Associations between Morphological Characteristics of Intracranial Arteries and Atherosclerosis Risk Factors in Subjects with Less Than 50% Intracranial Arterial Stenosis

다국어 초록 (Multilingual Abstract)

Purpose: To assess associations between morphological characteristics of intracranial arteries in time-of-flight MR angiography (TOF-MRA) and atherosclerotic risk factors.
Materials and Methods: From January 2014 to October 2015, a total of 129 patients (65 men and 64 women) without intracranial arterial stenosis > 50% were included in this study. All MRIs were performed using a 3T machine with 3D TOFMRA sequences. We evaluated irregularity, tortuosity, and dilatation of intracranial arteries in maximal intensity projection (MIP) of TOF-MRA. Subjects’ risk factors for atherosclerosis including history of hypertension and diabetes were collected by reviewing their medical records. Associations between morphological characteristics and each known atherosclerosis risk factor were examined using univariate regression analysis. Multivariate regression models were built to determine combined association between those risk factors and morphologic changes of intracranial arteries.
Results: In multivariate analysis, hypertension (coefficient [95% CI]: 0.162 [0.036, 0.289], P = 0.012) and absence of diabetes (coefficient [95% CI]: -0.159 [-0.296, -0.023], P = 0.022) were associated with large diameter of intracranial arteries.
Males (coefficient [95% CI]: 0.11 [-0.006, 0.23], P = 0.062) and higher age (coefficient [95% CI]: 0.003 [-0.001, 0.008], P = 0.138) had marginal association with increased diameter. Tortuosity was associated with old age (OR: 1.04 [1.02, 1.07], P < 0.001).
Irregular contour of intracranial arteries was significantly associated with old age (OR: 1.05 [1.02, 1.09], P = 0.004), presence of diabetes (OR: 2.88 [1.36, 6.15], P = 0.0058), and previous ischemic stroke (OR: 3.91 [1.41, 11.16], P = 0.0092).
Conclusion: Morphological characteristics (irregularity, tortuosity, dilatation) of intracranial arteries seen in TOF-MRA might be associated with atherosclerotic risk factors in subjects with no or mild stenosis.

참고문헌 (Reference)

1 Lee SJ, "White matter hyperintensities (WMH) are associated with intracranial atherosclerosis rather than extracranial atherosclerosis" 53 : e129-e132, 2011

2 Diedrich KT, "Validation of an arterial tortuosity measure with application to hypertension collection of clinical hypertensive patients" 12 (12): S15-, 2011

3 Charidimou A, "Total magnetic resonance imaging burden of small vessel disease in cerebral amyloid angiopathy: An imaging-pathologic study of concept validation" 73 : 994- 1001, 2016

4 Del Corso L, "Tortuosity, kinking, and coiling of the carotid artery: expression of atherosclerosis or aging?" 49 : 361-371, 1998

5 Han J, "The three-dimensional shape analysis of the M1 segment of the middle cerebral artery using MRA at 3T" 56 : 995-1005, 2014

6 Lee SJ, "The leukoaraiosis is more prevalent in the large artery atherosclerosis stroke subtype among Korean patients with ischemic stroke" 8 : 31-, 2008

7 Khan U, "Risk factor profile of cerebral small vessel disease and its subtypes" 78 : 702-706, 2007

8 Saffari SE, "Regression models for analyzing radiological visual grading studies-- an empirical comparison" 15 : 49-, 2015

9 Pancera P, "Prevalence of carotid artery kinking in 590 consecutive subjects evaluated by Echocolordoppler. Is there a correlation with arterial hypertension?" 248 : 7-12, 2000

10 Kasner SE, "Predictors of ischemic stroke in the territory of a symptomatic intracranial arterial stenosis" 113 : 555-563, 2006

11 Qiao Y, "Patterns and implications of intracranial arterial remodeling in stroke patients" 47 : 434-440, 2016

12 Lee WJ, "Non-stenotic intracranial arteries have atherosclerotic changes in acute ischemic stroke patients: a 3T MRI study" 57 : 1007-1013, 2015

13 Dobrin PB, "Mechanisms of arterial and aneurysmal tortuosity" 104 : 568-571, 1988

14 Bullitt E, "Measuring tortuosity of the intracerebral vasculature from MRA images" 22 : 1163-1171, 2003

15 Dieleman N, "Magnetic resonance imaging of plaque morphology, burden, and distribution in patients with symptomatic middle cerebral artery stenosis" 47 : 1797-1802, 2016

16 Degnan AJ, "MR angiography and imaging for the evaluation of middle cerebral artery atherosclerotic disease" 33 : 1427-1435, 2012

17 Korogi Y, "Intracranial vascular stenosis and occlusion: diagnostic accuracy of three-dimensional, Fourier transform, time-of-flight MR angiography" 193 : 187-193, 1994

18 Pico F, "Intracranial arterial dolichoectasia and small-vessel disease in stroke patients" 57 : 472-479, 2005

19 Hoi Y, "In vivo assessment of rapid cerebrovascular morphological adaptation following acute blood flow increase" 109 : 1141-1147, 2008

20 Ryu CW, "High resolution wall and lumen MRI of the middle cerebral arteries at 3 tesla" 27 : 433-442, 2009

21 Hegedus K, "Ectasia of the basilar artery with special reference to possible pathogenesis" 24 : 463-469, 1985

22 Gutierrez J, "Dolichoectasia-an evolving arterial disease" 7 : 41-50, 2011

23 Yarchoan M, "Cerebrovascular atherosclerosis correlates with Alzheimer pathology in neurodegenerative dementias" 135 : 3749-3756, 2012

24 Pantoni L, "Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges" 9 : 689-701, 2010

25 Fazekas F, "CT and MRI rating of white matter lesions" 13 (13): 31-36, 2002

26 Klein IF, "Basilar artery atherosclerotic plaques in paramedian and lacunar pontine infarctions: a high-resolution MRI study" 41 : 1405-1409, 2010

27 Mazighi M, "Autopsy prevalence of intracranial atherosclerosis in patients with fatal stroke" 39 : 1142-1147, 2008

28 Colwell JA, "Atherosclerosis in diabetes mellitus" 34 : 1-4, 1981

29 Park JH, "Association of intracranial atherosclerotic stenosis with severity of white matter hyperintensities" 22 : 44-, 2015

30 Tsuruda J, "Artifacts associated with MR neuroangiography" 13 : 1411-1422, 1992

31 Ma N, "Arterial remodeling of advanced basilar atherosclerosis: a 3-tesla MRI study" 75 : 253-258, 2010

32 Li MH, "Accurate diagnosis of small cerebral aneurysms