Mayer-Suess Lukas, Peball Tamara, Pereverzyev Sergiy, Steiger Ruth, Galijasevic Malik, Kiechl Stefan, Knoflach Michael, Gizewski Elke R, Mangesius Stephanie
Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria.
Quant Imaging Med Surg. 2024 Feb 1;14(2):1383-1391. doi: 10.21037/qims-23-1057. Epub 2024 Jan 2.
Assessments of subclinical connective tissue disorders depend on complex approaches, emphasizing the need for more accessible methods applicable to clinical routine. Therefore, we aimed to establish a reliable approach assessing cervical vessel tortuosity, which is known to be associated with such disorders.
Magnetic resonance angiography (MRA) images of ReSect study participants [single-center prospective cohort of spontaneous cervical artery dissection (sCeAD) patients] were used. Each patient underwent the same magnetic resonance imaging (MRI) protocol. The segmentation procedure was done using MATrix LABoratory 9.4 [up-sampling of raw MRA images, distance metric (DM) calculation], ITK-SNAP [region of interest (ROI) determination, vessel segmentation] and Vascular Modelling ToolKit (centerline determination). To assess inter-user variability and validity, we (I) had two blinded independent users segment all arteries and we (II) compared the results of our method to visual appraisal of vessel tortuosity done by two blinded expert neuro-radiologists.
A total of 526 extracranial cervical arteries were available for analysis. The inter-user variability of our method users was below 0.5% throughout. Overall, our method outperformed the visual tortuosity appraisal, as the visual grading underestimated the DM in 38.8% subjects when tasked to assess overall cervical artery tortuosity (both vertebral and internal carotid arteries) and in 16.6% and 33.3% respectively if tasked to grade anterior or posterior circulation separately.
We present a reliable method to assess cervical artery tortuosity derived from MRA images applicable in clinical routine and future research investigating the potential correlation of sCeAD and connective tissue disorder.
亚临床结缔组织疾病的评估依赖于复杂的方法，这凸显了对适用于临床常规的更便捷方法的需求。因此，我们旨在建立一种可靠的方法来评估已知与此类疾病相关的颈血管迂曲情况。
使用了ReSect研究参与者（自发性颈内动脉夹层分离[sCeAD]患者的单中心前瞻性队列）的磁共振血管造影（MRA）图像。每位患者都接受了相同的磁共振成像（MRI）方案。分割过程使用MATrix LABoratory 9.4（原始MRA图像的上采样、距离度量[DM]计算）、ITK-SNAP（感兴趣区域[ROI]确定、血管分割）和血管建模工具包（中心线确定）完成。为了评估用户间的变异性和有效性，我们（I）让两名不知情的独立用户对所有动脉进行分割，并且（II）将我们方法的结果与两名不知情的专家神经放射科医生对血管迂曲的视觉评估结果进行比较。
共有526条颅外颈动脉可供分析。我们方法的用户间变异性始终低于0.5%。总体而言，我们的方法优于视觉迂曲评估，因为在评估颈总动脉迂曲（椎动脉和颈内动脉）时，视觉分级在38.8%的受试者中低估了DM，而在分别评估前循环或后循环时，低估率分别为16.6%和33.3%。
我们提出了一种可靠的方法来评估源自MRA图像的颈总动脉迂曲情况，该方法适用于临床常规以及未来研究sCeAD与结缔组织疾病潜在相关性的研究。
