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Benson JC, Shahid A, Larson A, Brinjikji W, Nasr D, Saba L, Lanzino G, Savastano LE. Carotid Artery Tortuosity and Internal Carotid Artery Plaque Composition. Clin Neuroradiol 2023; 33:1017-1021. [PMID: 37286876 DOI: 10.1007/s00062-023-01302-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/27/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Little is known about the association between carotid artery tortuosity and internal carotid artery atherosclerosis. This study sought to evaluate the associations between various types of arterial tortuosity and vulnerable plaque components on magnetic resonance angiography (MRA). MATERIAL AND METHODS A retrospective review was completed of 102 patients who had undergone MRA neck imaging, with intraplaque hemorrhage (IPH) present in one or both cervical internal carotid arteries (ICA). Each ICA was assessed for two categories of tortuosity: variant arterial pathway(s) (retrojugular and/or retropharyngeal) and abnormal curvature (kinks, loops, and/or coils). All ICA plaques were assessed for the presence or absence of intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), ulceration, and enhancement, as well as the volume of IPH and degree of luminal stenosis. RESULTS The mean age of included patients was 73.5 years (SD = 9.0 years) and 88 (86.3%) subjects were male. The left carotid plaque was significantly more likely to have IPH (68.6% vs. 47.1%; p = 0.02). The left ICA was more likely to have a retrojugular course (22% vs. 9.9%; p = 0.002) and any variant arterial course (26.5% versus 14.67%, p = 0.01). On the right there was an association between the presence of a LRNC and retropharyngeal and/or retrojugular arterial pathway (p = 0.03). On the left there was an association between the presence of any abnormal arterial curvature and IPH volume (p = 0.03). Neither association met the adjusted statistical threshold after Bonferroni correction, with alpha set at 0.0028. CONCLUSION ICA tortuosity is not associated with carotid artery plaque composition, and likely does not play a role in the development of high-risk plaques.
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Affiliation(s)
- John C Benson
- Department of Radiology, Mayo Clinic, 200 1st St. SW Rochester, 55905, Rochester, MN, USA.
| | - Adnan Shahid
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Anthony Larson
- Department of Radiology, Mayo Clinic, 200 1st St. SW Rochester, 55905, Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, 200 1st St. SW Rochester, 55905, Rochester, MN, USA
| | - Deena Nasr
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Luca Saba
- Department of Medical Imaging, Azienda Ospedaliero Universitaria of Cagliari-Polo di Monserrato, Cagliari, Italy
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Sun Z, Jiang D, Liu P, Muccio M, Li C, Cao Y, Wisniewski TM, Lu H, Ge Y. Age-Related Tortuosity of Carotid and Vertebral Arteries: Quantitative Evaluation With MR Angiography. Front Neurol 2022; 13:858805. [PMID: 35572919 PMCID: PMC9099009 DOI: 10.3389/fneur.2022.858805] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/30/2022] [Indexed: 01/14/2023] Open
Abstract
Background and Purpose The vascular tortuosity (VT) of the internal carotid artery (ICA), and vertebral artery (VA) can impact blood flow and neuronal function. However, few studies involved quantitative investigation of VT based on magnetic resonance imaging (MRI). The main purpose of our study was to evaluate the age and gender effects on ICA and VA regarding the tortuosity and flow changes by applying automatic vessel segmentation, centerline tracking, and phase mapping on MR angiography. Methods A total of 247 subjects (86 males and 161 females) without neurological diseases participated in this study. All subjects obtained T1-weighted MRI, 3D time-of-flight MR angiography, and 2D phase-contrast (PC) MRI scans. To generate quantitative tortuosity metrics from TOF images, the vessel segmentation and centerline tracking were implemented based on Otsu thresholding and fast marching algorithms, respectively. Blood flow and velocity were measured using PC MRI. Among the 247 subjects, 144 subjects (≤ 60 years, 49 males/95 females) were categorized as the young group; 103 subjects (>60 years, 37 males/66 females) were categorized as the old group. Results Independent t-test showed that older subjects had higher tortuosity metrics, whereas lower blood flow and velocity than young subjects (p < 0.0025, Bonferroni-corrected). Cerebral blood flow calculated using the sum flux of four target arteries normalized by the brain mass also showed significantly lower values in older subjects (p < 0.001). The age was observed to be positively correlated with the VT metrics. Compared to the males, the females demonstrated higher geometric indices within VAs as well as faster age-related vascular profile changes. After adjusting age and gender as covariates, maximum blood velocity is negatively correlated with geometric measurements. No association was observed between blood flux and geometric measures. Conclusions Vascular auto-segmentation, centerline tracking, and phase mapping provide promising quantitative assessments of tortuosity and its effects on blood flow. The neck arteries demonstrate quantifiable and significant age-related morphological and hemodynamic alterations. Moreover, females showed more distinct vascular changes with age. Our work is built upon a comprehensive quantitative investigation of a large cohort of populations covering adult lifespan using MRI, the results can serve as reference ranges of each decade in the general population.
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Affiliation(s)
- Zhe Sun
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, United States,Vilcek Institute of Biomedical Science, NYU Grossman School of Medicine, New York, NY, United States
| | - Dengrong Jiang
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Peiying Liu
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Marco Muccio
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, United States
| | - Chenyang Li
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, United States,Vilcek Institute of Biomedical Science, NYU Grossman School of Medicine, New York, NY, United States
| | - Yan Cao
- Department of Mathematical Sciences, University of Texas at Dallas, Richardson, TX, United States
| | - Thomas M. Wisniewski
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States,Department of Pathology, NYU Grossman School of Medicine, New York, NY, United States,Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, United States,Center for Cognitive Neurology, NYU Grossman School of Medicine, New York, NY, United States
| | - Hanzhang Lu
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Yulin Ge
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, United States,*Correspondence: Yulin Ge
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