Association between spontaneous internal carotid artery dissection and perivascular adipose tissue attenuation on computed tomography angiography
Journal
International Journal of Stroke
ISSN
1747-4930
1747-4949
Date Issued
2023
Author(s)
Kevin Cheng
Andrew Lin
Tomas Bernstein
Gonzalo Martinez
William Cameron
Stephen J Nicholls
Sanjay Patel
Damini Dey
Dennis TL Wong
Type
Resource Types::text::journal::journal article
URL Institutional Repository
Abstract
<jats:sec><jats:title>Background:</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Objectives:</jats:title><jats:p> We evaluate the CT attenuation of PVAT surrounding the internal carotid artery (PVAT<jats:sub>carotid</jats:sub>) with and without spontaneous dissection. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> 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, PVAT<jats:sub>carotid</jats:sub> was measured as the mean Hounsfield unit (HU) attenuation of adipose tissue within a defined volume of interest surrounding the ICA. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> PVAT<jats:sub>carotid</jats:sub> 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 PVAT<jats:sub>carotid</jats:sub> 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 PVAT<jats:sub>carotid</jats:sub> following multivariable adjustment for age and the presence of ICA occlusion. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> PVAT<jats:sub>carotid</jats:sub> is elevated in the presence of sCAD and may decrease following the acute event. </jats:p></jats:sec>
Cite this document
Cheng, K., Lin, A., Stecher, X., Bernstein, T., Zuñiga, P., Mazzon, E., Brunser, A., Diaz, V., Martinez, G., Cameron, W., Nicholls, S. J., Patel, S., Dey, D., Wong, D. T., & Muñoz Venturelli, P. (2023). Association between spontaneous internal carotid artery dissection and perivascular adipose tissue attenuation on computed tomography angiography. International Journal of Stroke, 18(7), 829-838. https://doi.org/10.1177/17474930231158538
Subjects
computed tomography angiography
;
internal carotid artery
;
perivascular adipose tissue
;
spontaneous dissection
;
adipose tissue
;
carotid artery, internal
;
carotid artery, internal, dissection
;
computed tomography angiography
;
humans
;
inflammation
;
stroke
;
tomography, x-ray computed
;
acetylsalicylic acid
;
clopidogrel
;
iohexol
;
acute disease
;
adult
;
age
;
article
;
carotid artery injury
;
cerebrovascular accident
;
cohort analysis
;
computed tomographic angiography
;
controlled study
;
female
;
follow up
;
human
;
image analysis
;
internal carotid artery
;
internal carotid artery occlusion
;
major clinical study
;
male
;
neurologic disease
;
non invasive measurement
;
observational study
;
perivascular adipose tissue
;
perivascular adipose tissue attenuation
;
prospective study
;
quantitative analysis
;
radiation attenuation
;
vasculitis
;
adipose tissue
;
cerebrovascular accident
;
complication
;
computed tomographic angiography
;
diagnostic imaging
;
inflammation
;
procedures
;
x-ray computed tomography