• Thomas Pfefferkorn, Jennifer Linn, Maximilian Habs, Christina Opherk, Clemens Cyran, Caroline Ottomeyer, Andreas Straube, Martin Dichgans, Konstantin Nikolaou, and Tobias Saam.
• Department of Neurology, University of Munich, Germany.
• J Neuroimaging. 2013 Jul 1;23(3):379-83.

ObjectivesSingle case reports suggest that black blood MRI (T1-weighted fat and blood suppressed sequences with and without contrast injection; BB-MRI) may visualize intracranial vessel wall contrast enhancement (CE) in primary angiitis of the central nervous system (PACNS). In this single-center observational pilot study we prospectively investigated the value of BB-MRI in the diagnosis of large artery PACNS.MethodsPatients with suspected large artery PACNS received a standardized diagnostic program including BB-MRI. Vessel wall CE was graded (grade 0-2) by two experienced readers blinded to clinical data and correlated to the final diagnosis.ResultsFour of 12 included patients received a final diagnosis of PACNS. All of them showed moderate (grade 1) to strong (grade 2) vessel wall CE at the sites of stenosis. A moderate (grade 1) vessel wall CE grade was also observed in 6 of the remaining 8 patients in whom alternative diagnoses were made: arteriosclerotic disease (n = 4), intracranial dissection (n = 1), and Moyamoya disease (n = 1).ConclusionsOur pilot study demonstrates that vessel wall CE is a frequent finding in PACNS and its mimics. Larger trials will be necessary to evaluate the utility of BB-MRI in the diagnostic workup of PACNS.Copyright © 2012 by the American Society of Neuroimaging.

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