From the Research
Diagnostic Yield Comparison
The diagnostic yield of Magnetic Resonance Imaging (MRI) and Angiography in secondary Central Nervous System (CNS) vasculitis of unknown etiology compared to brain biopsy is a complex issue.
- The study by 1 found that cerebral angiography and histopathologic testing (biopsy/postmortem) were undertaken in a minority of published cases with a diagnosis of primary CNS vasculitis, and when both diagnostic tests were performed, disagreement between them was more than 5 times more likely than agreement.
- Another study by 2 examined the concordance of angiography and cerebral biopsy results for suspected primary central nervous system vasculitis and found that positive angiography was not correlated with positive biopsy.
- The diagnostic accuracy of brain biopsy was found to be 100% in small vessel variant (SVV) and 57.1% in large-medium vessel variant (LMVV) by the study 3.
- High-resolution vessel wall MR imaging was found to be useful in identifying inflamed intracranial vessels and enabling precise localization of biopsy targets by the study 4.
Diagnostic Approaches
Different diagnostic approaches may be necessary for different variants of CNS vasculitis.
- The study by 3 found that the diagnostic approach for primary CNS vasculitis differs concerning the affected vessel size, with HR-VWI being useful for the diagnosis of large-medium vessel variant (LMVV) and brain biopsy remaining the gold standard for proving primary CNS vasculitis with small vessel variant (SVV).
- The study by 5 noted that the diagnosis of isolated CNS vasculitis is challenging due to the poor performance of available diagnostic procedures, including magnetic resonance imaging, angiography, and brain biopsy.
- The study by 1 suggested that diagnostic criteria for primary CNS vasculitis may require revision to classify the clinical, pathologic, and radiologic features of this condition more accurately.