Key result
Generalized vessel wall inflammation was detected in 14% of patients by hrMRI and 24% by PET-CT, and was significantly associated with >2 simultaneous dissections on hrMRI (P=0.015).
Why the study?
Does contrast-enhanced hrMRI and PET-CT detect vessel wall inflammation in patients with spontaneous cervical artery dissection?
Observational (n=37)
No
Does contrast-enhanced hrMRI and PET-CT detect vessel wall inflammation in patients with spontaneous cervical artery dissection?
A subset of patients with spontaneous cervical artery dissection exhibit generalized transient inflammatory arteriopathy on hrMRI and PET-CT, which may predispose them to multiple dissections.
Generalized VWI on hrMRI/PET-CT may flag CAD patients at higher multiple-dissection risk; leaves open whether inflammation drives pathogenesis.
BACKGROUND AND PURPOSE: Vessel wall inflammation (VWI) may be a pathogenetic factor in cervical artery dissection (CAD). We used contrast-enhanced high-resolution MRI (hrMRI) and positron emission tomography CT (PET-CT) to systematically investigate VWI in spontaneous CAD. METHODS: In this monocentric, prospective, observational study, all consecutive patients with acute, MRI-confirmed, spontaneous CAD admitted to our center between August 2007 and August 2009 were included. VWI was defined as perivascular contrast enhancement in hrMRI and increased perivascular [18F]-fluorodesoxyglucose uptake in PET-CT. VWI was further differentiated between local (restricted to the site of dissection) and generalized (exceeding the site of dissection). RESULTS: A total of 37 patients were included. Multiple dissections were seen in 10 patients (27%). Twenty-five patients received both modalities as planned, 8 received only PET-CT, and 4 received only hrMRI. A subset of patients showed signs of a generalized VWI in hrMRI (4/29 patients, 14%) and PET-CT (8/33 patients, 24%). In patients who received both modalities, all with hrMRI signs of generalized VWI were PET-CT positive (3/3), whereas some PET-CT-positive patients were hrMRI-negative (4/7). If present, generalized VWI in hrMRI completely resolved within 6 months. The presence of >2 simultaneous dissections (seen in 2 patients) was significantly associated with generalized VWI in hrMRI (P=0.015) but marginally not in PET-CT (P=0.053). CONCLUSIONS: A subset of patients with spontaneous CAD showed signs of a generalized transient inflammatory arteriopathy in contrast-enhanced hrMRI and PET-CT. This subset of patients may be more prone to multiple dissections.
No takes yet. Share an insight, caveat, or question.
Pfefferkorn et al. (2011) conducted an observational in spontaneous cervical artery dissection (n=37). Vessel wall inflammation assessment via hrMRI and PET-CT was evaluated on generalized vessel wall inflammation (VWI). Generalized vessel wall inflammation was detected in 14% of patients by hrMRI and 24% by PET-CT, and was significantly associated with >2 simultaneous dissections on hrMRI (P=0.015).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: