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Radiological management of reversible cerebral vasoconstriction syndrome (RCVS) in France: a national multicenter
Benoît Dimitrov1, Thomas Samoyeau1, Thibault Agripnidis1
1From the Department of Radiology (B.D., V.L.), Angers University Hospital, Angers, France; Hôpital Universitaire Necker-Enfants Malades (T.S.), Department of Pediatric Radiology, AP-HP, 149 rue de Sèvres, 75015, Paris, France; Department of Neuroradiology (T.A.), University Hospital La Timone, AP-HM, Marseille, France; Department of Neuroradiology (L.S.), Henri Mondor Hospital, Créteil, France; Radiology Department (V.D.), Poitiers University Medical Center, Poitiers, Vienne, France; Neuroradiology (G.F.), University Hospital Centre Clermont-Ferrand Division of Diagnostic Imaging and Interventional Radiology, Clermont-Ferrand, Auvergne-Rhône-Alpes, France and Institut Pascal, TGI, UMR6602 CNRS SIGMA Université Clermont Auvergne, Clermont-Ferrand, France; Interventional and Diagnostic Neuroradiology (G.M.), Bordeaux University Hospital, Bordeaux, Aquitaine, France; Interventional Neuroradiology Department (G.C.), Besançon University Hospital, Besançon, France; Department of Diagnostic and Therapeutic Neuroradiology (F.Z.), University Hospital of Nancy and IADI INSERM U1254, université de Lorraine, Nancy, France; Radiology Department (Q.H.), Sainte-Anne Military Teaching Hospital (C.P., Q.H.), Toulon, France; Department of Neuroradiology (J.B.), CHU Rennes, Rennes, France; Department of Interventional Neuroradiology (E.S.), Pitié-Salpêtrière University Hospital, Paris, France; Department of Diagnostic and Interventional Neuroradiology (B.D.), Tours University Hospital, Tours, Centre-Val de Loire, France; Department of Neuroradiology (A.G.), Lariboisière Hospital, Paris, France; Service de Neuroradiologie Interventionnelle et Diagnostique, Hôpital Purpan - CHU (G.B.), Toulouse, France; Department of Interventional Neuroradiology (J.O), CHU Cavale Blanche, Inserm, UMR 1304, Brest, France; Department of Interventional Neuroradiology (J.C.), NEURI Brain Vascular Center, Bicetre Hospital, Le Kremlin- Bicetre, France; Department of Neuroradiology (G.T.), Hôpital Nord Laennec, Nantes, France; Department of Interventional Neuroradiology (A.R.), Limoges University Hospital, Limoges, France; Department of Radiology (L.H.), University Hospital of Strasbourg, 1 Avenue Moliere, 67098, Strasbourg, France. Engineering Science Computer Science and Imaging Laboratory (ICube), UMR 7357, 67000 Strasbourg, France; Department of Radiology (C.B.), University Hospital, EA7423 TAPE, UJM, Saint Etienne, France; Department of Radiology (J.B.), CHU Grenoble Alpes, Grenoble, France; Department of Diagnostic and Interventional Radiology (A.K.), University Hospital of Martinique, 97261 Fort-de-France, French Antilles, France; Department of Neuroradiology (A.L.), Foundation Adolphe de Rothschild Hospital, 75019, Paris, France; Université Paris Cité, Faculté de Médecine, 75006, Paris, France; Department of Neuroradiology (P.P.), Hôpital Maison Blanche, CHU Reims, Reims, France and Univ Rouen Normandie (J.B.), Normandie Univ, Inserm U1245 and CHU Rouen, Department of Radiology, F-76000 Rouen, France.
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.
