Magnetic resonance imaging of the carotid artery in long-term head and neck cancer survivors treated with radiotherapy

<div><p></p><p><b><i>Background.</i></b> In head and neck cancer (HNC) patients, long-term treatment-related complications include radiotherapy (RT)-induced carotid vasculopathy and stroke. The current study investigated the magnetic resonance imaging (MRI) characteristics of the carotid wall in long-term HNC survivors treated with RT.</p><p><b><i>Methods.</i></b> MRI of the carotid arteries was performed within a prospective cohort of 42 HNC patients on average 7 years after RT. Two independent radiologists assessed maximal vessel wall thickness of common and internal carotid arteries. In case of wall thickening (≥ 2 mm) the MRI signals as well as length of the thickened segment were assessed.</p><p><b><i>Results.</i></b> Mean (SD) age of the 42 patients at baseline was 53 (13) years and mean (SD) follow-up time after RT was 6.8 (1.3) years. In total 62% were men and 60% had one or more cerebrovascular risk factors. Mean (SD) dose of RT on the common carotid arteries and internal carotid arteries was 57 Gy (11) and 61 Gy (10), respectively. Wall thickening was observed in 58% of irradiated versus 27% of non-irradiated common carotid arteries and 24% of irradiated versus 6% of non-irradiated internal carotid arteries (p < 0.05). Mean (SD) thickness of the irradiated and non-irradiated common carotid arteries was 2.5 (0.9) and 2 (0.7) mm (p = 0.02). Mean thickness of the irradiated and non-irradiated internal carotid arteries was 1.8 (0.8) and 1.5 mm (0.3) (n.s.). Mean length of the thickened vessel wall was 48 mm versus 36 mm in the irradiated versus non-irradiated common carotid arteries (p = 0.03) and 20 mm versus 15 mm in the irradiated versus non-irradiated internal carotid arteries (n.s.). No significant differences were observed for signal intensities of the vessel walls.</p><p><b><i>Conclusions.</i></b> Our study showed significantly more vessel wall thickening in irradiated versus non-irradiated carotid arteries years after RT for HNC, while no differences in signal intensities were observed.</p></div

Baseline characteristics of patients.

<p>Abbreviations: TIA, transient ischemic attack; SD, standard deviation; NIHSS, National Institute of Health Stroke Scale; IQR, interquartile range; TOAST, Trial of Org 10172 in Acute Stroke Treatment.</p><p>Data are given as number (percentage) or otherwise stated</p>*<p>Scores range from 0 to 42 with higher scores on the scale indicating worse stroke severity. 0.5% of NIHSS was missing.</p>†<p>Smoking was defined as smoking at least 1 cigarette a day in the year prior to the event. 1.9% of data on smoking was missing.</p>‡<p>Excess alcohol consumption was defined as consuming more than 200 grams of pure alcohol per week</p>§<p>First degree family member. 0.9% of data on family history of diabetes was missing.</p

Presence of baseline factors in patients with incident diabetes or impaired fasting glucose at follow-up.

<p>Abbreviations: IFG, impaired fasting glucose; TIA, transient ischemic attack; SD, standard deviation; NIHSS, National Institute of Health Stroke Scale; IQR, interquartile range; TOAST, Trial of Org 10172 in Acute Stroke Treatment.</p><p>Data are given as number (percentage) or otherwise stated</p>*<p><i>p</i> values refer to a comparison between patients with incident diabetes and patients with no IFG or diabetes</p>†<p><i>p</i> values refer to a comparison between patients with IFG and patients with no IFG or diabetes</p>‡<p>Scores range from 0 to 42 with higher scores on the scale indicating worse stroke severity. 0.4% of NIHSS was missing.</p>§<p>Smoking was defined as smoking at least 1 cigarette a day in the year prior to the event. 2.9% of data on smoking was missing.</p>||<p>Excess alcohol consumption was defined as consuming more than 200 grams of pure alcohol per week</p>¶<p>First degree family member. 1.0% of data on family history of diabetes was missing.</p