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

Hokyun Byun; Jinhee Jang; Hyun Seok Choi; So-Lyung Jung; Kook-Jin Ahn; Bum-soo Kim

doi:10.13104/imri.2018.22.3.150

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Byun, Jang, Choi, Jung, Ahn, and Kim: Associations between Morphological Characteristics of Intracranial Arteries and Atherosclerosis Risk Factors in Subjects with Less Than 50% Intracranial Arterial Stenosis

Original Article

iMRI 2018;22(3):150-157.

Published online: 12 January 2018

DOI: https://doi.org/10.13104/imri.2018.22.3.150

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

Hokyun Byun, Jinhee Jang, Hyun Seok Choi, So-Lyung Jung, Kook-Jin Ahn, Bum-soo Kim

^¹Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to: Jinhee Jang, M.D. Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea. Tel. +82-2-2258-5799 Fax. +82-2-599-6771 E-mail: znee@catholic.ac.kr

Received 14 May 2018 Revised 26 June 2018 Accepted 28 June 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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: Time-of-flight MR angiography, Morphologic characteristics, Atherosclerosis, Hypertension

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Fig. 1.

Patient selection flow chart. After systematic review of radiologic database, we included 129 subjects in this study.

Fig. 2.

A scheme showing seven segments of assessed intracranial arteries. Blue = basilar arteries; Green = distal internal carotid arteries; Orange = V4 segments of vertebral arteries; Yellow = M1 segments of middle cerebral arteries

Fig. 3.

Three schemes used to assess morphological features of intracranial arteries. Each panel explains criteria for irregularity (a), tortuosity (b), and diameter (c).

Table 1.

Patients Characteristics (n = 129)

Variables
Sex	Male	65 (50.4%)
	Female	64 (49.6%)
Age		66.4 ± 13.2
Hypertension	None	50 (38.8%)
	Present	79 (61.2%)
Diabetes	None	94 (72.9%)
	Present	35 (27.1%)
Dyslipidemia	None	92 (71.3%)
	Present	37 (28.7%)
Previous ischemic stroke	None	112 (86.8%)
	Present	17 (13.2%)
History of ischemic heart disease	None	113 (87.6%)
	Present	16 (12.4%)
Deep white matter grading (Fazeka's scale)	0	72 (55.8%)
	1	37 (28.7%)
	2	12 (9.3%)
	3	8 (6.2%)
Irregularity score		1.2 ± 1.8 [0, 0–2]
Tortuosity score		2.3 ± 1.3 [2, 1–3]
Mean diameter		2.8 ± 0.4 [2.74, 2.52–2.93]

Numbers in parenthesis is percentage. Numbers in bracket are median and interquartile range.

Table 2.

Univariate Analysis Results

	Diameter		Tortuosity score		Irregularity score
	Coefficient (95% CI)	P-value	Odd ratio (95% CI)	P-value	Odd ratio (95% CI)	P-value
Sex	0.08 (−0.04∼0.20)	0.188	0.65 (0.35, 1.21)	0.174	0.98 (0.50, 1.93) 0	0.96
Age	0.004 (0∼0.008)	0.097	1.04 (1.01, 1.07)	0.0006	1.06 (1.03, 1.10) 0	0.00012
Hypertension	0.158 (0.034∼0.282)	0.012	2.05 (1.09, 3.92)	0.0277	2.77 (1.34, 6.03) 0	0.008
Diabetes	–0.098 (−0.236∼0.04)	0.159	1.13 (0.56, 2.30)	0.730	3.35 (1.62, 6.99) 0	0.0017
Dyslipidemia	0.027 (−0.111∼0.165)	0.7	0.56 (0.28, 1.14)	0.114	1.00 (0.46, 2.12) 0	0.99
Previous ischemic stroke	–0.053 (−0.236∼0.131)	0.566	1.51 (0.60, 3.85)	0.380	4.85 (1.74, 13.80) 0	0.0026
Ischemic heart disease	0.129 (−0.055∼0.313)	0.17	0.56 (0.22, 1.46)	0.233	1.95 (0.69, 5.33) 0	0.196
WMH
Grade 1	0.121 (−0.019∼0.261)	0.09	1.72 (0.85–3.45)	0.138	1.39 (0.64–3.05) 0	0.413
Grade 2	0.122 (−0.094∼0.338)	0.261	1.22 (0.41–3.66)	0.719	1.72 (0.55–5.35) 0	0.359
Grade 3	0.264 (0.006∼0.522)	0.043	1.75 (0.52–5.90)	0.367	2.64 (0.71–9.81) 0	0.148

CI = confidence interval; WMH = white matter hyperintensity Linear regression was done for mean diameter. Ordinal logistic regression was done for tortuosity and irregularity score.

Table 3.

Multivariate Analysis Results

	Diameter		Tortuosity		Irregularity
	Coefficient (95% CI)	P-value	Odd ratio (95% CI)	P-value	Odd ratio (95% CI)	P-value
Sex	0.11 (−0.006, 0.23)	0.062	NA		NA
Age	0.003 (−0.001, 0.008)	0.138	1.04 (1.02, 1.07)	0.0005	1.05 (1.02, 1.09)	0.004
Hypertension	0.162 (0.036, 0.289)	0.012	NA		1.97 (0.89, 4.54)	0.10
Diabetes	–0.159 (−0.296, −0.023)	0.022	NA		2.88 (1.36, 6.15)	0.0058
Previous ischemic stroke	NA		NA		3.91 (1.41, 11.16)	0.0092

CI = confidence interval; NA = non-applicable. Linear regression was done for mean diameter. Ordinal logistic regression was done for tortuosity and irregularity score.

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