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Angiography of Primary Central Nervous System Angiitis of Childhood: Conventional Angiography versus Magnetic Resonance Angiography at Presentation

R.I. Aviva,f,h, S.M. Benselerb,d, G. DeVeberc,d,f,h, E.D. Silvermanb,d,f,g,h, P.N. Tyrrellb, L.M. Tsangb and D. Armstronga,e,h

a Division of Neuroradiology, Hospital for Sick Children, Toronto, Ontario, Canada
b Division of Rheumatology, Hospital for Sick Children, Toronto, Ontario, Canada
c Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
d Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
e Department of Radiology, Hospital for Sick Children, Toronto, Ontario, Canada
f Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
g Department of Immunology, University of Toronto, Toronto, Ontario, Canada
h Department of Radiology, University of Toronto, Toronto, Ontario, Canada


Figure 1
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  		Fig 1. Representative MRA and angiographic images. Aggressive appearing lesions were those that demonstrated multiple short segment irregularity with alternating narrowing and dilation (beading) (white arrow) (A) or multiple longer segmental narrowing with normal intervening vessel (black arrowheads) (B). Aneurysms (not shown) were included in this definition. Benign appearing lesions (C) had smooth (white arrows), often solitary, tapered (white arrowhead) narrowing that could be concentric or eccentric. Incidental hypoplasia of the ipsilateral A1 is noted.


Figure 2
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  		Fig 2. Good agreement of CA (A) and (B) MRA for right ICA. Both modalities demonstrate tapered narrowing of the terminal carotid and proximal M1 and A1 (carotid terminus) with focal midM1 dilation and distal narrowing. Both modalities identify beading of the proximal A1 (black arrows).


Figure 3
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  		Fig 3. Abnormal CA (A) in the context of normal MRA (B) in a patient with a lone focal stenosis of the left PcomA. No other CA abnormality was present. MR imaging was abnormal maintaining suspicion for vasculitis despite a negative MRA.


Figure 4
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  		Fig 4. A, Occlusion of the P3 segment of the right PCA on TOF MRA (white arrowhead). Inferior temporal branches (white arrows) are slightly more prominent than on the contralateral side but B, extent of collaterals and reconstitution of the distal PCA (black arrow) best seen on CA.





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X