Carotid artery hemodynamics and geometry as predictors of cerebral small vessel disease: insights from 4D flow imaging.

IF 2.6 3区医学 Q2 CLINICAL NEUROLOGY Neuroradiology Pub Date : 2025-04-01 Epub Date: 2025-03-03 DOI:10.1007/s00234-025-03569-2

Yurong Ma, Na Han, Juan Liang, Hui Zhang, Songhong Yue, Chuang Wu, Jintao Wang, Jing Zhang

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Abstract

Background and purpose: Cerebral small vessel disease (cSVD) is a common condition with complex pathophysiology, resulting in poor clinical outcomes. This study uses four-dimensional flow (4D flow) imaging to examine how carotid artery hemodynamics and geometry impact cSVD development.

Methods: Combining ultrasound, 4D flow, and three-dimensional time-of-flight magnetic resonance angiography (3D-TOF MRA), we analyzed and measured internal carotid artery (ICA) hemodynamics and geometric parameters. Based on cranial magnetic resonance imaging (MRI) findings, the characteristics, counts, and scores of small vessel diseases were assessed. Single-factor analyses affecting cSVD were conducted, followed by multivariable logistic regression to pinpoint independent risk factors. A P-value of < 0.05 was considered statistically significant. ROC curves were used to evaluate the model's performance and explanatory power.

Results: Multivariable analysis revealed differences in white matter hyperintensities (WMH) related to maximum pressure gradient (PG_max), with an OR_Zscore of 1.602. Maximum velocity(velocity_max) negatively correlated with enlarged perivascular space (PVS) count (P = 0.025). ICA-C5/ICA initial segment diameter ratio, velocity_max, and PG_max were independent risk factors for lacune (Lac) (P < 0.01). Circumferential wall shear stress (WSS_mean) and PG_max were positively correlated with cerebral microbleed (CMB) count (P = 0.019 and P = 0.002), while the ICA-C5/ICA ratio was negatively correlated (P = 0.003). The MCA/ICA-C5 diameter ratio was positively associated with SVD score (P = 0.021). ROC curves demonstrated strong model performance for WMH and Lac.

Conclusion: Diameter variations in the ICA and MCA may indicate changes in vascular compliance and potential remodeling abnormalities. Hemodynamic anomalies in the ICA's initial segment could suggest distal vascular disease, offering new insights into cSVD pathogenesis.

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颈动脉血流动力学和几何作为脑血管疾病的预测指标：来自4D血流成像的见解。

背景与目的：脑血管病（cSVD）是一种病理生理复杂的常见病，临床预后差。本研究使用四维血流成像（4D血流）检查颈动脉血流动力学和几何形状如何影响cSVD的发展。方法：结合超声、四维血流和三维飞行时间磁共振血管造影（3D-TOF MRA），分析和测量颈内动脉（ICA）血流动力学和几何参数。根据颅磁共振成像（MRI）的发现，评估小血管疾病的特征、计数和评分。进行影响cSVD的单因素分析，然后进行多变量logistic回归以确定独立危险因素。结果的p值：多变量分析显示白质高信号（WMH）与最大压力梯度（PGmax）相关，ORZscore为1.602。最大流速（velocitymax）与血管周围空间（PVS）增大呈负相关（P = 0.025）。ICA- c5 /ICA初始节段直径比、velocitymax和PGmax是lacune （Lac）的独立危险因素（P平均值），PGmax与脑微出血（CMB）计数呈正相关（P = 0.019和P = 0.002）， ICA- c5 /ICA比呈负相关（P = 0.003）。MCA/ICA-C5直径比值与SVD评分呈正相关（P = 0.021）。ROC曲线显示WMH和Lac具有较强的模型性能。结论：ICA和MCA的直径变化可能预示着血管顺应性的改变和潜在的重构异常。ICA初始段的血流动力学异常可能提示远端血管疾病，为cSVD的发病机制提供了新的见解。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neuroradiology 医学-核医学

CiteScore

5.30

自引率

3.60%

发文量

214

审稿时长

4-8 weeks

期刊介绍： Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.