Radiological management of reversible cerebral vasoconstriction syndrome (RCVS) in France: a national multicenter survey

BACKGROUND AND PURPOSE: The management of reversible cerebral vasoconstriction syndrome (RCVS) lacks formal imaging guidelines, resulting in variable diagnostic and follow-up strategies. This study aimed to evaluate contemporary radiological practices for RCVS across French academic centers and to derive a pragmatic imaging pathway based on observed consensus and literature data. MATERIALS AND METHODS: A national, multicenter, cross-sectional survey was conducted between February 2025 and January 2026 among French academic neuroradiology centers. An online questionnaire assessed first-line imaging modalities, protocol components, confirmatory strategies, and long-term follow-up practices as implemented during the 2024 calendar year. Data were analyzed descriptively. RESULTS: Twenty-six centers responded (87%, 26/30). CT angiography was the preferred first-line modality (77%). MRI was universally incorporated, with consistent use of a core protocol (diffusion-weighted imaging, fluid-attenuated inversion recovery, susceptibility-weighted imaging, and MR angiography), while advanced sequences showed marked variability. After a positive initial examination, 54% of centers performed confirmatory imaging, most commonly MRI. In cases of high clinical suspicion despite negative initial imaging, 69% performed follow-up imaging, with heterogeneous timing. Long-term imaging to document reversibility was performed by 85% of centers. Digital subtraction angiography was reserved for selected cases and was not performed for therapeutic purposes. CONCLUSIONS: The radiological management of reversible cerebral vasoconstriction syndrome in France demonstrates a strong consensus regarding initial emergency imaging but substantial heterogeneity in confirmatory and follow-up strategies. Based on survey findings and published data on the temporal dynamics of reversible cerebral vasoconstriction syndrome, we propose a pragmatic imaging pathway intended as a structured synthesis rather than a formal recommendation. Prospective validation is warranted.