Cervicocerebral quantitative arterial tortuosity: a biomarker of arteriopathy in children with intracranial aneurysms

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Although intracranial arterial aneurysms (IAAs) of childhood are usually idiopathic, it is possible that underlying arteriopathy escapes detection when using conventional diagnostic tools. Quantitative arterial tortuosity (QAT) has been studied as a biomarker of arteriopathy. The authors analyzed cervicocerebral QAT in children with idiopathic IAAs to assess the possibility of arteriopathy.


Cases were identified by text-string searches of imaging reports spanning the period January 1993 through June 2017. QAT of cervicocerebral arterial segments was measured from cross-sectional studies using image-processing software. Other imaging and clinical data were confirmed by retrospective electronic record review. Children with idiopathic IAAs and positive case controls, with congenital arteriopathy differentiated according to aneurysm status (with and without an aneurysm), were compared to each other and to healthy controls without vascular risk factors.


Cervicocerebral QAT was measured in 314 children: 24 with idiopathic IAAs, 163 with congenital arteriopathy (including 14 arteriopathic IAAs), and 127 healthy controls. QAT of all vertebrobasilar segments was larger in children with IAAs (idiopathic and arteriopathic forms) (p < 0.05). In children with congenital arteriopathy without an aneurysm, QAT was decreased for the distal cervical vertebral arteries and increased for the supraspinal vertebral artery relative to healthy children. QAT of specific cervicocerebral segments correlated with IAA size and rupture status.


Cervicocerebral QAT is a biomarker of arteriopathy in children with IAA, even in the absence of other disease markers. Additional findings suggest a correlation of cervicocerebral QAT with IAA size and rupture status and with the presence of IAA in children with congenital arteriopathy.

ABBREVIATIONS IAA = intracranial arterial aneurysm; ICA = internal carotid artery; QAT = quantitative arterial tortuosity; VA = vertebral artery.

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Article Information

Correspondence J. Michael Taylor: University of Cincinnati College of Medicine, Cincinnati, OH. jm.taylor@cchmc.org.

INCLUDE WHEN CITING Published online July 26, 2019; DOI: 10.3171/2019.5.PEDS1982.

Disclosures Dr. Vadivelu reports that he is a consultant for Alcyone Lifesciences, Inc.

© AANS, except where prohibited by US copyright law.



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    Anatomical detail of arterial segments used in this analysis. A: Details of the vertebrobasilar system, including the VA and the basilar artery (BA), divided into the proximal extracranial VA (V1–V2) beginning at the subclavian origin of the VA (arrow 1) and extending to the transverse foramen of C2 (arrow 2); the distal extracranial VA (V3) continuing to the lateral margin of the C1 posterior neural arch (arrow 3); the intracranial VA (V4) extending to the vertebrobasilar junction (arrow 4); and the BA from the vertebrobasilar junction to the BA terminus (arrow 5). B: Details of the anterior circulation, where the extracranial (EC) ICA begins at the carotid bifurcation (arrow 6) and extends to the exocranial ostium of the carotid canal (arrow 7); the petrous segment of the ICA begins at the prior segment and extends to the endocranial ostium of the carotid canal (arrow 8); and the intracranial ICA extends to the ICA terminus (arrow 9). C: Graphical detail of the QAT calculation and 2 sample arterial segments with corresponding QAT values.

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    Comparison of the QAT index to IAA size by longest linear measure. The linear relationship between extracranial ICA QAT and linear measure is shown with a best-fit trend line.




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