Arterial Tortuosity: An Imaging Biomarker of Childhood Stroke Pathogenesis?
Arterial Tortuosity: An Imaging Biomarker of Childhood Stroke Pathogenesis?
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DOI：
10.1161/strokeaha.115.011331
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发表时间：
2016-05-01
期刊：
影响因子：
8.3
通讯作者：
Kirton, Adam
中科院分区：
文献类型：
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作者：
Wei, Felix;Diedrich, Karl T.;Kirton, Adam
背景和目的动脉病是儿童动脉缺血性卒中的主要原因。机制知之甚少，但可能包括动脉结构的固有异常。颅外夹层与成人卒中中的结缔组织疾病相关。局灶性脑动脉病是一种常见的综合征，其病理生理学尚不清楚，但可能包括颅内夹层或短暂性脑动脉病。我们的目的是量化脑动脉迂曲在儿童动脉缺血性中风，假设增加迂曲在dispensation. Methods儿童（1个月至18岁）与动脉缺血性中风的血管内招募的影响，在儿科中风（VIPS）的研究与控制卡尔加里儿科中风计划。客观、多名研究者审查定义的诊断类别。经验证的成像软件方法使用三维飞行时间磁共振血管造影源图像计算主要脑动脉的平均动脉迂曲度。比较了夹层、短暂性脑动脉病、脑膜炎、烟雾病、心源性卒中和对照组儿童未受影响血管的迂曲度（ANOVA和事后Tukey）。创伤相关与自发性夹层进行了比较（学生t检验）。结果115名儿童进行了研究（中位数，6.8岁，43%的妇女）。各组的年龄和性别相似。迂曲度平均值和方差与验证研究一致。对照组的迂曲度（1.346 +/- 0.074; n=15）与烟雾病（1.324 +/- 0.038; n=15; P=0.998）、脑膜炎（1.348 +/- 0.052; n=11; P=0.989）和心源性栓塞（1.379 +/- 0.056; n=27; P=0.190）病例相当。在颅外夹层（1.404 +/- 0.084; n=22; P=0.021）和短暂性脑动脉病（1.390 +/- 0.040; n=27; P=0.001）儿童中，迂曲度较高。创伤性与自发性夹层之间的迂曲度没有差异（P=0.70）。结论：在患有夹层和短暂性脑动脉病的儿童中，脑动脉显示迂曲度增加。定量动脉迂曲度可能代表儿科卒中中血管生物学的临床相关成像生物标志物。
Background and Purpose-Arteriopathy is the leading cause of childhood arterial ischemic stroke. Mechanisms are poorly understood but may include inherent abnormalities of arterial structure. Extracranial dissection is associated with connective tissue disorders in adult stroke. Focal cerebral arteriopathy is a common syndrome where pathophysiology is unknown but may include intracranial dissection or transient cerebral arteriopathy. We aimed to quantify cerebral arterial tortuosity in childhood arterial ischemic stroke, hypothesizing increased tortuosity in dissection.Methods-Children (1 month to 18 years) with arterial ischemic stroke were recruited within the Vascular Effects of Infection in Pediatric Stroke (VIPS) study with controls from the Calgary Pediatric Stroke Program. Objective, multi-investigator review defined diagnostic categories. A validated imaging software method calculated the mean arterial tortuosity of the major cerebral arteries using 3-dimensional time-of-flight magnetic resonance angiographic source images. Tortuosity of unaffected vessels was compared between children with dissection, transient cerebral arteriopathy, meningitis, moyamoya, cardioembolic strokes, and controls (ANOVA and post hoc Tukey). Trauma-related versus spontaneous dissection was compared (Student t test).Results-One hundred fifteen children were studied (median, 6.8 years; 43% women). Age and sex were similar across groups. Tortuosity means and variances were consistent with validation studies. Tortuosity in controls (1.346 +/- 0.074; n=15) was comparable with moyamoya (1.324 +/- 0.038; n=15; P=0.998), meningitis (1.348 +/- 0.052; n=11; P=0.989), and cardioembolic (1.379 +/- 0.056; n=27; P=0.190) cases. Tortuosity was higher in both extracranial dissection (1.404 +/- 0.084; n=22; P=0.021) and transient cerebral arteriopathy (1.390 +/- 0.040; n=27; P=0.001) children. Tortuosity was not different between traumatic versus spontaneous dissections (P=0.70).Conclusions-In children with dissection and transient cerebral arteriopathy, cerebral arteries demonstrate increased tortuosity. Quantified arterial tortuosity may represent a clinically relevant imaging biomarker of vascular biology in pediatric stroke.