Assessing radiation-induced carotid vasculopathy using ultrasound after unilateral irradiation: a cross-sectional study

Judith T Pruijssen, Joyce Wilbers, Frederick J A Meijer, Sjoert A H Pegge, Jacqueline J Loonen, Chris L de Korte, Johannes H A M Kaanders, Hendrik H G Hansen, Judith T Pruijssen, Joyce Wilbers, Frederick J A Meijer, Sjoert A H Pegge, Jacqueline J Loonen, Chris L de Korte, Johannes H A M Kaanders, Hendrik H G Hansen

Abstract

Background: Increased head and neck cancer (HNC) survival requires attention to long-term treatment sequelae. Irradiated HNC survivors have a higher ischemic stroke risk. However, the pathophysiology of radiation-induced vasculopathy is unclear. Arterial stiffness could be a biomarker. This study examined alterations in intima-media thickness (IMT) and stiffness-related parameters, shear wave (SWV) and pulse wave velocity (PWV), in irradiated compared to control carotids in unilateral irradiated patients.

Methods: Twenty-six patients, median 40.5 years, 5-15 years after unilateral irradiation for head and neck neoplasms underwent a bilateral carotid ultrasound using an Aixplorer system with SL18-5 and SL10-2 probes. IMT, SWV, and PWV were assessed in the proximal, mid, and distal common (CCA) and internal carotid artery (ICA). Plaques were characterized with magnetic resonance imaging. Measurements were compared between irradiated and control sides, and radiation dose effects were explored.

Results: CCA-IMT was higher in irradiated than control carotids (0.54 [0.50-0.61] vs. 0.50 [0.44-0.54] mm, p = 0.001). For stiffness, only anterior mid-CCA and posterior ICA SWV were significantly higher in the irradiated side. A radiation dose-effect was only (weakly) apparent for PWV (R2: end-systolic = 0.067, begin-systolic = 0.155). Ultrasound measurements had good-excellent intra- and interobserver reproducibility. Plaques had similar characteristics but were more diffuse in the irradiated side.

Conclusions: Increased CCA-IMT and SWV in some segments were seen in irradiated carotids. These alterations, even in young patients, mark the need for surveillance of radiation-induced vasculopathy.

Trial registration: clinicaltrials.gov ( https://ichgcp.net/clinical-trials-registry/NCT04257968 ).

Keywords: Carotid vasculopathy; Intima-media thickness; Pulse wave velocity; Radiotherapy; Shear wave elastography.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flowchart of patient inclusion. NPA neuropsychological assessment, RT radiotherapy, MRI magnetic resonance imaging
Fig. 2
Fig. 2
Box- and dot plots of differences in intima-media thickness (upper left), pulse wave velocity (upper right), and shear wave velocity (bottom) between the irradiated and control side in different carotid segments. IMT intima-media thickness, CCA common carotid artery, ICA internal carotid artery, PWV pulse wave velocity, BS begin-systolic, ES end-systolic, SWV shear wave velocity, Prox proximal, Dist distal, Ant anterior, Post posterior. *Significant difference (p < 0.05) between irradiated and control side
Fig. 3
Fig. 3
Scatterplots of radiation dose–effect relation for intima-media thickness (upper left), pulse wave velocity (upper right), and shear wave velocity in the different carotid segments (middle left to lower right). Differences in ultrasound parameters are plotted against differences in radiotherapy dose in the irradiated compared to the control side. IMT intima-media thickness, PWV pulse wave velocity, SWV shear wave velocity, BS begin-systolic, ES end-systolic, CCA common carotid artery, ICA internal carotid artery. 1One outlier is not shown with an IMT and dose difference of 0.36 mm and 1.9 Gy, respectively

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