Key result
Uncontrolled hypertension links to increased arterial tortuosity, an association absent in controlled patients.
Why the study?
Hypertension may increase arterial tortuosity, but the ability of distance factor metric-based measurements to detect this increase using existing MRA brain images was untested.
Does a distance factor metric (DFM)-based measurement detect increases in arterial tortuosity in hypertensive patients compared to negative controls?
Case-Control (n=201)
Yes
Does a distance factor metric (DFM)-based measurement detect increases in arterial tortuosity in hypertensive patients compared to negative controls?
p-value: p=<0.05
A DFM-based measurement applied to MRA brain images successfully detected elevated arterial tortuosity in hypertensive patients compared to controls, demonstrating its utility for quantitative vascular assessment.
Tortuosity-hypertension link appears population-dependent; hypothesis-generating and should not yet inform vascular risk assessment.
BACKGROUND: Hypertension may increase tortuosity or twistedness of arteries. We applied a centerline extraction algorithm and tortuosity metric to magnetic resonance angiography (MRA) brain images to quantitatively measure the tortuosity of arterial vessel centerlines. The most commonly used arterial tortuosity measure is the distance factor metric (DFM). This study tested a DFM based measurement's ability to detect increases in arterial tortuosity of hypertensives using existing images. Existing images presented challenges such as different resolutions which may affect the tortuosity measurement, different depths of the area imaged, and different artifacts of imaging that require filtering. METHODS: The stability and accuracy of alternative centerline algorithms was validated in numerically generated models and test brain MRA data. Existing images were gathered from previous studies and clinical medical systems by manually reading electronic medical records to identify hypertensives and negatives. Images of different resolutions were interpolated to similar resolutions. Arterial tortuosity in MRA images was measured from a DFM curve and tested on numerically generated models as well as MRA images from two hypertensive and three negative control populations. Comparisons were made between different resolutions, different filters, hypertensives versus negatives, and different negative controls. RESULTS: In tests using numerical models of a simple helix, the measured tortuosity increased as expected with more tightly coiled helices. Interpolation reduced resolution-dependent differences in measured tortuosity. The Korean hypertensive population had significantly higher arterial tortuosity than its corresponding negative control population across multiple arteries. In addition one negative control population of different ethnicity had significantly less arterial tortuosity than the other two. CONCLUSIONS: Tortuosity can be compared between images of different resolutions by interpolating from lower to higher resolutions. Use of a universal negative control was not possible in this study. The method described here detected elevated arterial tortuosity in a hypertensive population compared to the negative control population and can be used to study this relation in other populations.
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Diedrich et al. (2011) conducted a case-control in Hypertension (n=201). Hypertension vs. Normotensive controls was evaluated on Arterial tortuosity (Distance Factor Metric) (p=<0.05). Hypertension was associated with significantly increased arterial tortuosity in an uncontrolled Korean population across multiple arteries, though this correlation was not observed in a controlled hypertensive population from Utah.
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