Diagnostic Performance of Vessel Wall Magnetic Resonance Imaging (VW-MRI) for Intracranial Vasculopathies: A Systematic Review and Meta-Analysis

Vessel wall magnetic resonance imaging (VW-MRI) provides superior capabilities, compared to traditional angiography, in evaluating intracranial vessel walls. This study aimed to assess the diagnostic performance of VW-MRI in intracranial vasculopathies. This systematic review and meta-analysis followed PRISMA guidelines. PubMed, Scopus, Web of Science, Cochrane Library, and ScienceDirect were searched to identify studies investigating the diagnostic performance of VW-MRI in intracranial vasculopathies. Eligible studies should report sufficient data to construct 2 × 2 contingency tables. Disease categories were included only if at least two studies were available. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) were estimated using a bivariate model. Study quality was assessed using the QUADAS (Quality Assessment of Diagnostic Accuracy Studies) tool. Ten studies on intracranial atherosclerotic disease (ICAD) demonstrated high diagnostic accuracy (sensitivity 0.877; specificity 0.808; DOR 34.2; AUC 0.907). Subgroup analyses confirmed reliability in detecting stenosis, distinguishing culprit from non-culprit lesions, and identifying eccentric wall thickening as a biomarker. Six studies on intracranial vasculitis showed strong diagnostic performance of concentric wall enhancement (sensitivity 0.817; specificity 0.864; DOR 44.9; AUC 0.909). Two studies on intracranial dissection reported high accuracy (sensitivity 0.901; specificity 0.829; DOR 58.1; AUC 0.930). VW-MRI demonstrates excellent diagnostic performance for ICAD, intracranial vasculitis, and dissection. It provides added value beyond conventional imaging by enabling evaluation of vessel wall features and lesion characterization. Further high-quality studies, with larger sample sizes, are needed to validate its clinical utility.