Intracranial arterial wall imaging: Techniques, clinical applicability, and future perspectives

Purpose:To review the current state of the art and future development of intracranial vessel wall imaging. Methods: Recent literature review and expert opinion about intracranial arterial wall imaging. Results: Intracranial large artery diseases represent an important cause of stroke and vascular cognitive impairment worldwide. Our traditional understanding of intracranial large artery diseases is based on the observation of luminal narrowing or occlusion with angiographic or ultrasound techniques. Recently, novel imaging techniques have made the intracranial artery wall accessible for noninvasive visualization. The main advantage of vessel-wall imaging as compared to conventional imaging techniques for visualization of intracranial arteries is the ability to detect vessel wall changes even before they get to cause any significant luminal stenosis. This diagnostic capacity is provoking a revolutionary change in the way we see the intracranial circulation. In this article, we will review the current state of magnetic resonance imaging and computed tomography-based intracranial arterial wall imaging, focusing on technical considerations and their clinical applicability. Moreover, we will provide the readers with our vision on the future development of vessel-wall imaging techniques. Conclusion: Intracranial arterial wall imaging methods are gaining increasing potential to impact the diagnosis and treatment of patients with cerebrovascular diseases.