Clinical implications of vessel wall imaging-State-of-the-art review

Diseases of the arterial wall are best diagnosed using vessel wall magnetic resonance imaging (MRI) since luminal imaging does not show the extent of wall pathology. Intracranial and extracranial carotid artery pathology such as atherosclerosis, dissections, vasculitis, and occlusions can lead to clinically significant events such as stroke. Direct visualization of the arterial wall pathology using vessel wall MRI can direct clinical diagnosis and management. This review highlights the importance of carotid and intracranial vessel wall MRI and their clinical applications in neurovascular pathologies. Recent developments such as the carotid Plaque-Reporting and Data System risk scoring and intracranial vasculopathy differentiation using vessel wall MRI are reviewed. Technical requirements of vessel wall MRI sequences for clinical diagnosis and future diagnostic approaches such as stroke etiology reclassification are also discussed.