Neuroradiology. 2026 Feb 6. doi: 10.1007/s00234-026-03913-0. Online ahead of print.
ABSTRACT
PURPOSE: To evaluate the associations between computer-aided multi-parametric tortuosity indexes and the occurrence and instability of intracranial aneurysms (IAs), and to explore the independence of these associations.
METHODS: A retrospective analysis was conducted on 705 patients (female: 64.1%, age: 58.58 ± 11.69) who underwent intracranial Computed Tomography Angiography, comprising 235 unstable aneurysm patients, 235 stable aneurysm patients, and 235 healthy controls. Computer-aided analysis quantified relative length (RL), triangular index (TI), and mean curvature (κmean) in bilateral internal carotid arteries (ICAs) and middle cerebral arteries (MCAs). Univariate analysis compared tortuosity parameters within/between groups, and multivariate analysis evaluated independence.
RESULTS: Compared with the non-aneurysm side, the ICA aneurysm-bearing side had a higher TI (p = 0.005) at the C6, and a higher RL (p = 0.004), TI (p = 0.003), and κmean (p = 0.009) at the C7. Compared with the healthy arteries from control subjects, the C6 of the ICA aneurysm-bearing arteries had higher κmean (p = 0.002), the C7 had higher TI (p < 0.001) and κmean (p < 0.001), aneurysm-bearing MCAs had higher TI (p < 0.001) and κmean (p = 0.004). Compared with arteries with stable aneurysms, the aneurysm-bearing ICAs in the unstable group had higher TI (p = 0.001) and κmean (p = 0.039), and the aneurysm-bearing MCAs had higher TI (p = 0.044). Multivariate analysis showed that TI (p < 0.001, OR = 4.63) was an independent risk factor for ICA aneurysm instability.
CONCLUSIONS: Increased intracranial arterial tortuosity is associated with the occurrence and instability of IAs. TI of the aneurysm-bearing arteries is an independent risk factor for the instability of ICA aneurysms. TI tends to have a higher sensitivity than RL.
PMID:41649505 | DOI:10.1007/s00234-026-03913-0