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High-resolution MR imaging of periarterial edema associated with biological inflammation in spontaneous carotid dissection

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Abstract

It has been suggested that spontaneous cervical carotid artery dissection (sCAD) may result from arterial inflammation. Periarterial edema (PAE), occasionally described in the vicinity of the mural hematoma in patients with sCAD, may support this hypothesis. Using cervical high-resolution magnetic resonance imaging, three readers, blinded to the mechanism of carotid artery dissection, searched for PAE, defined as periarterial T2-hyperintensity and T1-hypointensity, in 29 consecutive CAD patients categorized as spontaneous CAD (sCAD, n = 18) or traumatic CAD (tCAD, n = 11; i.e., major head or neck trauma within 2 weeks before the clinical onset). The relationships between PAE, inflammatory biological markers, history of infection and CAD mechanism were explored. Multiple CADs (n = 8) were found only in sCAD patients. Compared with tCAD, patients with sCAD were more likely to have a recent history of infection (OR = 12.5 [95%CI = 1.3–119], p = 0.03), PAE (83% vs. 27%; OR = 13.3 [95%CI = 2.2–82.0], p = 0.005) and to have elevated CRP (OR = 6.1 [95%CI = 1.2–32.1], p = 0.0002) or ESR (OR = 8.8 [95%CI = 1.5–50.1], p = 0.002) values. Interobserver agreement was 0.84 or higher for PAE identification. sCAD was associated with PAE and biological inflammation. Our results support the hypothesis of an underlying arterial inflammation in sCAD.

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Authors and Affiliations

  1. Department of Neuroradiology, Paris-Descartes University, EA 4055, INSERM U894, Centre Hospitalier Sainte-Anne, 1 rue Cabanis, 75014, Paris, France

    Olivier Naggara, Rodolpho Marsico, Jean-François Meder & Catherine Oppenheim

  2. Department of Neurology, Paris-Descartes University, EA 4055, INSERM U894, Centre Hospitalier Sainte-Anne, Paris, France

    Emmanuel Touzé & Jean-Louis Mas

  3. Department of Neuroradiology, University Hospital Roger Salengro, EA 2691, Lille, France

    Xavier Leclerc & Jean-Pierre Pruvo

  4. Department of Neurology, Neurosurgery, and Radiology, Boston University Medical Center, Boston, MA, USA

    Thanh Nguyen

Authors
  1. Olivier Naggara
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  2. Emmanuel Touzé
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  3. Rodolpho Marsico
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  4. Xavier Leclerc
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  5. Thanh Nguyen
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  6. Jean-Louis Mas
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  7. Jean-Pierre Pruvo
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  8. Jean-François Meder
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  9. Catherine Oppenheim
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Correspondence to Olivier Naggara.

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Naggara, O., Touzé, E., Marsico, R. et al. High-resolution MR imaging of periarterial edema associated with biological inflammation in spontaneous carotid dissection. Eur Radiol 19, 2255–2260 (2009). https://doi.org/10.1007/s00330-009-1415-5

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  • DOI: https://doi.org/10.1007/s00330-009-1415-5

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