Still difficult if not impossible to diagnose CNS vasculitis by just imaging. Notoriously, neuro-radiologists tend to over-read these images, including the mentioning of "vasculitis" in just about every differential diagnosis, prompting rheumatology consults in a variety of different setting and diseases. That's the problem, since such a diagnosis would mandate immunosuppression. I have discontinued said therapy in many patients with diabetes and widespread atherosclerotic disease, diagnosed as having "CNS vasculitis". They all had a vasculopathy allright but not true vasculitis,