Intracranial internal carotid artery changes in acromegaly: a quantitative magnetic resonance angiography study.
OBJECTIVE
Although cerebrovascular mortality is increased up to eightfold in acromegaly, intracranial internal carotid artery (ICA) changes have not been well investigated. This is a magnetic resonance angiography (MRA) quantitative cross-sectional study of ICA tortuosity, ectasia and intercarotid distance in acromegalic patients with subsequent analysis of concomitant clinical, laboratory and neuroimaging findings.


METHODS
One hundred seventy six acromegalic patients (mean-age 55 ± 14 years, age range 21-88, 92 females) and 104 subjects with headache or transient neurological deficits underwent MRA with the same 1.5 T scanner. Clinical data, laboratory and pituitary adenoma imaging findings were recorded. Using a commercially available software, we measured the tortuosity index [(curved/linear ICA length from C3-midpoint to intracranial bifurcation) - 1], ICA ectasia index (intracavernous/petrous ICA diameter) and intercarotid distance at C3 and C4 levels.


RESULTS
Mean ICA tortuosity and ectasia indices were increased in acromegalic patients compared with controls (1.06 ± 0.29 vs 0.93 ± 0.26, p < 0.001; 1.02 ± 0.10 vs 0.92 ± 0.09, p < 0.001). Mean intercarotid distance was reduced at C3 and increased at C4 in acromegalic patients (16.7 ± 3.4 vs 17.9 ± 2.5 mm, p < 0.001; 16.7 ± 4.6 vs 15.4 ± 4.1 mm, p < 0.05; t test). ICA tortuosity and ectasia correlated neither with laboratory findings nor with previous or current treatment. On multivariate analysis, C3 intercarotid distance was reduced in patients on dopamine agonist treatment (p < 0.01) and increased in patients with GH-deficit (p = 0.01), while C4 intercarotid distance was increased with macroadenoma (p = 0.01) and reduced in patients under dopamine agonist (p < 0.01) or somatostatin analogue (p < 0.05) treatment.


CONCLUSIONS
Intracranial ICA changes are common findings in acromegaly, and further studies focused on their possible clinical impact are needed.
Neuroradiology, University of Salerno, Via S. Allende, 84081, Baronissi, Italy, rmanara@unisa.it.
Renzo
R
Manara
Joseph
J
Gabrieli
Valentina
V
Citton
Filippo
F
Ceccato
Silvia
S
Rizzati
Giulia
G
Bommarito
Chiara
C
Briani
Alessandro
A
Della Puppa
Francesca
F
Dassie
Laura
L
Milanese
Francesco
F
Di Salle
Mario
M
Ermani
Carla
C
Scaroni
Chiara
C
Martini
Pietro
P
Maffei
D000172:Acromegaly / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002343:Carotid Artery, Internal / Q000473:pathology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D055815:Young Adult