PMC9238195_01
Carotid vessel wall MRI of acute cerebral infarction caused by polycythemia vera in a 30 year-old male.. A. Diffusion-weighted imaging depicts restricted diffusion in the left frontal lobe (arrow, apparent diffusion coefficient map is not shown), reflecting acute infarction.. B. Intracranial TOF MR angiography demonstrates multifocal stenosis (arrows) in the left M2 segment, right A1 segment, right M1 segment, and diffuse luminal narrowing at the left distal ICA.. C. Neck TOF MR angiography depicts short segmental severe stenosis in the left carotid bulb to the proximal cervical ICA (arrow), diffuse luminal narrowing of the ICA, and moderate stenosis in the right carotid bulb (arrowhead).. D, E. The left carotid VW-MRI (D) and the right carotid VW-MRI (E) show diffuse circumferential wall thickening along both cervical ICAs and carotid bulbs with iso-signal intensity on both T1-and T2WIs; most thickened VWs show no enhancement on post-contrast images, but some show multifocal minor enhancement in the left carotid bulb and cervical ICA; the dotted lines indicate the level of axial imaging, and the arrows point to each blood vessel (VW-MRI parameters are the following: matrix of 320 x 288, field of view of 160 x 160 mm, and section thickness of 1.0 [reconstructed]).. CE = contrast-enhanced, ICA = internal carotid artery, T1WI = T1 weighted image, T2WI = T2 weighted image, TOF = time-of-flight, VW = vessel wall
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F1
The initial brain MRI showed acute infarction in the frontal cortical and subcortical areas of the left middle cerebral artery (MCA) territory on the diffusion-weighted images (Fig. 1A). Time-of-flight MR angiography revealed moderate to severe stenosis in the insular (M2) segment of the left MCA and the horizontal (A1) segment of the right anterior cerebral artery, and mild stenosis in the sphenoidal (M1) segment of the right MCA (Fig. 1B). In addition, short segmental severe stenosis was seen in the left carotid bulb to the proximal cervical internal carotid artery (ICA) with diffuse luminal narrowing of its distal ICA, and moderate stenosis was seen in the right carotid bulb (Fig. 1C). Most thickened blood VWs showed no enhancement in the post-contrast imaging, but some showed multifocal minor enhancement in the left carotid bulb and cervical ICA (Fig. 1D, E; left carotid artery is 1D, and right carotid artery is 1E).