Introduction The recognition of the use of Intracranial magnetic resonance vessel wall imaging (MR-VWI) in clinical practice has gained significantly since its initial attention. Recent research and technological advancement have enabled this tool to assist in diagnosing causes of ischaemic stroke, and also further assist in identifying unstable unruptured aneurysm or ruptured aneurysm when multiple aneurysms are present.

Aim of Study We aim to report and illustrate our initial experience in MR-VWI in a tertiary centre.

Methods Retrospective data collection performed to identify patients’ who had MR-VWI study between 2020 and 2022 at a tertiary care centre in England. Radiological and clinical diagnosis were recorded. Images with positive finding were reanalysed for confirmation.

Results A total of 50 VWI studies were identified, with 18 cases demonstrating positive imaging finding. Majority of the ischaemic cases (10) demonstrate imaging characteristic of intracranial atherosclerotic disease (ICAD). 2 cases of vasculitis were identified which were compatible clinically and biochemically. 2 cases of reverse cerebral vasoconstriction (RCVS) were seen, with normal MR-VWI imaging follow up in 6 months. MR-VWI also identified 4 cases of ruptured/unstable aneurysm in acute presentation. Furthermore, MR-VWI was used in 2 cases to support the clinical diagnosis and exclude the aneurysm as the cause of patient’s intracranial haemorrhage.

Conclusion Our centre’s experience recognises the role of MR-VWI in the imaging of ischaemic stroke, as well as its potential in management of acute unstable intracranial aneurysm. Clinical-radiological correlation remains imperative and emphasis is placed on understanding the potential technical pitfall of MR-VWI.

Disclosure of Interest Nothing to disclose for all authors