Investigative Magnetic Resonance Imaging

Korean Society of Magnetic Resonance in Medicine (대한자기공명의과학회)
권호 표지
DOI QR코드

DOI QR Code

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

  • Byun, Hokyun (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Jang, Jinhee (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Choi, Hyun Seok (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Jung, So-Lyung (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Ahn, Kook-Jin (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Bum-soo (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2018.05.14
  • Accepted : 2018.06.28
  • Published : 2018.09.30
Download PDF
⟨ Previous Next ⟩

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 TOF-MRA 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.

Keywords

References

  1. Li MH, Li YD, Gu BX, et al. Accurate diagnosis of small cerebral aneurysms https://doi.org/10.1148/radiol.14122770
  2. Korogi Y, Takahashi M, Mabuchi N, et al. Intracranial vascular stenosis and occlusion: diagnostic accuracy of three-dimensional, Fourier transform, time-of-flight MR angiography. Radiology 1994;193:187-193 https://doi.org/10.1148/radiology.193.1.8090890
  3. Lee WJ, Choi HS, Jang J, et al. Non-stenotic intracranial arteries have atherosclerotic changes in acute ischemic stroke patients: a 3T MRI study. Neuroradiology 2015;57:1007-1013 https://doi.org/10.1007/s00234-015-1566-9
  4. Ma N, Jiang WJ, Lou X, et al. Arterial remodeling of advanced basilar atherosclerosis: a 3-tesla MRI study. Neurology 2010;75:253-258 https://doi.org/10.1212/WNL.0b013e3181e8e714
  5. Qiao Y, Anwar Z, Intrapiromkul J, et al. Patterns and implications of intracranial arterial remodeling in stroke patients. Stroke 2016;47:434-440 https://doi.org/10.1161/STROKEAHA.115.009955
  6. Degnan AJ, Gallagher G, Teng Z, Lu J, Liu Q, Gillard JH. MR angiography and imaging for the evaluation of middle cerebral artery atherosclerotic disease. AJNR Am J Neuroradiol 2012;33:1427-1435 https://doi.org/10.3174/ajnr.A2697
  7. Pico F, Labreuche J, Touboul PJ, Leys D, Amarenco P. Intracranial arterial dolichoectasia and small-vessel disease in stroke patients. Ann Neurol 2005;57:472-479 https://doi.org/10.1002/ana.20423
  8. Gutierrez J, Sacco RL, Wright CB. Dolichoectasia-an evolving arterial disease. Nat Rev Neurol 2011;7:41-50 https://doi.org/10.1038/nrneurol.2010.181
  9. Han J, Qiao H, Li X, et al. The three-dimensional shape analysis of the M1 segment of the middle cerebral artery using MRA at 3T. Neuroradiology 2014;56:995-1005 https://doi.org/10.1007/s00234-014-1414-3
  10. Hoi Y, Gao L, Tremmel M, et al. In vivo assessment of rapid cerebrovascular morphological adaptation following acute blood flow increase. J Neurosurg 2008;109:1141-1147 https://doi.org/10.3171/JNS.2008.109.12.1141
  11. Bullitt E, Gerig G, Pizer SM, Lin W, Aylward SR. Measuring tortuosity of the intracerebral vasculature from MRA images. IEEE Trans Med Imaging 2003;22:1163-1171 https://doi.org/10.1109/TMI.2003.816964
  12. Diedrich KT, Roberts JA, Schmidt RH, Kang CK, Cho ZH, Parker DL. Validation of an arterial tortuosity measure with application to hypertension collection of clinical hypertensive patients. BMC Bioinformatics 2011;12 Suppl 10:S15
  13. Lee SJ, Kim JS, Chung SW, Kim BS, Ahn KJ, Lee KS. White matter hyperintensities (WMH) are associated with intracranial atherosclerosis rather than extracranial atherosclerosis. Arch Gerontol Geriatr 2011;53:e129-132 https://doi.org/10.1016/j.archger.2010.07.008
  14. Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol 2010;9:689-701 https://doi.org/10.1016/S1474-4422(10)70104-6
  15. Park JH, Kwon HM, Lee J, Kim DS, Ovbiagele B. Association of intracranial atherosclerotic stenosis with severity of white matter hyperintensities. Eur J Neurol 2015;22:44-52, e42-43
  16. Lee SJ, Kim JS, Lee KS, et al. The leukoaraiosis is more prevalent in the large artery atherosclerosis stroke subtype among Korean patients with ischemic stroke. BMC Neurol 2008;8:31 https://doi.org/10.1186/1471-2377-8-31
  17. Dieleman N, Yang W, Abrigo JM, et al. Magnetic resonance imaging of plaque morphology, burden, and distribution in patients with symptomatic middle cerebral artery stenosis. Stroke 2016;47:1797-1802 https://doi.org/10.1161/STROKEAHA.116.013007
  18. Ryu CW, Jahng GH, Kim EJ, Choi WS, Yang DM. High resolution wall and lumen MRI of the middle cerebral arteries at 3 tesla. Cerebrovasc Dis 2009;27:433-442 https://doi.org/10.1159/000209238
  19. Kasner SE, Chimowitz MI, Lynn MJ, et al. Predictors of ischemic stroke in the territory of a symptomatic intracranial arterial stenosis. Circulation 2006;113:555-563 https://doi.org/10.1161/CIRCULATIONAHA.105.578229
  20. Tsuruda J, Saloner D, Norman D. Artifacts associated with MR neuroangiography. AJNR Am J Neuroradiol 1992;13:1411-1422
  21. Fazekas F, Barkhof F, Wahlund LO, et al. CT and MRI rating of white matter lesions. Cerebrovasc Dis 2002;13 Suppl 2:31-36
  22. Saffari SE, Love A, Fredrikson M, Smedby O. Regression models for analyzing radiological visual grading studies-- an empirical comparison. BMC Med Imaging 2015;15:49 https://doi.org/10.1186/s12880-015-0083-y
  23. Mazighi M, Labreuche J, Gongora-Rivera F, Duyckaerts C, Hauw JJ, Amarenco P. Autopsy prevalence of intracranial atherosclerosis in patients with fatal stroke. Stroke 2008;39:1142-1147 https://doi.org/10.1161/STROKEAHA.107.496513
  24. Yarchoan M, Xie SX, Kling MA, et al. Cerebrovascular atherosclerosis correlates with Alzheimer pathology in neurodegenerative dementias. Brain 2012;135:3749-3756 https://doi.org/10.1093/brain/aws271
  25. Klein IF, Lavallee PC, Mazighi M, Schouman-Claeys E, Labreuche J, Amarenco P. Basilar artery atherosclerotic plaques in paramedian and lacunar pontine infarctions: a high-resolution MRI study. Stroke 2010;41:1405-1409 https://doi.org/10.1161/STROKEAHA.110.583534
  26. Del Corso L, Moruzzo D, Conte B, et al. Tortuosity, kinking, and coiling of the carotid artery: expression of atherosclerosis or aging? Angiology 1998;49:361-371 https://doi.org/10.1177/000331979804900505
  27. Pancera P, Ribul M, Presciuttini B, Lechi A. Prevalence of carotid artery kinking in 590 consecutive subjects evaluated by Echocolordoppler. Is there a correlation with arterial hypertension? J Intern Med 2000;248:7-12 https://doi.org/10.1046/j.1365-2796.2000.00611.x
  28. Dobrin PB, Schwarcz TH, Baker WH. Mechanisms of arterial and aneurysmal tortuosity. Surgery 1988;104:568-571
  29. Hegedus K. Ectasia of the basilar artery with special reference to possible pathogenesis. Surg Neurol 1985;24:463-469 https://doi.org/10.1016/0090-3019(85)90309-X
  30. Colwell JA. Atherosclerosis in diabetes mellitus. J Chronic Dis 1981;34:1-4 https://doi.org/10.1016/0021-9681(81)90075-8
  31. Charidimou A, Martinez-Ramirez S, Reijmer YD, et al. Total magnetic resonance imaging burden of small vessel disease in cerebral amyloid angiopathy: An imaging-pathologic study of concept validation. JAMA Neurol 2016;73:994- 1001 https://doi.org/10.1001/jamaneurol.2016.0832
  32. Khan U, Porteous L, Hassan A, Markus HS. Risk factor profile of cerebral small vessel disease and its subtypes. J Neurol Neurosurg Psychiatry 2007;78:702-706