Arterial tortuosity: an imaging biomarker of childhood stroke pathogenesis?

Wei, Felix; Diedrich, K.; Fullerton, Heather J.; DeVeber, G; Wintermark, Max; Hodge, Jacquie; Kirton, Adam

doi:10.1017/cjn.2015.93

Cited by 5 publications

(10 citation statements)

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“…Acute ischemic stroke (AIS) and Alzheimer's disease (AD), the two most common cerebrovascular and neurodegenerative diseases, respectively, often coexist and are among the leading causes of mortality and morbidity worldwide 1 . Both conditions are hypothesized to possess significantly altered architecture of the brain vascular network 2–4 . These changes can often precede clinical symptoms and may serve as early disease markers 5,6 .…”

Section: Introductionmentioning

confidence: 99%

Novel imaging markers for altered cerebrovascular morphology in aging, stroke, and Alzheimer's disease

Deshpande

Elliott

Kari

et al. 2022

Journal of Neuroimaging

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Background and Purpose: Altered brain vasculature is a key phenomenon in several neurologic disorders. This paper presents a quantitative assessment of the anatomical variations in the Circle of Willis (CoW) and vascular morphology in healthy aging, acute ischemic stroke (AIS) and Alzheimer's Disease (AD). Methods:We used our novel automatic method to segment and extract geometric features of the cerebral vasculature from MR angiography scans of 175 healthy subjects, which were used to create a probabilistic atlas of cerebrovasculature and to study normal aging and intersubject variations in CoW anatomy. Subsequently, we quantified and analyzed vascular alterations in 45AIS and 50 AD patients, two prominent cerebrovascular and neurodegenerative disorders. Results:In the sampled cohort, we determined that the CoW is fully formed in only 35% of healthy adults and found significantly (p < .05) increased tortuosity and fractality, with increasing age and also with disease in both AIS and AD. We also found significantly lower vessel length, volume, and number of branches in AIS patients, as expected. The AD cerebral vessels exhibited significantly smaller diameter and more complex branching patterns, compared to age-matched healthy adults. These changes were significantly heightened (p < .05) among healthy, early onset mild AD, and moderate/severe dementia groups. Conclusion:Although our study does not include longitudinal data due to paucity of such datasets, the specific geometric features and quantitative comparisons demonstrate the potential for using vascular morphology as a noninvasive imaging biomarker for neurologic disorders.

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Section: Introductionmentioning

confidence: 99%

Novel imaging markers for altered cerebrovascular morphology in aging, stroke, and Alzheimer's disease

Deshpande

Elliott

Kari

et al. 2022

Journal of Neuroimaging

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“…Research priorities include developing predictive biomarkers and treatments to prevent vascular progression and recurrent events. Radiological biomarkers of FCA include MR or conventional angiography findings of focal or segmental irregular stenosis with intimal banding 13 and arterial tortuosity, 21 but International Journal of Stroke, 14 (1) reliability of arteriopathy diagnosis is limited, particularly on initial imaging. 13 Pre-and post-contrast, high resolution, fat saturated, T1 weighted, wall imaging has the potential in adults to differentiate between vascular pathologies including atherosclerosis, inflammatory disease and dissection, 22 and to monitor disease progression 23 (Figure 1).…”

Section: Risk Factors and Disease Mechanisms For Aismentioning

confidence: 99%

Recent developments and new frontiers in childhood arterial ischemic stroke

Mackay

Steinlin

2018

International Journal of Stroke

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This review will discuss important developments in childhood arterial ischemic stroke over the past decade, focusing on improved understanding of the causes, consequences, and targets for intervention. Risk factors for childhood arterial ischemic stroke are different to adults. Infections, particularly herpes group viruses, are important precipitants for stroke. Non-atherosclerotic arteriopathies are the most common cause of childhood arterial ischemic stroke and an important predictor of recurrent events. Recent advances include the identification of serum biomarkers for inflammation and endothelial injury, and imaging biomarkers to monitor for vascular progression. Multicenter trials of immunotherapies in focal cerebral arteriopathies are currently in development. Recognition of clinical and radiological phenotypic patterns has facilitated the discovery of multisystem disorders associated with arterial ischemic stroke including ACTA2 arteriopathy and adenosine deaminase 2 deficiency. Identification of these Mendelian disorders provide insights into genetic mechanisms of disease and have implications for medical and surgical management. In contrast to adults, there are long diagnostic delays in childhood arterial ischemic stroke. Refinement of pediatric Code Stroke protocols and clinical decision support tools are essential to improve diagnostic certainty and improve access to reperfusion therapies. Children do not recover better than adults following arterial ischemic stroke, with more than half of survivors having long-term impairments. The physical, cognitive, and behavioral consequences of childhood arterial ischemic stroke are increasingly reported but further research is required to understand their impact on participation, quality of life, psychosocial, and family functioning. Longitudinal studies and the use of advanced imaging techniques, to understand neurobiological correlates of functional reorganization, are essential to developing targeted intervention strategies to facilitate recovery.

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“…108 In addition, the resultant imaging library became a valuable resource, allowing new analytic techniques to be retrospectively applied, such as a method for measuring arterial tortuosity using MRA data. 61 However, imaging data in vascular effects of infection in pediatric stroke (VIPS) study were limited by variability in the clinical stroke imaging protocols at the 37 different enrolling sites.…”

Section: Building Collaborative Networkmentioning

confidence: 99%

“…60 Simple angiographic patterns of arterial anatomy, such as arterial tortuosity, may also provide clues to the nature of arteriopathic stroke in childhood. 61,62 Imaging impact of stroke and plasticity…”

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confidence: 99%

Harnessing Neuroimaging Capability in Pediatric Stroke: Proceedings of the Stroke Imaging Laboratory for Children Workshop

Dlamini

Wintermark

Fullerton

et al. 2017

Pediatric Neurology

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On June 5, 2015 the International Pediatric Stroke Study and the Stroke Imaging Laboratory for Children cohosted a unique workshop focused on developing neuroimaging research in pediatric stroke. Pediatric neurologists, neuroradiologists, interventional neuroradiologists, physicists, nurse practitioners, neuropsychologists, and imaging research scientists from around the world attended this one-day meeting. Our objectives were to (1) establish a group of experts to collaborate in advancing pediatric neuroimaging for stroke, (2) develop consensus clinical and research magnetic resonance imaging protocols for pediatric stroke patients, and (3) develop imaging-based research strategies in pediatric ischemic stroke. This article provides a summary of the meeting proceedings focusing on identified challenges and solutions and outcomes from the meeting. Further details on the workshop contents and outcomes are provided in three additional articles in the current issue of Pediatric Neurology.

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Arterial tortuosity: an imaging biomarker of childhood stroke pathogenesis?

Cited by 5 publications

References 0 publications

Novel imaging markers for altered cerebrovascular morphology in aging, stroke, and Alzheimer's disease

Novel imaging markers for altered cerebrovascular morphology in aging, stroke, and Alzheimer's disease

Recent developments and new frontiers in childhood arterial ischemic stroke

Harnessing Neuroimaging Capability in Pediatric Stroke: Proceedings of the Stroke Imaging Laboratory for Children Workshop

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