title: Vessel wall inflammation in spontaneous cervical artery dissection: a prospective, observational positron emission tomography, computed tomography, and magnetic resonance imaging study.
abstract: OBJECTIVE
  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.
authors.affiliation: Klinikum Grosshadern, Department of Neurology, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany. Thomas.Pfefferkorn@med.uni-muenchen.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Pfefferkorn
authors.forename: Tobias
authors.initials: T
authors.lastname: Saam
authors.forename: Axel
authors.initials: A
authors.lastname: Rominger
authors.forename: Maximilian
authors.initials: M
authors.lastname: Habs
authors.forename: Lisa-Ann
authors.initials: LA
authors.lastname: Gerdes
authors.forename: Caroline
authors.initials: C
authors.lastname: Schmidt
authors.forename: Clemens
authors.initials: C
authors.lastname: Cyran
authors.forename: Andreas
authors.initials: A
authors.lastname: Straube
authors.forename: Jennifer
authors.initials: J
authors.lastname: Linn
authors.forename: Konstantin
authors.initials: K
authors.lastname: Nikolaou
authors.forename: Peter
authors.initials: P
authors.lastname: Bartenstein
authors.forename: Maximilian
authors.initials: M
authors.lastname: Reiser
authors.forename: Marcus
authors.initials: M
authors.lastname: Hacker
authors.forename: Martin
authors.initials: M
authors.lastname: Dichgans
mesh_terms: D000328:Adult; D001158:Arteries / Q000473:pathology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007249:Inflammation / Q000000981:diagnostic imaging / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D020217:Vertebral Artery Dissection / Q000000981:diagnostic imaging* / Q000473:pathology*
chemical_list: D019788:Fluorodeoxyglucose F18