy in stroke. J Stroke. 19(1):40-9, 2017](http://www.ncbi.nlm.nih.gov/pubmed/?term=28178411%5Bpmid%5D)
|
||||
1. [López-Cuevas R et al: Downstream migration and fragmentation of a spontaneous calcific embolus after thrombolysis in a patient with ischemic stroke. J Stroke Cerebrovasc Dis. 25(10):e165-6, 2016](http://www.ncbi.nlm.nih.gov/pubmed/?term=27499273%5Bpmid%5D)
|
||||
1. [Pikija S et al: Intracranial thrombus morphology and composition undergoes time-dependent changes in acute ischemic stroke: a CT densitometry study. Int J Mol Sci. 17(11), 2016](http://www.ncbi.nlm.nih.gov/pubmed/?term=27886084%5Bpmid%5D)
|
||||
1. [Walker BS et al: Calcified cerebral emboli, a "do not miss" imaging diagnosis: 22 new cases and review of the literature. AJNR Am J Neuroradiol. 35(8):1515-9, 2014](http://www.ncbi.nlm.nih.gov/pubmed/?term=24651819%5Bpmid%5D)
|
||||
1. [Christian BA et al: Showered calcific emboli to the brain, the 'salted pretzel' sign, originating from the ipsilateral internal carotid artery causing acute cerebral infarction. Stroke. 40(5):e319-21, 2009](http://www.ncbi.nlm.nih.gov/pubmed/?term=19286589%5Bpmid%5D)
|
||||
|
||||
|
||||
## Images
|
||||
|
||||
|
||||
### Selected Images
|
||||
|
||||
|
||||
**Physiologic Hyperdensity**
|
||||
*Axial NECT shows a hyperdense middle cerebral artery (MCA) <img src='img/arrows/CS.png'/> and basilar arteries <img src='img/arrows/CO.png'/> in this patient with dehydration. Typically, the circle of Willis arteries are mildly hyperdense compared with normal brain parenchyma. Vessels become prominent in normal newborns with unmyelinated, hypodense brain.*
|
||||
|
||||
|
||||
**Physiologic Hyperdensity**
|
||||
*Axial NECT shows a hyperdense middle cerebral artery (MCA) <img src='img/arrows/CS.png'/> and basilar arteries <img src='img/arrows/CO.png'/> in this patient with dehydration. Typically, the circle of Willis arteries are mildly hyperdense compared with normal brain parenchyma. Vessels become prominent in normal newborns with unmyelinated, hypodense brain.*
|
||||
|
||||
|
||||
**Physiologic Hyperdensity**
|
||||
*Axial NECT shows bilateral dense MCA signs <img src='img/arrows/CS.png'/> and ↑ density in venous structures in an anoxic patient with diffuse cerebral edema. Low-density brain makes the normal vascular structures appear hyperdense.*
|
||||
|
||||
|
||||
**Cerebral Ischemia-Infarction, Acute**
|
||||
*Axial NECT shows ↑ density in the left MCA <img src='img/arrows/CO.png'/> (dense MCA sign) in a patient with acute right-sided symptoms. The density is from acute thrombus within the vessel. Note the associated loss of gray-white differentiation in the MCA territory <img src='img/arrows/BO.png'/>.*
|
||||
|
||||
|
||||
**Cerebral Ischemia-Infarction, Acute**
|
||||
*Axial NECT in the same patient 48 hours later shows a large left MCA distribution infarct <img src='img/arrows/CS.png'/> with hemorrhagic transformation <img src='img/arrows/WO.png'/>. Infarct in the basal ganglia indicates involvement of lenticulostriate arteries, which typically arise from the proximal MCA.*
|
||||
|
||||
|
||||
**Cerebral Ischemia-Infarction, Acute**
|
||||
*Axial NECT shows ↑ density related to a dot sign in a distal left MCA branch <img src='img/arrows/CS.png'/>, representing acute thrombus. Hypodensity related to early infarct is seen in the adjacent brain parenchyma.*
|
||||
|
||||
|
||||
**Atherosclerosis, Intracranial**
|
||||
*Axial NECT shows calcification in the supraclinoid internal carotid arteries <img src='img/arrows/BS.png'/>, a common location for intracranial atherosclerosis. Intracranial atherosclerosis is associated with atherosclerosis of the carotids, coronaries, aorta, renal arteries, and iliofemoral system.*
|
||||
|
||||
|
||||
**Fusiform Aneurysm (ASVD, Non-ASVD)**
|
||||
*Axial NECT shows a large, hyperdense basilar artery <img src='img/arrows/CO.png'/> related to a fusiform aneurysm. Atherosclerotic calcification and hyperdensity is also present in the proximal left MCA <img src='img/arrows/WS.png'/>.*
|
||||
|
||||
|
||||
**Devices and Complications**
|
||||
*Axial NECT shows embolized hyperdense material <img src='img/arrows/WS.png'/> in the left MCA in an IV drug abuser, possibly secondary to talc powder. Adjacent hypodense parenchyma <img src='img/arrows/CS.png'/> is related to a subacute infarct.*
|
||||
|
||||
|
||||
### Additional Images
|
||||
|
||||
|
||||
**Physiologic Hyperdensity**
|
||||
*Axial NECT demonstrates relatively hyperdense internal carotid arteries <img src='img/arrows/WS.png'/> in this neonate. Note the corresponding ↑ density of the transverse sinuses <img src='img/arrows/WC.png'/>.*
|
||||
|
||||
|
||||
**Physiologic Hyperdensity**
|
||||
*Axial NECT shows false dense MCA sign in a patient with diffuse cerebral edema. Low-density brain makes normal MCA <img src='img/arrows/WS.png'/> and cerebellum <img src='img/arrows/WO.png'/> appear hyperdense.*
|
||||
|
||||
|
||||
**Cerebral Ischemia-Infarction, Acute**
|
||||
*Axial NECT suggests increased linear density in the left sylvian branches <img src='img/arrows/WS.png'/>, more evident when compared to the normal appearing right-sided branches <img src='img/arrows/WC.png'/>.*
|
||||
|
||||
|
||||
**Fusiform Aneurysm (ASVD, Non-ASVD)**
|
||||
*Axial NECT shows extensive calcification in the internal carotid and MCS <img src='img/arrows/BS.png'/> and a dilated hyperdense basilar artery with peripheral calcification <img src='img/arrows/BO.png'/>.*
|
||||
|
||||
|
||||
**Fusiform Aneurysm (ASVD, Non-ASVD)**
|
||||
*Axial NECT shows a nonatherosclerotic fusiform aneurysm of the MCA with a lobulated hyperdense mass seen in the left sylvian fissure <img src='img/arrows/WS.png'/>.*
|
||||
|
||||
|
||||
**Pseudoaneurysm**
|
||||
*Axial NECT shows a hyperdense lesion <img src='img/arrows/WS.png'/> in the region of the cavernous sinus representing a large pseudoaneurysm in this 31-year-old man with a remote history of skull base fracture.*
|
||||
|
||||
|
||||
**Pseudoaneurysm**
|
||||
*Axial CTA in the same patient reveals communication with the right internal carotid artery <img src='img/arrows/WS.png'/>.*
|
||||
|
||||
|
||||
**Devices and Complications**
|
||||
*Axial NECT shows a coil <img src='img/arrows/WS.png'/> in the left internal carotid artery.*
|
||||
|
||||
|
||||
**Polycythemia**
|
||||
*Axial NECT shows hyperdense arteries <img src='img/arrows/WS.png'/> as well as veins and dural sinuses <img src='img/arrows/WO.png'/> in a patient with markedly elevated hematocrit. Polycythemia can mimic a CECT scan but vessels are usually not as dense.*
|
||||
|
||||
|
||||
**Dissection**
|
||||
*Axial NECT shows high-density thrombus in the internal carotid artery <img src='img/arrows/WC.png'/> related to dissection of the left internal carotid artery just above the carotid bulb (not shown).*
|
||||
|
||||
|
||||
**Physiologic Hyperdensity**
|
||||
*Coronal NECT shows ↑ density in the vascular structures compatible with physiologic hyperdensity.*
|
||||
|
||||
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+320
@@ -0,0 +1,320 @@
|
||||
---
|
||||
title: "Multifocal Arterial Narrowing"
|
||||
docid: "761665cd-65e1-48e7-a539-1a5d7c148a6b"
|
||||
authors:
|
||||
- key: "2bca6b86-1eca-4e93-b997-4e18913686a7"
|
||||
value: "Hediyeh Baradaran, MD, MS"
|
||||
- key: "f6dcad15-b660-4243-a242-a9845c929101"
|
||||
value: "J. Scott McNally, MD, PhD"
|
||||
breadcrumbs:
|
||||
-
|
||||
name: "Brain"
|
||||
slug: "brain"
|
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treeNodeId: "6d8829f1-14d7-45af-8675-255189aa526a"
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-
|
||||
name: "Differential Diagnosis"
|
||||
slug: "differential-diagnosis"
|
||||
treeNodeId: "a7fdd139-664e-4bb8-8d18-400e4733ff60"
|
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-
|
||||
name: "Arteries"
|
||||
slug: "arteries"
|
||||
treeNodeId: "f5fee8ee-062f-41f2-b449-efcca9fb78f9"
|
||||
-
|
||||
name: "Anatomically Based Differentials"
|
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slug: "anatomically-based-differentials"
|
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treeNodeId: "9955b05e-9840-401a-b3da-4039f8b22a35"
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name: "Multifocal Arterial Narrowing"
|
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slug: "multifocal-arterial-narrowing"
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treeNodeId: null
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category: "Brain"
|
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documentVersionId: "c67290b9-b36e-40c7-8b42-406b9bfad39e"
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imageCount: 25
|
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lastUpdated: "02/22/23"
|
||||
pageDescription: "Multifocal Arterial Narrowing"
|
||||
pageKeywords: "Brain, Differential Diagnosis, Arteries, Anatomically Based Differentials, Multifocal Arterial Narrowing"
|
||||
pageTitle: "Multifocal Arterial Narrowing | STATdx"
|
||||
enhancedTitle: "Multifocal Arterial Narrowing"
|
||||
type: "DDX"
|
||||
references: true
|
||||
breadcrumbs:
|
||||
- "Brain"
|
||||
- "Differential Diagnosis"
|
||||
- "Arteries"
|
||||
- "Anatomically Based Differentials"
|
||||
- "Multifocal Arterial Narrowing"
|
||||
---
|
||||
# ESSENTIAL INFORMATION
|
||||
|
||||
- ## Key Differential Diagnosis Issues
|
||||
|
||||
|
||||
- **Clinical history major determinant of DDx (if available)**
|
||||
- **Arteriosclerotic vascular disease**(ASVD): Clinical history of uncontrolled diabetes, hypertension, hyperlipidemia, smoking
|
||||
- **Reversible cerebral vasoconstriction syndrome**(RCVS): Thunderclap headache and vasoactive drug use (cannabis, SSRI)
|
||||
- **Vasospasm**: Recent subarachnoid hemorrhage (SAH)
|
||||
- **Vasculitis**: Smoldering headache and CSF/systemic inflammatory markers
|
||||
- **Intravascular large B-cell lymphoma (IVL):** DDx excluded, progression despite treatment
|
||||
- **Effect of patient age on DDx**
|
||||
- **Middle-aged or older adults**
|
||||
- ASVD, vasculitis, RCVS
|
||||
- **Child or young adult**
|
||||
- Transient arteriopathy of young, moyamoya, inherited vasculopathy (e.g., Ehlers-Danlos), congenital infection (e.g., HIV vasculopathy)
|
||||
- **Is there hemorrhage?**
|
||||
- **Subarachnoid**→ RCVS, vasospasm, dissection, or pseudoaneurysm
|
||||
- **Parenchymal**→ vasculitis, RCVS, moyamoya, IVL
|
||||
- ## Helpful Clues for Common Diagnoses
|
||||
|
||||
|
||||
- **Atherosclerosis****, Intracranial**
|
||||
- **Location**
|
||||
- ASVD occurs in areas of flow reversal and oscillatory shear stress (e.g., bifurcations)
|
||||
- Proximal circle of Willis branches, vertebrobasilar, internal carotid arteries (ICAs)
|
||||
- **Lumen imaging of intracranial atherosclerosis**
|
||||
- Focal stenoses, lumen irregularities, elongation/ectasia
|
||||
- Stenosis measured by WASID criteria
|
||||
- CTA vs. 3D time-of-flight (TOF) MRA
|
||||
- CTA has slightly higher resolution than 3D TOF
|
||||
- 3D TOF can be limited in tortuous vessels with signal loss in inferiorly directed branches
|
||||
- 3D TOF MRA at 3T outperforms CTA in distal branches due to venous contamination
|
||||
- 3D TOF MIPs outperform CTA MIPs
|
||||
- **MR + CT**
|
||||
- High T2 signal → lipid/necrotic core (ASVD)
|
||||
- High T1 signal → intraplaque hemorrhage (less common)
|
||||
- Enhancement → unstable/active ASVD
|
||||
- Highly associated with acute territorial stroke; can persist for months
|
||||
- High repeat stroke risk despite medical therapy (15-30% per year)
|
||||
- Positive remodeling → outward bulging of vessel wall as compensatory response to plaque; may have little vessel narrowing on angiographic imaging
|
||||
- Calcification on CT/CTA → atherosclerosis
|
||||
- Most common cause of vessel narrowing ASVD, **not**vasculitis
|
||||
- ## Helpful Clues for Less Common Diagnoses
|
||||
|
||||
|
||||
- **Reversible Cerebral Vasoconstriction Syndrome**
|
||||
- **Etiology**
|
||||
- Spontaneous, related to vasoactive substances, postpartum state
|
||||
- **Lumen imaging**
|
||||
- Multifocal segmental narrowing, ± dilatations
|
||||
- **Vessel wall imaging**
|
||||
- No T2 signal, no or mild enhancement
|
||||
- **Vasospasm**
|
||||
- **Etiology**
|
||||
- Most common: Aneurysmal SAH
|
||||
- Less common: Trauma
|
||||
- **Lumen imaging**
|
||||
- Multifocal narrowing
|
||||
- **Vessel wall imaging**
|
||||
- No T2 signal, no or mild enhancement
|
||||
- **Vasculitis**
|
||||
- **Etiology**
|
||||
- Primary arteritis of CNS
|
||||
- Secondary vasculitis
|
||||
- Infectious
|
||||
- Autoimmune
|
||||
- **Lumen imaging**
|
||||
- Multifocal alternating stenoses, dilatations
|
||||
- **Vessel wall imaging**
|
||||
- T2 signal: None or mild
|
||||
- Wall enhancement: Positive, concentric
|
||||
- **Vasculopathy, Non-ASVD**
|
||||
- **Lumen imaging**
|
||||
- Fusiform or alternating areas of stenosis and dilatation, "beading"
|
||||
- Long, nonbranching vessel segments
|
||||
- **Vessel wall imaging**
|
||||
- Not well studied, likely active and inactive stages similar to ASVD
|
||||
- Younger patients
|
||||
- Vertebrobasilar > carotid
|
||||
- Inherited (e.g., Ehlers-Danlos) or acquired (e.g., viral)
|
||||
- **Dissection**
|
||||
- **Pathophysiology**
|
||||
- Can be traumatic or spontaneous, ± SAH
|
||||
- Often combined with pseudoaneurysm (dissecting pseudoaneurysm)
|
||||
- **Location**
|
||||
- Vertebral > > ICA
|
||||
- **Lumen imaging**
|
||||
- Lumen irregularity, ± dilation (pseudoaneurysm)
|
||||
- Reimage if dilation, risk of growth/rupture
|
||||
- **Vessel wall imaging**
|
||||
- T2 signal: Variable high signal, depends on age
|
||||
- T1 signal: High signal if subacute (~ 2-8 weeks old)
|
||||
- Wall enhancement: Avid if acute
|
||||
- **Pseudoaneurysm**
|
||||
- **Pathophysiology**
|
||||
- Lacks normal arterial wall layers, contained by adventitia or cavitated clot
|
||||
- Trauma, infection = common causes
|
||||
- Rapidly changes within hours or days, easily ruptures
|
||||
- **Location**
|
||||
- Can be peripheral location (distal to circle of Willis)
|
||||
- Often adjacent to skull base fractures or dura
|
||||
- e.g., dorsal variant ICA blister aneurysm
|
||||
- **Lumen imaging**
|
||||
- Often adjacent vessel segment irregular
|
||||
- Suspect pseudoaneurysm if broad-based bulge without neck
|
||||
- Look carefully for pseudoaneurysms in "angiogram-negative" SAH
|
||||
- ## Helpful Clues for Rare Diagnoses
|
||||
|
||||
|
||||
- **Intravascular Large B-Cell Lymphoma**
|
||||
- Consider after excluding other diagnoses
|
||||
- Often initial response with steroids with recrudescence of symptoms and progression of infarcts and hemorrhages
|
||||
- **Moyamoya**
|
||||
- Characteristic "puff of smoke" on DSA
|
||||
- Most often seen in children and young adults
|
||||
- **Radiation Vasculopathy**
|
||||
- Consider radiation vasculopathy if age-accelerated vessel narrowing/ASVD
|
||||
- History of prior radiation key
|
||||
- ## Other Essential Information
|
||||
|
||||
|
||||
- **Clinical management of intracranial atherosclerosis**
|
||||
- SAMPRIS trial: Intensive medical therapy superior to stenting
|
||||
- Recommended by SAMPRIS for symptomatic intracranial ASVD
|
||||
- Life coach, smoking cessation, dual antiplatelets, antihypertensive therapy, statins
|
||||
- Still had ~ 15% annual stroke risk
|
||||
- **Artifacts and limitations**
|
||||
- Motion degrades CTA, MRA, and vessel wall MR
|
||||
- Motion affects studies with longer acquisition times: Vessel wall MR > MRA > CTA
|
||||
- Motion degrades black blood vessel wall MR due to misregistration artifact ("ghosting" can mimic wall enhancement)
|
||||
- Pulsation artifact
|
||||
- Can obscure vessel narrowing on 3D TOF
|
||||
- Occurs in phase-encoding direction
|
||||
- Occluded vessels difficult to detect on CTA/MRA
|
||||
- T2 MR to troubleshoot (e.g., T2 SPACE)
|
||||
- CSF pulsation artifact may cause spin dephasing and mimic pathology (especially around distal basilar artery)
|
||||
- DANTE prepulse eliminates CSF pulsation artifact
|
||||
- Incomplete suppression of flowing contrast in black blood imaging
|
||||
- DANTE prepulse eliminates flowing contrast
|
||||
- DANTE T1 SPACE much higher signal:noise ratio and contrast:noise ratio than T1 SPACE alone
|
||||
- Slow-flow and entry slice phenomenon → T1 shortening may mimic thrombus
|
||||
- Venous contrast on CTA limits distal branch evaluation (3rd and 4th order)
|
||||
- 3D TOF MRA at 3T outperforms CTA in these areas
|
||||
|
||||
## References
|
||||
|
||||
# Selected References
|
||||
|
||||
1. [Culleton S et al: MRI detection of carotid intraplaque hemorrhage and postintervention cognition. AJNR Am J Neuroradiol. 43(12):1762-9, 2022](http://www.ncbi.nlm.nih.gov/pubmed/?term=36357151%5Bpmid%5D)
|
||||
1. [Larson AS et al: Nonstenotic carotid plaques and embolic stroke of undetermined source: a multimodality review. AJNR Am J Neuroradiol. ePub, 2022](http://www.ncbi.nlm.nih.gov/pubmed/?term=36549844%5Bpmid%5D)
|
||||
1. [McCarty JL et al: Ischemic infarction in young adults: a review for radiologists. Radiographics. 39(6):1629-48, 2019](http://www.ncbi.nlm.nih.gov/pubmed/?term=31589580%5Bpmid%5D)
|
||||
1. [Schaafsma JD et al: Diagnostic Impact of intracranial vessel wall MRI in 205 patients with ischemic stroke or TIA. AJNR Am J Neuroradiol. 40(10):1701-6, 2019](http://www.ncbi.nlm.nih.gov/pubmed/?term=31488500%5Bpmid%5D)
|
||||
1. [Mandell DM et al: Intracranial vessel wall MRI: principles and expert consensus recommendations of the American Society of Neuroradiology. AJNR Am J Neuroradiol. 38(2):218-29, 2017](http://www.ncbi.nlm.nih.gov/pubmed/?term=27469212%5Bpmid%5D)
|
||||
1. [Alexander MD et al: High-resolution intracranial vessel wall imaging: imaging beyond the lumen. J Neurol Neurosurg Psychiatry. 87(6):589-97, 2016](http://www.ncbi.nlm.nih.gov/pubmed/?term=26746187%5Bpmid%5D)
|
||||
1. [Lehman VT et al: Clinical interpretation of high-resolution vessel wall MRI of intracranial arterial diseases. Br J Radiol. 89(1067):20160496, 2016](http://www.ncbi.nlm.nih.gov/pubmed/?term=27585640%5Bpmid%5D)
|
||||
1. [Mossa-Basha M et al: Added value of vessel wall magnetic resonance imaging in the differentiation of moyamoya vasculopathies in a non-Asian Cohort. Stroke. 47(7):1782-8, 2016](http://www.ncbi.nlm.nih.gov/pubmed/?term=27272486%5Bpmid%5D)
|
||||
1. [Miller TR et al: Reversible cerebral vasoconstriction syndrome, part 1: epidemiology, pathogenesis, and clinical course. AJNR Am J Neuroradiol. 36(8):1392-9, 2015](http://www.ncbi.nlm.nih.gov/pubmed/?term=25593203%5Bpmid%5D)
|
||||
1. [Miller TR et al: Reversible cerebral vasoconstriction syndrome, part 2: diagnostic work-up, imaging evaluation, and differential diagnosis. AJNR Am J Neuroradiol. 36(9):1580-8, 2015](http://www.ncbi.nlm.nih.gov/pubmed/?term=25614476%5Bpmid%5D)
|
||||
1. [Mossa-Basha M et al: Multicontrast high-resolution vessel wall magnetic resonance imaging and its value in differentiating intracranial vasculopathic processes. Stroke. 46(6):1567-73, 2015](http://www.ncbi.nlm.nih.gov/pubmed/?term=25953365%5Bpmid%5D)
|
||||
|
||||
|
||||
## Images
|
||||
|
||||
|
||||
### Selected Images
|
||||
|
||||
|
||||
**Atherosclerosis, Intracranial**
|
||||
*MIP MRA shows multifocal stenoses <img src='img/arrows/CS.png'/>, characteristic for intracranial atherosclerosis, the most common cause of alternating stenoses and dilatations. Risk factors include diabetes, hypertension, hyperlipidemia, and smoking.*
|
||||
|
||||
|
||||
**Atherosclerosis, Intracranial**
|
||||
*MIP MRA shows multifocal stenoses <img src='img/arrows/CS.png'/>, characteristic for intracranial atherosclerosis, the most common cause of alternating stenoses and dilatations. Risk factors include diabetes, hypertension, hyperlipidemia, and smoking.*
|
||||
|
||||
|
||||
**Atherosclerosis, Intracranial**
|
||||
*CTA in the right middle cerebral artery (MCA) shows focal severe stenosis <img src='img/arrows/CS.png'/> with associated avid enhancement <img src='img/arrows/WS.png'/> on postcontrast vessel wall MR as well as T2 hyperintensity <img src='img/arrows/BS.png'/> in the vessel wall, consistent with active atherosclerotic plaque.*
|
||||
|
||||
|
||||
**Reversible Cerebral Vasoconstriction Syndrome**
|
||||
*NECT in a patient with RCVS shows vertex subarachnoid hemorrhage (SAH) <img src='img/arrows/WS.png'/>. There is no associated enhancement on MR T1 DANTE SPACE pre- <img src='img/arrows/CS.png'/> or post- <img src='img/arrows/CO.png'/> contrast. Typical presentation includes a thunderclap headache; history of vasoactive drug use is also common.*
|
||||
|
||||
|
||||
**Reversible Cerebral Vasoconstriction Syndrome**
|
||||
*DSA in the same patient shows multifocal narrowing <img src='img/arrows/BS.png'/> on the initial ICA injection. Following Verapamil injection, there is reversal of the multifocal narrowing <img src='img/arrows/CS.png'/> with a more normal caliber of the intracranial vasculature, compatible with RCVS.*
|
||||
|
||||
|
||||
**Vasospasm**
|
||||
*Lateral DSA shows a saccular aneurysm <img src='img/arrows/BO.png'/> and narrowed cortical vessels <img src='img/arrows/BS.png'/>, indicating a vasospasm caused by an aneurysmal SAH (aSAH).*
|
||||
|
||||
|
||||
**Vasospasm**
|
||||
*DWI MR in a traumatic brain injury patient shows SAH and right MCA vasospasm with acute infarct <img src='img/arrows/WS.png'/>. The right MCA proximal M2 is narrowed on 3D TOF MR <img src='img/arrows/WO.png'/>. No intrinsic MR T1 signal is seen on precontrast <img src='img/arrows/CS.png'/> image, and there is no enhancement on postcontrast <img src='img/arrows/CO.png'/> DANTE T1 SPACE, consistent with posttraumatic SAH-induced vasospasm.*
|
||||
|
||||
|
||||
**Vasculitis**
|
||||
*3D TOF MRA in a young patient with vasculitis and MCA stroke shows lumen irregularity of the right anterior circulation <img src='img/arrows/WS.png'/>. DSA confirms lumen findings <img src='img/arrows/BO.png'/> and more subtle right M2 MCA narrowing <img src='img/arrows/WO.png'/>. Avid wall enhancement is on DANTE T1 SPACE comparing pre- <img src='img/arrows/WC.png'/> (magnified <img src='img/arrows/CS.png'/>), vs. postcontrast <img src='img/arrows/CC.png'/> (magnified <img src='img/arrows/CO.png'/>).*
|
||||
|
||||
|
||||
**Vasculopathy, Non-ASVD**
|
||||
*MIP MRA in a drug user shows multifocal narrowing in the right MCA and anterior cerebral artery branches <img src='img/arrows/WS.png'/>, confirmed on DSA <img src='img/arrows/CS.png'/>, compatible with drug-induced vasculopathy.*
|
||||
|
||||
|
||||
**Dissection**
|
||||
*Axial T1 C+ FS MR in a patient with posterior circulation ischemic symptoms after severe deceleration injury shows both vertebral arteries markedly enlarged by subacute clot <img src='img/arrows/WS.png'/>. The right vertebral artery is completely thrombosed, while small residual lumen is seen on the left <img src='img/arrows/WO.png'/>.*
|
||||
|
||||
|
||||
**Pseudoaneurysm**
|
||||
*Right V4 vertebral artery pseudoaneurysm in a trauma patient with initial <img src='img/arrows/WS.png'/> and follow-up <img src='img/arrows/WO.png'/> 3D TOF MRA shows growth with 2 areas of dilation <img src='img/arrows/CO.png'/>, confirmed on angiography (DSA <img src='img/arrows/BS.png'/> and 3D <img src='img/arrows/CS.png'/>).*
|
||||
|
||||
|
||||
**Pseudoaneurysm**
|
||||
*Dorsal variant ICA pseudoaneurysm is shown on 3D TOF MRA <img src='img/arrows/WS.png'/> and DSA <img src='img/arrows/BO.png'/> with wall enhancement on MR T1 SPACE <img src='img/arrows/WO.png'/> and magnified views in bottom right.*
|
||||
|
||||
|
||||
**Intravascular Large B-Cell Lymphoma**
|
||||
*Biopsy-proven intravascular lymphoma with multifocal hemorrhages, infarcts, and surrounding edema <img src='img/arrows/WS.png'/> is shown on FLAIR, DTI, and SWI. DSA shows multifocal distal vessel lumen irregularity <img src='img/arrows/CS.png'/>. Vessel wall MR was negative. Intravascular large B-cell lymphoma is often a diagnosis of exclusion. Skin biopsy or brain biopsy is typically needed to make the diagnosis.*
|
||||
|
||||
|
||||
**Moyamoya**
|
||||
*Lateral DSA angiography shows tapered occlusion <img src='img/arrows/BS.png'/> of supraclinoid ICA with a tangle of "puff of smoke" lenticulostriate <img src='img/arrows/BO.png'/>, characteristic of moyamoya.*
|
||||
|
||||
|
||||
**Radiation Vasculopathy**
|
||||
*Axial DWI shows a recent infarct <img src='img/arrows/WS.png'/> superimposed on a FLAIR hyperintense <img src='img/arrows/BS.png'/>, remote right posterior cerebral artery (PCA) infarct with delayed MTT <img src='img/arrows/WO.png'/> in a patient with radiation vasculopathy. DSA shows severe right PCA narrowing with near occlusion <img src='img/arrows/CS.png'/> and contralateral PCA narrowing <img src='img/arrows/CO.png'/>.*
|
||||
|
||||
|
||||
### Additional Images
|
||||
|
||||
|
||||
**Vasculopathy, Non-ASVD**
|
||||
*Lateral angiography shows a posterior communicating ICA aneurysm with multiple lobulations <img src='img/arrows/BS.png'/> and an unusually long "aspect ratio." This atypical aneurysm is likely related to a vasculopathy.*
|
||||
|
||||
|
||||
**Pseudoaneurysm**
|
||||
*Lateral angiography in a patient with a skull base fracture and stroke shows a pseudoaneurysm <img src='img/arrows/BS.png'/> at the junction of the ascending/horizontal cavernous carotid artery. Note narrowing <img src='img/arrows/BO.png'/> and intimal irregularity <img src='img/arrows/BC.png'/>, a potential source for embolic stroke.*
|
||||
|
||||
|
||||
**Pseudoaneurysm**
|
||||
*Axial T2 MR in a 30-year-old man with headache, a history of a motor vehicle accident and basilar skull fracture 10 years earlier shows a cavernous pseudoaneurysm <img src='img/arrows/WO.png'/>.*
|
||||
|
||||
|
||||
**Pseudoaneurysm**
|
||||
*Anteroposterior angiography in a patient who decompensated clinically 24 hours after admission for a closed head injury shows traumatic pseudoaneurysm <img src='img/arrows/BO.png'/> caused by impingement of ACA against falx.*
|
||||
|
||||
|
||||
**Atherosclerosis, Intracranial**
|
||||
*3D TOF MPR <img src='img/arrows/CO.png'/> and axial TOF <img src='img/arrows/WS.png'/> show ~ 50% narrowing of the left V4 vertebral artery. T2 SPACE shows a lipid/necrotic core <img src='img/arrows/BS.png'/>. MPRAGE is positive for IPH <img src='img/arrows/CS.png'/>. DANTE T1 SPACE pre- <img src='img/arrows/WC.png'/> and post- <img src='img/arrows/WO.png'/> contrast images demonstrate avid wall enhancement (active plaque).*
|
||||
|
||||
|
||||
**Vasculopathy, Non-ASVD**
|
||||
*HIV vasculopathy with bilateral fusiform aneurysms of the terminal ICAs is shown. A T2-hyperintense clot is present in the right ICA terminus aneurysm <img src='img/arrows/WS.png'/>, and there is a preserved flow void in the aneurysmal left ICA terminus <img src='img/arrows/CS.png'/>. CTA shows an occluded right terminal ICA aneurysm <img src='img/arrows/WO.png'/> and patent left terminal ICA fusiform aneurysm <img src='img/arrows/WC.png'/>. DSA confirms these findings with a fusiform aneurysm of the left ICA terminus <img src='img/arrows/CO.png'/>.*
|
||||
|
||||
|
||||
**Reversible Cerebral Vasoconstriction Syndrome**
|
||||
*Postpartum RCVS shows slow flow/vertex SAH on FLAIR <img src='img/arrows/WS.png'/>, multivessel narrowing on 3D TOF <img src='img/arrows/WC.png'/>, and absent enhancement on DANTE T1 SPACE pre- <img src='img/arrows/CS.png'/> or post- <img src='img/arrows/CO.png'/> contrast.*
|
||||
|
||||
|
||||
**Atherosclerosis, Intracranial**
|
||||
*Anteroposterior angiography shows multifocal stenoses characteristic for atherosclerosis, the most common cause of alternating stenoses and dilatations.*
|
||||
|
||||
|
||||
**Atherosclerosis, Intracranial**
|
||||
*DSA shows multifocal stenoses <img src='img/arrows/CS.png'/> characteristic for atherosclerosis, the most common cause of alternating stenoses and dilatations.*
|
||||
|
||||
|
||||
**Vasculopathy, Non-ASVD**
|
||||
*DSA shows fusiform elongation of an MCA branch <img src='img/arrows/BO.png'/>. The patient later admitted to using street drugs.*
|
||||
|
||||
|
||||
**Pseudoaneurysm**
|
||||
*Lateral angiography shows a classic blood, blister-like aneurysm <img src='img/arrows/BS.png'/> along the greater curvature of the supraclinoid ICA. A hemispherical bulge with a broad orifice is typical for blood blister aneurysms. (Courtesy D. Phillips, MD).*
|
||||
|
||||
@@ -0,0 +1,290 @@
|
||||
---
|
||||
title: "Vessel Wall Abnormalities"
|
||||
docid: "850dc563-30b3-4627-87bc-fd858bccf896"
|
||||
authors:
|
||||
- key: "2bca6b86-1eca-4e93-b997-4e18913686a7"
|
||||
value: "Hediyeh Baradaran, MD, MS"
|
||||
- key: "f6dcad15-b660-4243-a242-a9845c929101"
|
||||
value: "J. Scott McNally, MD, PhD"
|
||||
breadcrumbs:
|
||||
-
|
||||
name: "Brain"
|
||||
slug: "brain"
|
||||
treeNodeId: "6d8829f1-14d7-45af-8675-255189aa526a"
|
||||
-
|
||||
name: "Differential Diagnosis"
|
||||
slug: "differential-diagnosis"
|
||||
treeNodeId: "a7fdd139-664e-4bb8-8d18-400e4733ff60"
|
||||
-
|
||||
name: "Arteries"
|
||||
slug: "arteries"
|
||||
treeNodeId: "f5fee8ee-062f-41f2-b449-efcca9fb78f9"
|
||||
-
|
||||
name: "Anatomically Based Differentials"
|
||||
slug: "anatomically-based-differentials"
|
||||
treeNodeId: "9955b05e-9840-401a-b3da-4039f8b22a35"
|
||||
-
|
||||
name: "Vessel Wall Abnormalities"
|
||||
slug: "vessel-wall-abnormalities"
|
||||
treeNodeId: null
|
||||
category: "Brain"
|
||||
documentVersionId: "9cf47507-a8f6-447a-8848-ac23bd794e2d"
|
||||
imageCount: 18
|
||||
lastUpdated: "02/22/23"
|
||||
pageDescription: "Vessel Wall Abnormalities"
|
||||
pageKeywords: "Brain, Differential Diagnosis, Arteries, Anatomically Based Differentials, Vessel Wall Abnormalities"
|
||||
pageTitle: "Vessel Wall Abnormalities | STATdx"
|
||||
enhancedTitle: "Vessel Wall Abnormalities"
|
||||
type: "DDX"
|
||||
references: true
|
||||
breadcrumbs:
|
||||
- "Brain"
|
||||
- "Differential Diagnosis"
|
||||
- "Arteries"
|
||||
- "Anatomically Based Differentials"
|
||||
- "Vessel Wall Abnormalities"
|
||||
---
|
||||
# ESSENTIAL INFORMATION
|
||||
|
||||
- ## Key Differential Diagnosis Issues
|
||||
|
||||
|
||||
- **Clinical history**
|
||||
- History can narrow DDx, but it is often absent initially
|
||||
- **Stroke**
|
||||
- DDx includes extra/intracranial atherosclerosis, dissection, vasospasm, reversible cerebral vasoconstriction syndrome (RCVS)
|
||||
- **Subarachnoid hemorrhage (SAH)**
|
||||
- DDx includes aneurysm (or other vascular lesion/arteriovenous malformation) vs. RCVS vs. vasculitis
|
||||
- Imaging can narrow differential, guide treatment
|
||||
- Vessel wall MR (vwMR) protocol
|
||||
- 3T MR, sub mm, 3D volumetric images
|
||||
- Precontrast: Time of flight (TOF), T2 SPACE, DANTE T1 SPACE, MPRAGE
|
||||
- Postcontrast: DANTE T1 SPACE, TOF
|
||||
- ## Helpful Clues for Common Diagnoses
|
||||
|
||||
|
||||
- **Atherosclerosis, Extracranial**
|
||||
- **Location**
|
||||
- Usually at branch points (e.g., carotid bifurcations)
|
||||
- Oscillatory shear stress at branch points predisposes to endothelial dysfunction and atrioventricular septal defect (ASVD)
|
||||
- **Lumen imaging (CTA or MRA)**
|
||||
- Plaque thickness
|
||||
- Positive remodeling occurs prior to stenosis
|
||||
- Increased soft plaque → lipid → necrosis → intraplaque hemorrhage
|
||||
- Stenosis
|
||||
- Carotid stenosis is measured by North American Symptomatic Carotid Endarterectomy Trial (NASCET) (a-b)/a: "a" = diameter of downstream ICA, and "b" = diameter at level of stenosis
|
||||
- Watch for near occlusion [e.g., downstream ICA < 3 mm or < external carotid artery (ECA)]
|
||||
- Millimeter stenosis measurement can also be used
|
||||
- Ulceration
|
||||
- CTA has high accuracy for detecting ulcerations measuring > 2 mm
|
||||
- Intraluminal thrombus
|
||||
- Rare, but if present, highly associated with acute infarction (positive predictive value: ~ 1)
|
||||
- Identified by donut sign on CTA or MRA
|
||||
- Calcification
|
||||
- Indicates atherosclerosis
|
||||
- Calcification itself may be stable but often adjacent to unstable components
|
||||
- Calcification pattern can indicate unstable plaque (e.g., spotty calcification)
|
||||
- Thin, adventitial calcification (< 2 mm) coupled with thick, soft plaque (> 2 mm) (rim sign) is associated with intraplaque hemorrhage
|
||||
- **vwMR**
|
||||
- Carotid intraplaque hemorrhage
|
||||
- American Heart Association (AHA) type VIb plaque (intraplaque rupture)
|
||||
- Highly associated with acute ipsilateral infarcts
|
||||
- High annual stroke risk (15-45%) despite medication
|
||||
- Best detected by heavily T1-weighted sequences; MPRAGE has ↑↑ signal-to-noise, spatial resolution, and accuracy compared to T1 FS or 3D TOF
|
||||
- MPRAGE-positive plaque: > 2x signal intensity of adjacent muscle, validated by histology
|
||||
- Lipid-rich necrotic core (LRNC)
|
||||
- Nonenhancing on DANTE T1 SPACE post contrast
|
||||
- Can also be detected as T2-hyperintense plaque
|
||||
- LRNC decreases after 1-2 years of statins
|
||||
- Fibrous cap (FC)
|
||||
- FC thinning (< 100 μm) or rupture indicates instability
|
||||
- FC (collagen-rich tissue) enhances on delayed T1 postcontrast black blood images, but detection of rupture can be difficult
|
||||
- **Atherosclerosis, Intracranial**
|
||||
- **Location**
|
||||
- Branch points predisposed
|
||||
- Proximal > distal branches
|
||||
- **Lumen imaging**
|
||||
- Focal stenosis, multifocal stenoses, lumen irregularities, ectasia
|
||||
- Stenosis measured by warfarin-aspirin symptomatic intracranial disease (WASID) criteria
|
||||
- **vwMR**
|
||||
- High T2 signal → lipid/necrotic core
|
||||
- High T1 signal → intraplaque hemorrhage (not as common as in extracranial plaque)
|
||||
- Enhancement → unstable/active atherosclerotic plaque
|
||||
- Highly associated with acute territorial stroke
|
||||
- High repeat stroke risk despite medical therapy (15-30% per year)
|
||||
- Calcification on CT/CTA → atherosclerosis
|
||||
- **Dissection**
|
||||
- **Location**
|
||||
- Extracranial > > intracranial
|
||||
- Vertebral > carotid arteries
|
||||
- Carotid arteries: Distal cervical ICAs > common carotid arteries (CCAs)
|
||||
- Vertebral arteries: V1/V3 > V2/V4 segments
|
||||
- **Lumen imaging**
|
||||
- Biffl grading system
|
||||
- Grade I: Mild irregularity with < 25% narrowing
|
||||
- Grade II: > 25% narrowing, dissection flap, intramural hematoma, or intraluminal thrombus
|
||||
- Grade III: Pseudoaneurysm
|
||||
- Grade IV: Occlusion
|
||||
- Grade V: Transection
|
||||
- **vwMR**
|
||||
- Intramural hematoma
|
||||
- Often, intramural hematoma is not present or detectable in dissection
|
||||
- T1-hyperintense signal indicates subacute dissection (methemoglobin)
|
||||
- Acute trauma: No T1-hyperintense signal and rarely hyperdense on CT
|
||||
- **Vasospasm**
|
||||
- Location
|
||||
- Usually, it is worst closest to source of SAH
|
||||
- Lumen imaging: Multifocal narrowing
|
||||
- vwMR: Negative = no T2 signal, no or mild enhancement
|
||||
- **Aneurysm**
|
||||
- Location
|
||||
- Occurs most often at branch points
|
||||
- If linear vessel segment, think pseudoaneurysm
|
||||
- Lumen imaging
|
||||
- Most often saccular
|
||||
- Irregularities and focal outpouchings more associated with instability
|
||||
- Rupture risk increases with size
|
||||
- vwMR
|
||||
- Wall enhancement associated with unstable aneurysm
|
||||
- Can identify SAH source if multiple aneurysms
|
||||
- **Pseudoaneurysm**
|
||||
- Location
|
||||
- Not often at branch points
|
||||
- Often adjacent to skull base fracture or dura
|
||||
- Common type is dorsal variant ICA blister aneurysm
|
||||
- Lumen imaging
|
||||
- Broad-based bulge, no neck, fusiform, irregular
|
||||
- Rapidly change in size over hours or days
|
||||
- vwMR
|
||||
- Avid wall enhancement at site of wall breakdown
|
||||
- ## Helpful Clues for Less Common Diagnoses
|
||||
|
||||
|
||||
- **Reversible Cerebral Vasoconstriction Syndrome**
|
||||
- Location: Multifocal, diffuse
|
||||
- Lumen imaging: Multiple alternating stenoses
|
||||
- vwMR: Negative = no T2 signal, no or mild enhancement
|
||||
- **Vasculitis**
|
||||
- Location: Multifocal, diffuse
|
||||
- Lumen imaging: Multiple alternating stenoses
|
||||
- vwMR: Avid wall enhancement, no/mild T2 signal
|
||||
- **Carotid Web**
|
||||
- Location: Posterolateral carotid bifurcation
|
||||
- Lumen imaging: Linear filling defect
|
||||
- ## Helpful Clues for Rare Diagnoses
|
||||
|
||||
|
||||
- **Perivascular Infection**
|
||||
- Location
|
||||
- Often direct spread from sinuses or mastoid air cells
|
||||
- Lumen imaging
|
||||
- Smooth or irregular stenosis
|
||||
- ± pseudoaneurysm, intraluminal thrombus
|
||||
- May require DSA for full delineation
|
||||
- vwMR: Wall enhancement with invasion
|
||||
- **Perivascular Tumor**
|
||||
- Location: Direct spread from adjacent tumor
|
||||
- Lumen imaging: Vessel narrowing, ± pseudoaneurysm, thrombus
|
||||
- vwMR: Thick, irregular wall enhancement
|
||||
|
||||
## References
|
||||
|
||||
# Selected References
|
||||
|
||||
1. [El-Masri S et al: Systematic review and meta-analysis of ipsilateral and contralateral carotid web prevalence in embolic supratentorial strokes of undetermined source. J Clin Neurosci. 107:118-23, 2023](http://www.ncbi.nlm.nih.gov/pubmed/?term=36535218%5Bpmid%5D)
|
||||
1. [Chung CY et al: Imaging intracranial aneurysms in the endovascular era: surveillance and posttreatment follow-up. Radiographics. 42(3):789-805, 2022](http://www.ncbi.nlm.nih.gov/pubmed/?term=35333634%5Bpmid%5D)
|
||||
1. [Culleton S et al: MRI detection of carotid intraplaque hemorrhage and postintervention cognition. AJNR Am J Neuroradiol. 43(12):1762-9, 2022](http://www.ncbi.nlm.nih.gov/pubmed/?term=36357151%5Bpmid%5D)
|
||||
1. [Fanning NF et al: Thromboembolism from carotid web. Radiology. 221504, 2022](http://www.ncbi.nlm.nih.gov/pubmed/?term=36378034%5Bpmid%5D)
|
||||
1. [Larson AS et al: Nonstenotic carotid plaques and embolic stroke of undetermined source: a multimodality review. AJNR Am J Neuroradiol. ePub, 2022](http://www.ncbi.nlm.nih.gov/pubmed/?term=36549844%5Bpmid%5D)
|
||||
1. [Lehman VT et al: Conventional and high-resolution vessel wall MRI of intracranial aneurysms: current concepts and new horizons. J Neurosurg. 1-13, 2017](http://www.ncbi.nlm.nih.gov/pubmed/?term=28598273%5Bpmid%5D)
|
||||
1. [McNally JS et al: Magnetic resonance imaging detection of intraplaque hemorrhage. Magn Reson Insights. 10:1-8, 2017](http://www.ncbi.nlm.nih.gov/pubmed/?term=28469441%5Bpmid%5D)
|
||||
1. [Eisenmenger LB et al: Prediction of carotid intraplaque hemorrhage using adventitial calcification and plaque thickness on CTA. AJNR Am J Neuroradiol. 37(8):1496-503, 2016](http://www.ncbi.nlm.nih.gov/pubmed/?term=27102316%5Bpmid%5D)
|
||||
1. [McNally JS et al: Intraluminal thrombus, intraplaque hemorrhage, plaque thickness, and current smoking optimally predict carotid stroke. Stroke. 46(1):84-90, 2015](http://www.ncbi.nlm.nih.gov/pubmed/?term=25406146%5Bpmid%5D)
|
||||
1. [Mossa-Basha M et al: Multicontrast high-resolution vessel wall magnetic resonance imaging and its value in differentiating intracranial vasculopathic processes. Stroke. 46(6):1567-73, 2015](http://www.ncbi.nlm.nih.gov/pubmed/?term=25953365%5Bpmid%5D)
|
||||
1. [Bartlett ES et al: Quantification of carotid stenosis on CT angiography. AJNR Am J Neuroradiol. 27(1):13-9, 2006](http://www.ncbi.nlm.nih.gov/pubmed/?term=16418349%5Bpmid%5D)
|
||||
|
||||
|
||||
## Images
|
||||
|
||||
|
||||
### Selected Images
|
||||
|
||||
![CTA shows a left carotid bifurcation/proximal ICA plaque. NASCET stenosis [(a-b)/a] is calculated by subtracting the maximal stenosis (b <img src='img/arrows/CS.png'/>) from the downstream normal-caliber ICA (a <img src='img/arrows/WS.png'/>) and normalizing to the downstream normal ICA (a). A single mm stenosis measurement (b) can alternatively be used. Maximum plaque thickness can also be measured on CTA <img src='img/arrows/CO.png'/>.](images/app.statdx.com_image_thumbnail_f989d945-abad-41d9-b68c-275ef656c54c_annotated_true_size_900_quality_90_679e427c9a49899cecad73baec4cb8abd5628178.jpg)
|
||||
**Atherosclerosis, Extracranial**
|
||||
*CTA shows a left carotid bifurcation/proximal ICA plaque. NASCET stenosis [(a-b)/a] is calculated by subtracting the maximal stenosis (b <img src='img/arrows/CS.png'/>) from the downstream normal-caliber ICA (a <img src='img/arrows/WS.png'/>) and normalizing to the downstream normal ICA (a). A single mm stenosis measurement (b) can alternatively be used. Maximum plaque thickness can also be measured on CTA <img src='img/arrows/CO.png'/>.*
|
||||
|
||||
![CTA shows a left carotid bifurcation/proximal ICA plaque. NASCET stenosis [(a-b)/a] is calculated by subtracting the maximal stenosis (b <img src='img/arrows/CS.png'/>) from the downstream normal-caliber ICA (a <img src='img/arrows/WS.png'/>) and normalizing to the downstream normal ICA (a). A single mm stenosis measurement (b) can alternatively be used. Maximum plaque thickness can also be measured on CTA <img src='img/arrows/CO.png'/>.](images/app.statdx.com_image_thumbnail_f989d945-abad-41d9-b68c-275ef656c54c_size_174_quality_85_ff3ccf1c1fb72983384b6b81e4d8e7e242cdc5ad.jpg)
|
||||
**Atherosclerosis, Extracranial**
|
||||
*CTA shows a left carotid bifurcation/proximal ICA plaque. NASCET stenosis [(a-b)/a] is calculated by subtracting the maximal stenosis (b <img src='img/arrows/CS.png'/>) from the downstream normal-caliber ICA (a <img src='img/arrows/WS.png'/>) and normalizing to the downstream normal ICA (a). A single mm stenosis measurement (b) can alternatively be used. Maximum plaque thickness can also be measured on CTA <img src='img/arrows/CO.png'/>.*
|
||||
|
||||
|
||||
**Atherosclerosis, Extracranial**
|
||||
*CTA (and MRA) can also detect ulceration (sagittal <img src='img/arrows/WS.png'/> and axial <img src='img/arrows/WO.png'/>) and intraluminal thrombus (sagittal <img src='img/arrows/CS.png'/> and axial <img src='img/arrows/CO.png'/>).*
|
||||
|
||||
|
||||
**Atherosclerosis, Extracranial**
|
||||
*Intraplaque hemorrhage (IPH) can be detected on MRA. 3D TOF can detect IPH (sagittal <img src='img/arrows/WS.png'/> and axial <img src='img/arrows/WO.png'/>), but TOF and conventional T1 FS MR are less accurate than MPRAGE <img src='img/arrows/CO.png'/> when compared to histology.*
|
||||
|
||||
|
||||
**Atherosclerosis, Extracranial**
|
||||
*While IPH is best detected with MR and heavily T1-weighted sequences, such as MPRAGE <img src='img/arrows/CS.png'/>, IPH can be inferred on CTA with a rim sign <img src='img/arrows/WS.png'/>, which consists of a thin, < 2-mm rim of calcification with ≥ 2-mm central soft plaque. Likelihood of IPH increases with soft plaque thickness.*
|
||||
|
||||
|
||||
**Atherosclerosis, Intracranial**
|
||||
*DSA shows ~ 50% narrowing of the midbasilar artery <img src='img/arrows/BS.png'/> in a patient with a pontine infarct. T2-hyperintense plaque <img src='img/arrows/WO.png'/> on vwMR, IPH on MPRAGE <img src='img/arrows/CC.png'/>, and wall enhancement <img src='img/arrows/CO.png'/> on DANTE T1 SPACE indicate active plaque.*
|
||||
|
||||
|
||||
**Dissection**
|
||||
*CTA shows traumatic dissection of the ICA with narrowing <img src='img/arrows/BO.png'/> and associated intramural hematoma on MR <img src='img/arrows/CO.png'/>. Intramural hematoma can be detected on MR using T1 FS MR or MPRAGE. Methemoglobin within intramural hematoma is T1 hyperintense.*
|
||||
|
||||
|
||||
**Aneurysm**
|
||||
*MRA 3D TOF source image shows an anterior communicating artery saccular aneurysm <img src='img/arrows/CS.png'/>. Vessel wall MR (vwMR) images show areas of wall enhancement comparing pre- <img src='img/arrows/WO.png'/> and postcontrast <img src='img/arrows/CO.png'/> DANTE T1 SPACE, thought to be linked to growth and rupture risk.*
|
||||
|
||||
|
||||
**Pseudoaneurysm**
|
||||
*Dorsal variant ICA blister aneurysm, or pseudoaneurysm, is shown on DSA <img src='img/arrows/BS.png'/>. Initial CTA shows mild lumen outpouching <img src='img/arrows/WO.png'/>. vwMR shows that avid wall enhancement is present comparing pre- <img src='img/arrows/WC.png'/> and postcontrast <img src='img/arrows/CO.png'/> DANTE T1 SPACE.*
|
||||
|
||||
|
||||
**Reversible Cerebral Vasoconstriction Syndrome**
|
||||
*Multifocal areas of narrowing <img src='img/arrows/BS.png'/> are shown on DSA in a patient with thunderclap headache. Multifocal anterior circulation narrowing was also present (not shown). vwMR was negative. The patient improved with calcium channel blockers. Imaging appearance is typical of RCVS.*
|
||||
|
||||
|
||||
**Reversible Cerebral Vasoconstriction Syndrome**
|
||||
*In the same patient, CT shows left-sided SAH <img src='img/arrows/WS.png'/>, and DWI MR shows a single punctate recent infarct <img src='img/arrows/CS.png'/>. There was no T2 signal <img src='img/arrows/WO.png'/> or vessel wall enhancement on DANTE T1 SPACE <img src='img/arrows/CO.png'/>. Diagnosis was RCVS.*
|
||||
|
||||
|
||||
**Vasculitis**
|
||||
*DSA in a 40-year-old patient with recurrent strokes and eventual diagnosis of vasculitis shows subtle right middle cerebral artery (MCA) narrowing <img src='img/arrows/WS.png'/>. Avid wall enhancement is present on vwMR DANTE T1 SPACE <img src='img/arrows/CS.png'/> without T2 signal <img src='img/arrows/BS.png'/>.*
|
||||
|
||||
|
||||
**Carotid Web**
|
||||
*CTA images show linear filling defects in the posterolateral carotid bifurcation in 3 different patients <img src='img/arrows/CO.png'/>, consistent with carotid webs. Carotid webs are associated with increased risk of ipsilateral ischemic infarct.*
|
||||
|
||||
|
||||
**Perivascular Infection**
|
||||
*3D TOF C+ MR in a 62-year-old man with left CNVI palsy and Horner syndrome shows left cavernous sinus thrombophlebitis <img src='img/arrows/WO.png'/> and intraluminal clot in the left ICA <img src='img/arrows/WS.png'/>. DSA confirms perivascular infection along the left ICA with intraluminal clot <img src='img/arrows/CS.png'/>.*
|
||||
|
||||
|
||||
**Perivascular Tumor**
|
||||
*A 59-year-old woman presented with left MCA infarcts <img src='img/arrows/WO.png'/> on DTI but elevated CBV along the left insula <img src='img/arrows/WS.png'/>. MR spectroscopy reveals elevated choline <img src='img/arrows/CS.png'/>. Vessel wall enhancement is present on DANTE T1 SPACE <img src='img/arrows/CO.png'/>. This was biopsy-proven GBM with MCA invasion.*
|
||||
|
||||
|
||||
### Additional Images
|
||||
|
||||
|
||||
**Vasospasm**
|
||||
*In a patient with a ruptured pseudoaneurysm <img src='img/arrows/BS.png'/>, DSA shows multifocal areas of vessel narrowing, consistent with vasospasm <img src='img/arrows/CS.png'/>. vwMR was negative in the areas of narrowing (not shown).*
|
||||
|
||||
|
||||
**Aneurysm**
|
||||
*Right ICA ophthalmic segment saccular aneurysm is shown on DSA <img src='img/arrows/CS.png'/> and 3D TOF MRA <img src='img/arrows/WO.png'/>. Note areas of wall enhancement comparing pre- <img src='img/arrows/WS.png'/> and postcontrast <img src='img/arrows/CO.png'/> DANTE T1 SPACE, thought to be linked to growth and rupture risk.*
|
||||
|
||||
|
||||
**Reversible Cerebral Vasoconstriction Syndrome**
|
||||
*DSA shows multifocal areas of narrowing <img src='img/arrows/WS.png'/> in a patient with thunderclap headache. Multifocal posterior circulation narrowing was also present, and vwMR was negative (not shown). The patient improved with calcium channel blockers. This was RCVS.*
|
||||
|
||||
|
||||
**Vasculitis**
|
||||
*DSA in a 40-year-old patient with recurrent strokes and eventual diagnosis of vasculitis shows severe right subclavian artery narrowing <img src='img/arrows/WS.png'/>. Wall enhancement is present on DANTE T1 SPACE <img src='img/arrows/CS.png'/> without T2 signal <img src='img/arrows/BS.png'/>.*
|
||||
|
||||
@@ -0,0 +1,132 @@
|
||||
---
|
||||
title: "Visual Network"
|
||||
docid: "404625d9-3125-4923-9f9d-53d0f81c3542"
|
||||
authors:
|
||||
- key: "15a1b74a-5576-4e3a-a193-2d84e315fbd0"
|
||||
value: "Jeffrey S. Anderson, MD, PhD"
|
||||
breadcrumbs:
|
||||
-
|
||||
name: "Brain"
|
||||
slug: "brain"
|
||||
treeNodeId: "6d8829f1-14d7-45af-8675-255189aa526a"
|
||||
-
|
||||
name: "Anatomy"
|
||||
slug: "anatomy"
|
||||
treeNodeId: "45a4cfd4-910b-4f11-8eba-c887895fdbf8"
|
||||
-
|
||||
name: "Brain Network Anatomy"
|
||||
slug: "brain-network-anatomy"
|
||||
treeNodeId: "95c502bb-ba84-4fbc-be46-f1f2600ce4dd"
|
||||
-
|
||||
name: "Visual Network"
|
||||
slug: "visual-network"
|
||||
treeNodeId: null
|
||||
category: "Brain"
|
||||
documentVersionId: "6e469918-0145-4a20-93a5-2cc5da2e3cac"
|
||||
imageCount: 1
|
||||
lastUpdated: "02/23/21"
|
||||
pageDescription: "Visual Network"
|
||||
pageKeywords: "Brain, Anatomy, Brain Network Anatomy, Visual Network"
|
||||
pageTitle: "Visual Network | STATdx"
|
||||
enhancedTitle: "Visual Network"
|
||||
type: "ANATOMY"
|
||||
references: true
|
||||
breadcrumbs:
|
||||
- "Brain"
|
||||
- "Anatomy"
|
||||
- "Brain Network Anatomy"
|
||||
- "Visual Network"
|
||||
---
|
||||
# IMAGING ANATOMY
|
||||
|
||||
- ## Overview
|
||||
|
||||
|
||||
- Visual cortex consumes virtually all of the occipital lobe, from primary sensory areas along the calcarine sulcus and occipital pole through the posterior parietal and temporal lobes
|
||||
- 2 primary sensory processing streams
|
||||
- Dorsal pathway ("where" pathway) extends from V1/V2 to V3 and into medial posterior parietal lobe
|
||||
- Processes localization of stimuli in space, visual attention, spatial awareness, coordination of reaching and grasping
|
||||
- Ventral pathway ("what" pathway) extends from V1/V2 to V4, V5/MT, and anterior inferior temporal lobe (AIT)
|
||||
- Processes complex feature detection in visual stimuli, motion perception
|
||||
- Multiple bilateral visual processing areas, each with a complete retinotopic map of visual space (V1, V2, V3, V4, V5/MT, V6, IPS regions)
|
||||
- ## Primary (Striate) Visual Cortex (V1)
|
||||
|
||||
|
||||
- 1st visual area receiving sensory input in the cortex
|
||||
- Located along margins of the calcarine sulcus
|
||||
- Foveal vision near occipital pole, with more peripheral vision extending anteriorly
|
||||
- ## Extrastriate Visual Cortex (V2, V3, V4, V5/MT)
|
||||
|
||||
|
||||
- V2 (Brodmann area 18): Immediately borders V1, with inverted retinotopic maps
|
||||
- V3 (Brodmann area 19): Superior and anterior area V2, part of dorsal stream
|
||||
- Processes progressively more abstract feature extraction
|
||||
- V3A and V3B retinotopic maps
|
||||
- V4 (Brodmann area 19 ): Anterior to V2 in lateral occipital cortex, part of ventral stream
|
||||
- Lateral occipital: LO-1, LO-2 retinotopic maps along lateral occipital cortex anterior to V3
|
||||
- Ventral occipital, human V4: VO-1, VO-2, hV4 retinotopic maps along inferomedial occipital cortex anterior to V3
|
||||
- V5 (Brodmann area 19): Middle temporal gyrus at temporooccipital junction; processes motion, color, and attention perception; part of ventral stream
|
||||
- V6 (Brodmann area 19): Along parietooccipital sulcus (medial motion area, analogue to primate mediodorsal area), part of dorsal stream
|
||||
- ## Lateral Geniculate Nuclei of Thalamus
|
||||
|
||||
|
||||
- Visualized on axial slice through superior colliculus at posterior lateral margin of the thalamus
|
||||
- Endpoint of optic tracts
|
||||
- Postsynaptic fibers extend anteromedial along Meyer loop, then posteriorly along optic radiations through visual cortex
|
||||
- Additional fibers likely extend through lingual gyrus of occipital lobe to reach primary visual cortex layer 4
|
||||
- ## Intraparietal Sulcus (IPS0/V7, IPS1, IPS2, IPS3, IPS4)
|
||||
|
||||
|
||||
- Posterior parietal regions processing stimulus attention
|
||||
- Visual attentional regions along medial aspect of intraparietal sulcus
|
||||
- Multiple areas with complete retinotopic map of visual space (IPS0, IPS1, IPS2, IPS3, IPS4)
|
||||
|
||||
# ANATOMY IMAGING ISSUES
|
||||
|
||||
- ## Imaging Recommendations
|
||||
|
||||
|
||||
- Expanding ring, rotating hemifield tasks for visual field mapping
|
||||
- ## Imaging Pitfalls
|
||||
|
||||
|
||||
- Should check visual acuity prior to fMRI visual field mapping
|
||||
|
||||
# CLINICAL IMPLICATIONS
|
||||
|
||||
- ## Clinical Importance
|
||||
|
||||
|
||||
- Vascular loops (P1 segment) can compress optic tracts and result in otherwise unexplained quadrantanopsia
|
||||
- Presurgical visual field mapping usually focused on preserving V1/V2 retinotopic maps and foveal vision, optic radiations
|
||||
- DTI best for imaging course of optic radiations for presurgical mapping
|
||||
|
||||
906ccf1c-1128-4cd5-bfeb-c469e993ee01
|
||||
|
||||
## References
|
||||
|
||||
# Selected References
|
||||
|
||||
1. [Ko H et al: The emergence of functional microcircuits in visual cortex. Nature. 496(7443):96-100, 2013](http://www.ncbi.nlm.nih.gov/pubmed/?term=23552948%5Bpmid%5D)
|
||||
1. [Baldassarre A et al: Individual variability in functional connectivity predicts performance of a perceptual task. Proc Natl Acad Sci U S A. 109(9):3516-21, 2012](http://www.ncbi.nlm.nih.gov/pubmed/?term=22315406%5Bpmid%5D)
|
||||
1. [Gaglianese A et al: Evidence of a direct influence between the thalamus and hMT+ independent of V1 in the human brain as measured by fMRI. Neuroimage. 60(2):1440-7, 2012](http://www.ncbi.nlm.nih.gov/pubmed/?term=22300813%5Bpmid%5D)
|
||||
1. [Chadick JZ et al: Differential coupling of visual cortex with default or frontal-parietal network based on goals. Nat Neurosci. 14(7):830-2, 2011](http://www.ncbi.nlm.nih.gov/pubmed/?term=21623362%5Bpmid%5D)
|
||||
1. [Wandell BA et al: Imaging retinotopic maps in the human brain. Vision Res. 51(7):718-37, 2011](http://www.ncbi.nlm.nih.gov/pubmed/?term=20692278%5Bpmid%5D)
|
||||
1. [Wendt J et al: The functional connectivity between amygdala and extrastriate visual cortex activity during emotional picture processing depends on stimulus novelty. Biol Psychol. 86(3):203-9, 2011](http://www.ncbi.nlm.nih.gov/pubmed/?term=21130141%5Bpmid%5D)
|
||||
1. [Yeo BT et al: The organization of the human cerebral cortex estimated by intrinsic functional connectivity. J Neurophysiol. 106(3):1125-65, 2011](http://www.ncbi.nlm.nih.gov/pubmed/?term=21653723%5Bpmid%5D)
|
||||
1. [Zou Q et al: Functional connectivity between the thalamus and visual cortex under eyes closed and eyes open conditions: a resting-state fMRI study. Hum Brain Mapp. 30(9):3066-78, 2009](http://www.ncbi.nlm.nih.gov/pubmed/?term=19172624%5Bpmid%5D)
|
||||
1. [Shmuel A et al: Neuronal correlates of spontaneous fluctuations in fMRI signals in monkey visual cortex: Implications for functional connectivity at rest. Hum Brain Mapp. 29(7):751-61, 2008](http://www.ncbi.nlm.nih.gov/pubmed/?term=18465799%5Bpmid%5D)
|
||||
1. [Wandell BA et al: Visual field maps in human cortex. Neuron. 56(2):366-83, 2007](http://www.ncbi.nlm.nih.gov/pubmed/?term=17964252%5Bpmid%5D)
|
||||
1. [Nir Y et al: Widespread functional connectivity and fMRI fluctuations in human visual cortex in the absence of visual stimulation. Neuroimage. 30(4):1313-24, 2006](http://www.ncbi.nlm.nih.gov/pubmed/?term=16413791%5Bpmid%5D)
|
||||
1. [Hampson M et al: Changes in functional connectivity of human MT/V5 with visual motion input. Neuroreport. 15(8):1315-9, 2004](http://www.ncbi.nlm.nih.gov/pubmed/?term=15167557%5Bpmid%5D)
|
||||
1. [Sereno MI et al: Borders of multiple visual areas in humans revealed by functional magnetic resonance imaging. Science. 268(5212):889-93, 1995](http://www.ncbi.nlm.nih.gov/pubmed/?term=7754376%5Bpmid%5D)
|
||||
|
||||
|
||||
## Images
|
||||
|
||||
|
||||
### Visual Network
|
||||
|
||||
|
||||
*The visual network cluster is shown from a 6-network parcellation of the brain based on whole-brain functional connectivity in 1,353 subjects. Regions within this cluster include striate and extrastriate visual cortex, medial parietal visual attentional regions, and lateral geniculate nuclei of the thalamus.*
|
||||
|
||||
Reference in New Issue
Block a user