Association between spontaneous internal carotid artery dissection and perivascular adipose tissue attenuation on computed tomography angiography

Author:

Cheng Kevin12ORCID,Lin Andrew123,Stecher Ximena4,Bernstein Tomas4,Zuñiga Paulo4,Mazzon Enrico56ORCID,Brunser Alejandro6,Diaz Violeta6,Martinez Gonzalo78,Cameron William1,Nicholls Stephen J12,Patel Sanjay9,Dey Damini3,Wong Dennis TL12,Muñoz Venturelli Paula5610ORCID

Affiliation:

1. Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University and MonashHeart, Monash Health, Clayton, VIC, Australia

2. Department of Medicine, Monash University, Clayton, VIC, Australia

3. Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA

4. Departamento de Imagenología, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile

5. Centro de Estudios Clínicos, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile

6. Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile

7. División de Enfermedades Cardiovasculares, Pontificia Universidad Católica de Chile, Santiago, Chile

8. Millennium Nucleus for Cardiovascular Magnetic Resonance, Santiago, Chile

9. Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia

10. The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia

Abstract

Background: Spontaneous cervical artery dissection (sCAD) is a leading cause of ischemic stroke in young patients. Studies using high-resolution magnetic resonance imaging and positron emission tomography have suggested vessel wall inflammation to be a pathogenic factor in sCAD. Computed tomography (CT) attenuation of perivascular adipose tissue (PVAT) is an established non-invasive imaging biomarker of inflammation in coronary arteries, with higher attenuation values reflecting a greater degree of vascular inflammation. Objectives: We evaluate the CT attenuation of PVAT surrounding the internal carotid artery (PVATcarotid) with and without spontaneous dissection. Methods: Single-center prospective observational study of 56 consecutive patients with CT-verified spontaneous dissection of the internal carotid artery (ICA). Of these patients, six underwent follow-up computed tomography angiography (CTA). Twenty-two patients who underwent CTA for acute neurological symptoms but did not have dissection formed the control group. Using semi-automated research software, PVATcarotid was measured as the mean Hounsfield unit (HU) attenuation of adipose tissue within a defined volume of interest surrounding the ICA. Results: PVATcarotid was significantly higher around dissected ICA compared with non-dissected contralateral ICA in the same patients (−58.7 ± 10.2 vs −68.9 ± 8.1 HU, p < 0.0001) and ICA of patients without dissection (−58.7 ± 10.2 vs −69.3 ± 9.3 HU, p < 0.0001). After a median follow-up of 89 days, there was a significant reduction in PVATcarotid around dissected ICA (−57.5 ± 13.4 to −74.3 ± 10.5 HU, p < 0.05), while no change was observed around non-dissected contralateral ICA (−71.0 ± 4.4 to −74.1 ± 4.1 HU, p = 0.19). ICA dissection was an independent predictor of PVATcarotid following multivariable adjustment for age and the presence of ICA occlusion. Conclusion: PVATcarotid is elevated in the presence of sCAD and may decrease following the acute event.

Funder

National Agency for Research and Development ANID FONDECYT

National Health and Medical Research Council

Publisher

SAGE Publications

Subject

Neurology,Neurology (clinical)

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