Investigative Magnetic Resonance Imaging

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

Assessment of Carotid Geometry by Using the Contrast-enhanced MR Angiography

조영증강 MR 혈관 조영술을 이용한 경동맥 기하학의 평가

  • Lee, Chung-Min (Department of Radiology, East-West Neo Medical Center, Kyung Hee University) ;
  • Ryu, Chang-Woo (Department of Radiology, East-West Neo Medical Center, Kyung Hee University) ;
  • Kim, Keun-Woo (Department of Radiology, East-West Neo Medical Center, Kyung Hee University)
  • 이정민 (경희대학교 동서신의학병원 영상의학과) ;
  • 류창우 (경희대학교 동서신의학병원 영상의학과) ;
  • 김건우 (경희대학교 동서신의학병원 영상의학과)
  • Received : 2010.05.24
  • Accepted : 2010.06.01
  • Published : 2010.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose : To evaluate the geometry of carotid artery by assessing the images of contrast-enhanced MR angiography (CE-MRA) and interrelationships between the geometry of carotid artery and clinical factors. Materials and Methods : 216 consecutive patients who performed supraaortic CE-MRA with fast spoiled gradient-echo imaging were included. Their medical records were reviewed for variable information including risk factors predictive of generalized atherosclerotic disease (age, hypertension (HTN), diabetes mellitus, hyperlipidema, and smoking), sex, body weight, height, and body mass index (BMI). We reviewed the CE-MRA with carotid origin (3 types), carotid artery tortuosity, angle of internal carotid artery bifurcation, the type of aortic arch branching, and the presence of the coiling of carotid artery. Results : Multinomial logistic regression analysis showed that significantly contributed clinical backgrounds for carotid origin were the age and the BMI. With an increase of age at 1, the probability that the type of carotid origin become from type 1 to type 2 was 0.9 times (p=0.004) in right carotid artery (RCA), 0.9 times (p = 0.031) in left carotid artery (LCA), 0.9 times that are likely to be type3 from type 2 (p<0.001) in RCA and 0.9 times in LCA (p=0.009). Increase in BMI at 1 increased odds of becoming type 2 as 1.1 times (p = 0.067) in RCA, 1.1 times (p=0.009) in LCA and increased chance of becoming type 3 as 1.2 times (p = 0.001) in RCA, 1.2 times (p=0.003) in LCA. Mean value of right and left carotid tortuosity were $240.9{\pm}69.0^{\circ}$and $154.4{\pm}55.0^{\circ}$, respectively. Conclusion : The BMI, age, sex and presence of HTN affects the geometry of carotid arteries, the site of origin and tortuosity of carotid artery specifically.

목적 : 조영증강 MR 혈관조영술을 이용하여 경동맥의 기하학(geometry)을 측정하고, 경동맥 기하학과 임상요인 사이의 상관관계를 분석하고자 하였다. 대상 및 방법 : 2007년 1월부터 6월까지 대동맥궁 상부 조영증강 MR 혈관조영술을 시행한 216명을 대상으로 하였다. 동맥경화 위험인자(나이, 고혈압, 당뇨, 고지혈증, 흡연), 성별, 체중, 신장, 체질량지수를 조사하였다. MR 혈관조영술에서는 경동맥 기시부 유형, 경동맥의 굴곡도, 내경동맥 분지각, 내경동맥 비틀림, 대동맥궁 소-유형(bovine type) 여부를 평가하였다. 경동맥 기시부 유형은 위치에 따라 3단계로 분류하였다. 기하학 요소와 임상정보간의 상관관계를 회귀분석을 이용하여 분석하였다. 결과 : 경동맥 기시부를 종속변수로 한 다항 로지스틱 회귀분석에서 나이가 많을수록 경동맥 기시부 1형의 빈도가 높았고, 체질량지수가 클수록 2형, 3형일 빈도가 높았다. 좌, 우측 경동맥의 굴곡도의 평균은 각각 $240.9{\pm}69.0^{\circ}$과 $154.4{\pm}55.0^{\circ}$였다. 다변량 회귀분석에서 고혈압 환자와 여자, 나이, 체질량지수가 클수록 경동맥의 굴곡도가 증가하였다. 내경동맥 분지각, 내경동맥 비틀림, 대동맥궁 소-유형은 통계분석에서 임상정보와 유의한 상관관계를 보이지 않았다. 결론 : 경동맥 기하학에 나이, 체질량지수, 성, 고혈압 여부가 영향을 미칠 수 있다. 이러한 정보는 대동맥궁 및 경동맥의 영상정보가 없는 경우, 경동맥 기하학 예측 및 침습적 혈관내 시술 전략 수립에 도움이 될 것이다.

Keywords

References

  1. Faggioli G, Ferri M, Gargiulo M, et al. Measurement and impact of proximal and distal tortuosity in carotid stenting procedures. J Vasc Surg 2007;46(6):1119-1124 https://doi.org/10.1016/j.jvs.2007.08.027
  2. Kastrup A, Schulz JB, Raygrotzki S, Groschel K, Ernemann U. Comparison of angioplasty and stenting with cerebral protection versus endarterectomy for treatment of internal carotid artery stenosis in elderly patients. J Vasc Surg 2004;40(5):945- 951 https://doi.org/10.1016/j.jvs.2004.08.022
  3. Hobson RW, 2nd. Carotid artery stenting in octogenarians: the jury is still out. J Endovasc Ther 2006;13(3):310-311 https://doi.org/10.1583/06-1836C.1
  4. Lam RC, Lin SC, DeRubertis B, Hynecek R, Kent KC, Faries PL. The impact of increasing age on anatomic factors affecting carotid angioplasty and stenting. J Vasc Surg 2007;45(5):875-880 https://doi.org/10.1016/j.jvs.2006.12.059
  5. Friedman MH, Deters OJ, Mark FF, Bargeron CB, Hutchins GM. Arterial geometry affects hemodynamics. A potential risk factor for athersoclerosis. Atherosclerosis 1983;46(2):225-231 https://doi.org/10.1016/0021-9150(83)90113-2
  6. Corso L, Moruzzo D, Conte B, et al. Tortuosity, Kinking, and coiling of the carotid artery: expression of atherosclerosis or aging? Angiology 1998;49(5):361-371 https://doi.org/10.1177/000331979804900505
  7. Madhwal S, Rajagopal V, Bhatt DL, Bajzer CT, Whitlow P, Kapadia SR. Predictors of difficult carotid stenting as determined by aortic arch angiography. J Invasive Cardiol 2008;20(5):200-204
  8. Lin SC, Trocciola SM, et al. Analysis of anatomic factors and age in patients undergoing carotid angioplasty and stenting. Ann Vasc Surg 2005;19(6):798-804 https://doi.org/10.1007/s10016-005-8045-4
  9. Togay IC, Kim J, Betterman K, et al. Carotid artery tortousity, kinking, coiling: stroke risk factor, marker, or curiosity? Acta Neurol Belg 2005;105(2):68-72
  10. 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(1):7-12 https://doi.org/10.1046/j.1365-2796.2000.00611.x
  11. Pancera P, Ribul M, De Marchi S, Arosio E, Lechi A. Prevalence of morphological alterations in cervical vessels: a colour duplex ultrasonographic study in a series of 3300 subjects. Int Angiol 1998;17(1):22-27
  12. Nederkoorn PJ, Elgersma OE, van der Graaf Y, Eikelboom BC, Kappelle LJ, Mali WP. Carotid artery stenosis: accuracy of contrast- enhanced MR angiography for diagnosis. Radiology 2003;228(3):677-682 https://doi.org/10.1148/radiol.2283020824
  13. Randoux B, Marro B, Koskas F, Chiras J, Dormont D, Marsault C. Proximal great vessels of aortic arch: comparison of threedimensional gadolinium-enhanced MR angiography and digital subtraction angiography. Radiology 2003;229(3):697-702 https://doi.org/10.1148/radiol.2292011648
  14. Ho VB, Foo TK. Optimization of gadolinium-enhanced magnetic resonance angiography using an automated bolus-detection algorithm (MR SmartPrep). Original investigation. Invest Radiol 1998;33(9):515-523 https://doi.org/10.1097/00004424-199809000-00006
  15. Faggioli GL Ferri, M, Freyrie A, et al. Aortic arch anomalies are associated with increased risk of neurological events in carotid stent procedures. Eur J Vasc Endovasc Surg 2007;33:436-441 https://doi.org/10.1016/j.ejvs.2006.11.026
  16. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991;15:325(7):445-453 https://doi.org/10.1056/NEJM199108153250701
  17. Wutke R, Fellner C, Fellner F, et al. 3D TOF turbo MRA of the carotid arteries: a fast alternative for imaging of atherosclerotic carotid disease. Eur Radiol 2000;10:126
  18. Fellner FA, Fellner C, Wutke R, et al. Fluoroscopically triggered contrast-enhanced 3D MR X-ray angiography and 3D time-of-flight turbo MRA of the carotid arteries: first clinical experiences in correlation with ultrasound, X-ray angiography, and endarterectomy findings. Magn Reson Imaging 2000; 18(5):575-585 https://doi.org/10.1016/S0730-725X(00)00135-1
  19. Back MR, Rogers GA, Wilson JS, Johnson BL, Shames ML, Bandyk DF. Magnetic resonance angiography minimizes need for arteriography after inadequate carotid duplex ultrasound scanning. J Vasc Surg 2003;38(3):422-430 https://doi.org/10.1016/S0741-5214(03)00794-8
  20. Weibel J., Fields WS. Tortuosity, coiling, and kinking of the ICA. Etiology and radiographic anatomy. Neurology 1965;15(1): 7-11 https://doi.org/10.1212/WNL.15.1.7
  21. Mochida M, Sakamoto H, Sawada Y, et al. Visceral fat obesity contributes to the tortuosity of the thoracic aorta on chest radiograph in poststroke Japanese patients. Angiology 2006;57(1): 85-91 https://doi.org/10.1177/000331970605700112
  22. Kornreich L, Hadar H, Sulkes J, et al. Effect of normal ageing on the sites of aortic bifurcation and inferior vena cava confluence: a CT study. Surg Radiol Anat 1998;20(1):63-68 https://doi.org/10.1007/BF01628118
  23. Leipzig TJ, Dohrmann GJ, et al. The tortous or kinked carotid artery: pathogenesis and clinical considerations. A historical review. Surg Neurol 1986;25(5):478-486 https://doi.org/10.1016/0090-3019(86)90087-X
  24. Sugawara J, Hayashi K, Yokoi T, Tanaka H. Age-associated elongation of the ascending aorta in adults. JACC Cardiovasc Imaging 2008;1(6):739-748 https://doi.org/10.1016/j.jcmg.2008.06.010
  25. Wood NB, Zhao SZ, Zambanini A, et al. Curvature and tortuosity of the superficial femoral artery: a possible risk factor for peripheral arterial disease. J Appl Physiol 2006;101(5):1412-1418 https://doi.org/10.1152/japplphysiol.00051.2006
  26. Hayashi K, Miyachi M, Seno N, et al. Variations in carotid arterial compliance during the menstrual cycle in young woman. Exp Physiol 2006;91(2):465-472 https://doi.org/10.1113/expphysiol.2005.032011