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      <h1 class="highwire-cite-title" id="page-title">Vessel Wall Imaging: A Powerful Diagnostic Tool but Not a Substitute for Biopsies</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">S.R. Zeiler</span> and <span class="highwire-citation-author" data-delta="1">B.A. Wasserman</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">December 2021,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">42 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(12) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">E79; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A7277 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-94539--61914184960" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">S.R. Zeiler </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Department of NeurologyJohns Hopkins UniversityBaltimore, Maryland</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.R.%2BZeiler%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Zeiler%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.R.%2BZeiler%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-5430-446X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S.R. Zeiler</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">B.A. Wasserman </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Diagnostic Radiology & Nuclear MedicineUniversity of Maryland School of Medicine and The Russell H. Morgan Department of Radiology and Radiological SciencesJohns Hopkins UniversityBaltimore, Maryland</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=B.A.%2BWasserman%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Wasserman%20B&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AB.A.%2BWasserman%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-8458-1778" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for B.A. Wasserman</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view "><span class="highwire-journal-article-marker-start"></span><p id="p-1">We read with interest the letter from Drs Corrêa and Hygino da Cruz, Jr, describing their patient with Varicella zoster virus vasculitis.<sup><a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a></sup> We agree that a biopsy is not always necessary for diagnosing vascular inflammation with the use of high-resolution 3D vessel wall MR imaging (VWMRI) in the appropriate clinical context. However, we caution readers who might then believe that brain biopsy can be replaced with VWMRI.</p><p id="p-2">Determining the underlying etiology of a patient’s intravascular inflammation is essential to determining prognostication and treatment. In the case presented by Drs Corrêa and Hygino da Cruz, Jr, Varicella zoster virus infection was diagnosed by polymerase chain reaction performed on CSF, suggesting that VWMRI was not needed in this case. In the many cases in which serum, CSF, and other work-ups are nondiagnostic for an underlying etiology, we suggest that biopsy remains instrumental in tailoring therapy. Notably, our data indicate that VWMRI can be used to identify inflamed intracranial vessels but is otherwise unable to distinguish among primary, infectious, and/or any etiology leading to perivascular inflammation.<sup><a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a></sup></p><p id="p-3">Thus, VWMRI should be paired with diagnostic tools that can confirm an etiology, namely VWMRI-directed intracranial biopsy, after which VWMRI could be useful for tracking treatment response. Thus, we disagree with the assertions of Drs Corrêa and Hygino da Cruz, Jr, that might encourage readers to turn to current VWMRI to avoid invasive procedures such as brain biopsy.</p><div class="section ref-list" id="ref-list-1"><h2 class="">References</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a><div class="cit ref-cit ref-journal" id="cit-42.12.E79.1" data-doi="10.3174/ajnr.A5950"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Corrêa</span>  <span class="cit-name-given-names">DG</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Hygino da Cruz</span>  <span class="cit-name-given-names">LC</span></span></li></ol><cite> Jr. <span class="cit-article-title">High-resolution vessel wall MR imaging as an alternative to brain biopsy</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">2019</span>;<span class="cit-vol">40</span>:<span class="cit-fpage">E17</span>–<span class="cit-lpage">18</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.3174/ajnr.A5950</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>30679219</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo4OiI0MC8zL0UxNyI7czo0OiJhdG9tIjtzOjIwOiIvYWpuci80Mi8xMi9FNzkuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">2.</span><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2. in text" id="ref-2">↵</a><div class="cit ref-cit ref-journal" id="cit-42.12.E79.2" data-doi="10.3174/ajnr.A5801"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Zeiler</span>  <span class="cit-name-given-names">SR</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Qiao</span>  <span class="cit-name-given-names">Y</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Pardo</span>  <span class="cit-name-given-names">CA</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Vessel wall MRI for targeting biopsies of intracranial vasculitis</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">2018</span>;<span class="cit-vol">39</span>:<span class="cit-fpage">2034</span>–<span class="cit-lpage">36</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.3174/ajnr.A5801</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>30262647</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czoxMDoiMzkvMTEvMjAzNCI7czo0OiJhdG9tIjtzOjIwOiIvYWpuci80Mi8xMi9FNzkuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li></ol></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2021 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 42</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 12 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Dec 2021 </div></div>
      
      
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