AJNR. American journal of neuroradiology · 2026
Radiological management of reversible cerebral vasoconstriction syndrome (RCVS) in France: a national multicenter survey.
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Dimitrov Benoît, Samoyeau Thomas, Agripnidis Thibault, Scarcia Luca, Dumas Victor, Forestier Géraud, Marnat Gaultier, Charbonnier Guillaume, Zhu François, Holay Quentin, Boucherit Julien, Shotar Eimad, Donnard Baptiste, Guedon Alexis, Bellanger Guillaume, Ognard Julien, Cortese Jonathan, Tessier Guillaume, Rouchaud Aymeric, Hausser Lucile, Boutet Claire, Bousquet Joachim, Keita Aboubacar, Lecler Augustin, Pagano Paolo, Burel Julien, L'allinec Vincent, JENI and JEDI Research Collaboration
Аннотация
BACKGROUND AND PURPOSE: The management of reversible cerebral vasoconstriction syndrome (RCVS) lacks formal imaging guidelines, resulting in variable diagnostic and follow-up strategies. This study aimed to evaluate contemporary radiological practices for RCVS across French academic centers and to derive a pragmatic imaging pathway based on observed consensus and literature data.
MATERIALS AND METHODS: A national, multicenter, cross-sectional survey was conducted between February 2025 and January 2026 among French academic neuroradiology centers. An online questionnaire assessed first-line imaging modalities, protocol components, confirmatory strategies, and long-term follow-up practices as implemented during the 2024 calendar year. Data were analyzed descriptively.
RESULTS: Twenty-six centers responded (87%, 26/30). CT angiography was the preferred first-line modality (77%). MRI was universally incorporated, with consistent use of a core protocol (diffusion-weighted imaging, fluid-attenuated inversion recovery, susceptibility-weighted imaging, and MR angiography), while advanced sequences showed marked variability. After a positive initial examination, 54% of centers performed confirmatory imaging, most commonly MRI. In cases of high clinical suspicion despite negative initial imaging, 69% performed follow-up imaging, with heterogeneous timing. Long-term imaging to document reversibility was performed by 85% of centers. Digital subtraction angiography was reserved for selected cases and was not performed for therapeutic purposes.
CONCLUSIONS: The radiological management of reversible cerebral vasoconstriction syndrome in France demonstrates a strong consensus regarding initial emergency imaging but substantial heterogeneity in confirmatory and follow-up strategies. Based on survey findings and published data on the temporal dynamics of reversible cerebral vasoconstriction syndrome, we propose a pragmatic imaging pathway intended as a structured synthesis rather than a formal recommendation. Prospective validation is warranted.
MATERIALS AND METHODS: A national, multicenter, cross-sectional survey was conducted between February 2025 and January 2026 among French academic neuroradiology centers. An online questionnaire assessed first-line imaging modalities, protocol components, confirmatory strategies, and long-term follow-up practices as implemented during the 2024 calendar year. Data were analyzed descriptively.
RESULTS: Twenty-six centers responded (87%, 26/30). CT angiography was the preferred first-line modality (77%). MRI was universally incorporated, with consistent use of a core protocol (diffusion-weighted imaging, fluid-attenuated inversion recovery, susceptibility-weighted imaging, and MR angiography), while advanced sequences showed marked variability. After a positive initial examination, 54% of centers performed confirmatory imaging, most commonly MRI. In cases of high clinical suspicion despite negative initial imaging, 69% performed follow-up imaging, with heterogeneous timing. Long-term imaging to document reversibility was performed by 85% of centers. Digital subtraction angiography was reserved for selected cases and was not performed for therapeutic purposes.
CONCLUSIONS: The radiological management of reversible cerebral vasoconstriction syndrome in France demonstrates a strong consensus regarding initial emergency imaging but substantial heterogeneity in confirmatory and follow-up strategies. Based on survey findings and published data on the temporal dynamics of reversible cerebral vasoconstriction syndrome, we propose a pragmatic imaging pathway intended as a structured synthesis rather than a formal recommendation. Prospective validation is warranted.