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Clin Neurol Neurosurg. 2019 Oct;185:105482. doi: 10.1016/j.clineuro.2019.105482. Epub 2019 Aug 9.

Concordance of angiography and cerebral biopsy results for suspected primary central nervous system vasculitis: A multi-center retrospective review.

Author information

1
Case Western Reserve University School of Medicine, Cleveland, OH, United States. Electronic address: axr602@case.edu.
2
Case Western Reserve University School of Medicine, Cleveland, OH, United States; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States. Electronic address: jmw171@case.edu.
3
Case Western Reserve University School of Medicine, Cleveland, OH, United States; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States. Electronic address: Christina.wright@uhhospitals.org.
4
Case Western Reserve University School of Medicine, Cleveland, OH, United States; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States. Electronic address: berje.shammassian@uhhospitals.org.
5
Case Western Reserve University School of Medicine, Cleveland, OH, United States. Electronic address: lxo45@case.edu.
6
Case Western Reserve University School of Medicine, Cleveland, OH, United States; Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, United States. Electronic address: hasina.momotaz@case.edu.
7
Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, United States. Electronic address: cxb43@case.edu.
8
Case Western Reserve University School of Medicine, Cleveland, OH, United States; Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, United States; Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland OH, United States; Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland OH, United States. Electronic address: Martha.sajatovic@uhhospitals.org.
9
Department of Neurology, University of Massachusetts Medical School, Worcester MA, United States; Department of Anesthesiology, University of Massachusetts Medical School, Worcester MA, United States; Department of Surgery, University of Massachusetts Medical School, Worcester MA, United States. Electronic address: Raphael.Carandang@umassmemorial.org.
10
Case Western Reserve University School of Medicine, Cleveland, OH, United States; Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland OH, United States. Electronic address: Anthony.furlan@uhhospitals.org.
11
Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland OH, United States; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, OH, United States. Electronic address: calabrl@ccf.org.
12
Case Western Reserve University School of Medicine, Cleveland, OH, United States; Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland OH, United States. Electronic address: Michael.DeGeorgia@UHhospitals.org.

Abstract

OBJECTIVE:

Primary CNS Vasculitis (PCNSV) is a rare disease that is often challenging to diagnose. Cerebral angiography and biopsy have been utilized in the diagnostic workup for several decades but limited literature reports on the concordance of findings of angiography and biopsy. The primary objective of this work was to examine how cerebral angiography corresponded with biopsy findings in patients with suspected PCNSV.

PATIENTS AND METHODS:

A total of 128 patients who underwent workup for PCNSV between years 2005-2016 were identified by query of existing neurological surgery and angiography databases at University Hospitals Cleveland Medical Center (UHCMC) and the Cleveland Clinic Foundation (CCF). The primary outcome was to examine the concordance of results between angiography and cerebral biopsy. Secondary outcomes included examining concordance between results of biopsy and other commonly performed tests for diagnosis of PCNSV including Magnetic Resonance Imaging (MRI), cerebrospinal fluid white blood cell count (CSF WBC), Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP).

RESULTS:

128 patients underwent cerebral biopsy for diagnosis of suspected PCNSV. 93 (73%) of these patients also underwent angiography. Of the 34 patients with positive biopsy findings, only 5 also had positive angiography. Positive angiography was not found to be correlated with positive biopsy in our analysis. The only test that was significantly associated with biopsy proven vasculitis was increased CSF WBC count (P = 0.0114).

CONCLUSIONS:

PCNSV is a rare disease and often requires multiple tests or procedures to obtain definitive diagnosis. These results suggest that cerebral angiography findings are not associated with biopsy findings and should be used cautiously in the diagnostic work-up of PCNSV.

KEYWORDS:

Angiogram; Angiography; Biopsy; CNS; Diagnosis; Vasculitis

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