Sila Ulus1, Umit Aksoy Ozcan2, Aydan Arslan2, Ali Buturak3, Alp Dincer2, Simay Kara2, Ercan Karaarslan2. 1. Department of Radiology, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey. silaulus@hotmail.com. 2. Department of Radiology, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey. 3. Department of Cardiology, Sisli Florence Nightingale Hospital, Istanbul, Turkey.
Abstract
PURPOSE: Acute neck pain can have non-vascular and vascular causes. Some patients present with distinct vascular and perivascular changes on imaging at the site of tenderness. This study aimed to evaluate the imaging findings of transient perivascular inflammation of the carotid artery (TIPIC) syndrome with an emphasis on vessel wall imaging using 3‑Tesla (3-T) high-resolution (HR) magnetic resonance imaging (MRI). METHODS: Clinical data along with diagnostic and follow-up imaging of patients presenting to these hospitals with acute neck pain/tenderness and at least 1 imaging study using color Doppler ultrasound (CDU) and/or MRI including vessel wall imaging from September 2013 through September 2017 were retrospectively evaluated. A total of 15 patients with no other underlying cause of pain, findings meeting the imaging criteria for TIPIC syndrome and clinical recovery (spontaneous or with treatment) were included in the study. RESULTS: The mean patient age was 43.2 years. With CDU and precontrast MRI, perivascular inflammation (PVI) of the involved artery segment was evident in all patients. Contrast enhancement of the adventitia and PVI were noted on postcontrast HR vessel wall MRI in all patients. Of the patients five had co-existing plaques at the site of tenderness. Follow-up imaging demonstrated pronounced regression or complete resolution of the findings. CONCLUSION: Imaging is useful for the establishment of TIPIC syndrome diagnosis and to rule out other conditions. The use of CDU is usually sufficient for diagnosis and follow-up but in clinically doubtful and complicated cases, vessel wall imaging with HR-MRI is very valuable. Thorough knowledge of this entity among radiologists enables a prompt diagnosis, which accelerates the clinical management.
PURPOSE: Acute neck pain can have non-vascular and vascular causes. Some patients present with distinct vascular and perivascular changes on imaging at the site of tenderness. This study aimed to evaluate the imaging findings of transient perivascular inflammation of the carotid artery (TIPIC) syndrome with an emphasis on vessel wall imaging using 3‑Tesla (3-T) high-resolution (HR) magnetic resonance imaging (MRI). METHODS: Clinical data along with diagnostic and follow-up imaging of patients presenting to these hospitals with acute neck pain/tenderness and at least 1 imaging study using color Doppler ultrasound (CDU) and/or MRI including vessel wall imaging from September 2013 through September 2017 were retrospectively evaluated. A total of 15 patients with no other underlying cause of pain, findings meeting the imaging criteria for TIPIC syndrome and clinical recovery (spontaneous or with treatment) were included in the study. RESULTS: The mean patient age was 43.2 years. With CDU and precontrast MRI, perivascular inflammation (PVI) of the involved artery segment was evident in all patients. Contrast enhancement of the adventitia and PVI were noted on postcontrast HR vessel wall MRI in all patients. Of the patients five had co-existing plaques at the site of tenderness. Follow-up imaging demonstrated pronounced regression or complete resolution of the findings. CONCLUSION: Imaging is useful for the establishment of TIPIC syndrome diagnosis and to rule out other conditions. The use of CDU is usually sufficient for diagnosis and follow-up but in clinically doubtful and complicated cases, vessel wall imaging with HR-MRI is very valuable. Thorough knowledge of this entity among radiologists enables a prompt diagnosis, which accelerates the clinical management.
Entities:
Keywords:
Carotidynia; Color Doppler ultrasonography; Magnetic resonance angiography; Magnetic resonance imaging; Neck pain
Authors: F Comacchio; R Bottin; G Brescia; K Tsilikas; T Volo; A Tregnaghi; A Martini Journal: Acta Otorhinolaryngol Ital Date: 2012-08 Impact factor: 2.124
Authors: Nicola Maggialetti; Ilaria De Marco; Sara Sasso; Giuseppe Farchi; Amato Antonio Stabile Ianora; Nicola Maria Lucarelli; Arnaldo Scardapane Journal: Radiol Case Rep Date: 2022-05-06