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Research ArticleAdult Brain
Open Access

Concordance of Time-of-Flight MRA and Digital Subtraction Angiography in Adult Primary Central Nervous System Vasculitis

H. de Boysson, G. Boulouis, J.-J. Parienti, E. Touzé, M. Zuber, C. Arquizan, N. Dequatre, O. Detante, B. Bienvenu, A. Aouba, L. Guillevin, C. Pagnoux and O. Naggara
American Journal of Neuroradiology October 2017, 38 (10) 1917-1922; DOI: https://doi.org/10.3174/ajnr.A5300
H. de Boysson
aFrom the Departments of Internal Medicine (H.d.B., B.B., A.A.)
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  • ORCID record for H. de Boysson
G. Boulouis
cDepartment of Neuroradiology (G.B., O.N.), Centre Hospitalier Sainte-Anne, Université Paris-Descartes, Institut National de la Santé et de la Recherche Médicale Unite Mixte de Recherche 894, Paris, France
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J.-J. Parienti
dBiostatistics and Clinical Research Unit (J.-J.P.), Caen University Hospital, Caen, France
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E. Touzé
bNeurology (E.T.), Caen University Hospital, University of Caen-Normandie, Institut National de la Santé et de la Recherche Médicale Unite Mixte de Recherche 919, Caen, France
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M. Zuber
eDepartment of Vascular Neurology (M.Z.), Centre Hospitalier Saint Joseph, Université Paris-Descartes, Institut National de la Santé et de la Recherche Médicale Unite Mixte de Recherche S 919, Paris, France
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C. Arquizan
fDepartment of Neurology (C.A.), Montpellier University Hospital, Institut National de la Santé et de la Recherche Médicale Unite Mixte de Recherche 894, Montpellier, France
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N. Dequatre
gDepartment of Neurology (N.D.), Lille University Hospital, Lille, France
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O. Detante
hDepartment of Neurology (O.D.), Grenoble Alpes University Hospital, Grenoble, France
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B. Bienvenu
aFrom the Departments of Internal Medicine (H.d.B., B.B., A.A.)
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A. Aouba
aFrom the Departments of Internal Medicine (H.d.B., B.B., A.A.)
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L. Guillevin
iDepartment of Internal Medicine (L.G.), Centre Hospitalier Cochin, Paris, France
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C. Pagnoux
jVasculitis Clinic (C.P.), Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada.
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O. Naggara
cDepartment of Neuroradiology (G.B., O.N.), Centre Hospitalier Sainte-Anne, Université Paris-Descartes, Institut National de la Santé et de la Recherche Médicale Unite Mixte de Recherche 894, Paris, France
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    Fig 1.

    DSA (A) and 3D-TOF-MRA (C) with respective magnifications (B and D) of a patient with primary central nervous system vasculitis. A near-occlusive stenotic lesion of the proximal middle cerebral artery segment extending to both superficial branches with a pseudodilation of the bifurcation is shown. Arterial lumen irregularities are also observed in A2 segments of both anterior cerebral arteries.

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    Fig 2.

    DSA (A) and 3D-TOF-MRA (C) with respective magnifications (B and D) of a patient with primary central nervous system vasculitis. Subtle irregularities of the arterial lumen of the A2–A3 segments of the left anterior cerebral artery are shown in a patient with otherwise near-occlusive stenoses of left intracranial internal carotid artery extending to the initial portion of the left MCA.

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    Table 1:

    Characteristics at diagnosis of the 31 patients with primary central nervous system vasculitisa

    CharacteristicsTotal (n = 31)Unenrolled Patients (n = 54)P Value
    Demographic data
        Age (yr)42 (24–65)46 (18–79).73
        Male/female16:1528:26.98
    Clinical manifestations
        Headaches17 (55)42 (78).03
        Focal deficits26 (84)43 (80).63
        Seizures9 (29)22 (41).28
        Cognitive impairment7 (23)26 (48).02
        Loss of consciousness3 (10)19 (35).01
        Psychiatric disorders6 (19)13 (24).61
        C-reactive protein, (mg/L)3 (0–47)5 (1–95).13
        Abnormal CSF18/29 (62)35/53 (66).13
        Leukocyte count (/mm3)6 (1–100)8 (0–250).07
        Protein concentration (mg/mL)0.6 (0.2–4.1)0.7 (0.1–2.8).19
        Abnormal brain biopsy findings8/16 (50)18/26 (69).32
        Abnormal DSA findings25 (81)26/41 (63).13
        Abnormal MRA findings24 (77)25/44 (57).09
    • ↵a Unless otherwise indicated, values are an absolute number (%) or median (range).

    • View popup
    Table 2:

    Concordance between 1.5T/3T MRA and DSA on cerebral vascular segments in primary central nervous system vasculitis

    1.5T MR (κ; 95% CI)3T MR (κ; 95% CI)
    Intracranial internal carotid artery11
    A10.90 (0.73–1)0.90 (0.75–1)
    A20.83 (0.59–1)0.83 (0.51–1)
    >A20.57 (0.34–0.72)0.86 (0.60–1)
    M10.94 (0.81–1)1
    M20.90 (0.76–1)0.91 (0.82–1)
    >M20.69 (0.41–0.97)0.74 (0.42–1)
    P111
    P20.60 (0.20–0.98)1
    >P20.64 (0.18–1)1
    V40.66 (0.38–1)0.86 (0.62–1)
    BA0.83 (0.50–1)1
    PICA/AICA/SCA0.88 (0.63–1)1
    • Note:—BA indicates basilar artery.

    • View popup
    Table 3:

    Diagnostic performance of 1.5T and 3T 3D-TOF-MRA in primary central nervous system vasculitis compared with DSA

    Sensitivity (%)Specificity (%)Accuracy (%)PPVNPV
    Diagnosis per patient96 (24/25)100 (6/6)96.77 (30/31)10085.7
    Diagnosis per segment on all MR units (n = 31)83.3 (116/141)98.9 (627/634)95.9 (743/775)94.396.2
        1.5 MR units (n = 20)81.5 (75/92)98.5 (402/408)95.4 (477/500)92.695.9
        3T MR units (n = 11)83.7 (41/49)99.6 (225/226)96.7 (266/275)97.696.6
    • Note:—PPV indicates positive predictive value; NPV, negative predictive value.

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American Journal of Neuroradiology: 38 (10)
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H. de Boysson, G. Boulouis, J.-J. Parienti, E. Touzé, M. Zuber, C. Arquizan, N. Dequatre, O. Detante, B. Bienvenu, A. Aouba, L. Guillevin, C. Pagnoux, O. Naggara
Concordance of Time-of-Flight MRA and Digital Subtraction Angiography in Adult Primary Central Nervous System Vasculitis
American Journal of Neuroradiology Oct 2017, 38 (10) 1917-1922; DOI: 10.3174/ajnr.A5300

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Concordance of Time-of-Flight MRA and Digital Subtraction Angiography in Adult Primary Central Nervous System Vasculitis
H. de Boysson, G. Boulouis, J.-J. Parienti, E. Touzé, M. Zuber, C. Arquizan, N. Dequatre, O. Detante, B. Bienvenu, A. Aouba, L. Guillevin, C. Pagnoux, O. Naggara
American Journal of Neuroradiology Oct 2017, 38 (10) 1917-1922; DOI: 10.3174/ajnr.A5300
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