Arterial Tortuosity: An Imaging Biomarker of Childhood Stroke Pathogenesis?

Vascular Effects of Infection in Pediatric Stroke (VIPS) Investigators

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1265-1270
Number of pages6
JournalStroke
Volume47
Issue number5
DOIs
StatePublished - May 1 2016

Fingerprint

Dissection
Biomarkers
Stroke
Cerebral Arteries
Pediatrics
Meningitis
Blood Vessels
Arterial Tortuosity Syndrome
Validation Studies
Connective Tissue
Analysis of Variance
Magnetic Resonance Spectroscopy
Software
Research Personnel
Students
Wounds and Injuries
Infection

Keywords

  • arterial tortuosity
  • child
  • dissection
  • magnetic resonance angiography
  • pediatric stroke
  • stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Vascular Effects of Infection in Pediatric Stroke (VIPS) Investigators (2016). Arterial Tortuosity: An Imaging Biomarker of Childhood Stroke Pathogenesis? Stroke, 47(5), 1265-1270. https://doi.org/10.1161/STROKEAHA.115.011331

Arterial Tortuosity : An Imaging Biomarker of Childhood Stroke Pathogenesis? / Vascular Effects of Infection in Pediatric Stroke (VIPS) Investigators.

In: Stroke, Vol. 47, No. 5, 01.05.2016, p. 1265-1270.

Research output: Contribution to journalArticle

Vascular Effects of Infection in Pediatric Stroke (VIPS) Investigators 2016, 'Arterial Tortuosity: An Imaging Biomarker of Childhood Stroke Pathogenesis?', Stroke, vol. 47, no. 5, pp. 1265-1270. https://doi.org/10.1161/STROKEAHA.115.011331
Vascular Effects of Infection in Pediatric Stroke (VIPS) Investigators. Arterial Tortuosity: An Imaging Biomarker of Childhood Stroke Pathogenesis? Stroke. 2016 May 1;47(5):1265-1270. https://doi.org/10.1161/STROKEAHA.115.011331
Vascular Effects of Infection in Pediatric Stroke (VIPS) Investigators. / Arterial Tortuosity : An Imaging Biomarker of Childhood Stroke Pathogenesis?. In: Stroke. 2016 ; Vol. 47, No. 5. pp. 1265-1270.
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abstract = "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.",
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author = "{Vascular Effects of Infection in Pediatric Stroke (VIPS) Investigators} and Felix Wei and Diedrich, {Karl T.} and Fullerton, {Heather J.} and Gabrielle DeVeber and Max Wintermark and Jacquie Hodge and Adam Kirton and Dowling, {M. M.} and Benedict, {S. L.} and Bernard, {T. J.} and Fox, {C. K.} and Friedman, {N. R.} and Lo, {W. D.} and Ichord, {R. N.} and Tan, {M. A.} and Mackay, {M. T.} and {Hernandez Chavez}, {M. I.} and P. Humphreys and Jordan, {L. C.} and Sultan, {S. M.} and Rivkin, {M. J.} and Rafay, {M. F.} and L. Titomanlio and Kovacevic, {G. S.} and Yager, {J. Y.} and C. Amlie-Lefond and N. Dlamini and J. Condie and Yeh, {E. A.} and R. Kneen and Bjornson, {B. H.} and P. Pergami and Zou, {L. P.} and J. Elbers and A. Abdalla and Chan, {A. K.} and O. Farooq and Lim, {M. J.} and Carpenter, {J. L.} and S. Pavlakis and Wong, {V. C N} and R. Forsyth",
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TY - JOUR

T1 - Arterial Tortuosity

T2 - An Imaging Biomarker of Childhood Stroke Pathogenesis?

AU - Vascular Effects of Infection in Pediatric Stroke (VIPS) Investigators

AU - Wei, Felix

AU - Diedrich, Karl T.

AU - Fullerton, Heather J.

AU - DeVeber, Gabrielle

AU - Wintermark, Max

AU - Hodge, Jacquie

AU - Kirton, Adam

AU - Dowling, M. M.

AU - Benedict, S. L.

AU - Bernard, T. J.

AU - Fox, C. K.

AU - Friedman, N. R.

AU - Lo, W. D.

AU - Ichord, R. N.

AU - Tan, M. A.

AU - Mackay, M. T.

AU - Hernandez Chavez, M. I.

AU - Humphreys, P.

AU - Jordan, L. C.

AU - Sultan, S. M.

AU - Rivkin, M. J.

AU - Rafay, M. F.

AU - Titomanlio, L.

AU - Kovacevic, G. S.

AU - Yager, J. Y.

AU - Amlie-Lefond, C.

AU - Dlamini, N.

AU - Condie, J.

AU - Yeh, E. A.

AU - Kneen, R.

AU - Bjornson, B. H.

AU - Pergami, P.

AU - Zou, L. P.

AU - Elbers, J.

AU - Abdalla, A.

AU - Chan, A. K.

AU - Farooq, O.

AU - Lim, M. J.

AU - Carpenter, J. L.

AU - Pavlakis, S.

AU - Wong, V. C N

AU - Forsyth, R.

PY - 2016/5/1

Y1 - 2016/5/1

N2 - 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.

AB - 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.

KW - arterial tortuosity

KW - child

KW - dissection

KW - magnetic resonance angiography

KW - pediatric stroke

KW - stroke

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