Intracranial arterial disease (ICAD) is a heterogeneous condition characterized by distinct pathologies, including atherosclerosis. Advances in magnetic resonance technology have enabled the visualization of intracranial arteries using high-resolution vessel wall imaging (HR-VWI). This review summarizes the anatomical, embryological, and histological differences between the intracranial and extracranial arteries. Next, we review the heterogeneous pathophysiology of ICAD, including atherosclerosis, moyamoya or RNF213 spectrum disease, intracranial dissection, and vasculitis. We also discuss how advances in HR-VWI can be used to differentiate ICAD etiologies. We emphasize that one should consider clinical presentation and timing of imaging in the absence of pathology-radiology correlation data. Future research should focus on understanding the temporal profile of HR-VWI findings and developing quantitative interpretative approaches to improve the decision-making and management of ICAD.

中文翻译：

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颅内动脉疾病的新概念：高分辨率血管壁 MRI 的作用。

颅内动脉疾病（ICAD）是一种异质性疾病，具有不同的病理特征，包括动脉粥样硬化。磁共振技术的进步使得使用高分辨率血管壁成像（HR-VWI）能够实现颅内动脉的可视化。本综述总结了颅内动脉和颅外动脉之间的解剖学、胚胎学和组织学差异。接下来，我们回顾 ICAD 的异质病理生理学，包括动脉粥样硬化、烟雾病或 RNF213 谱系疾病、颅内夹层和血管炎。我们还讨论了如何利用 HR-VWI 的进展来区分 ICAD 病因。我们强调，在缺乏病理学-放射学相关数据的情况下，应考虑临床表现和影像学时机。未来的研究应侧重于了解 HR-VWI 结果的时间概况，并开发定量解释方法以改进 ICAD 的决策和管理。