Cerebrovascular morphology in aging and disease -- imaging biomarkers for ischemic stroke and Alzheimers disease

Background and Purpose: Altered brain vasculature is a key phenomenon in several neurologic disorders. This paper presents a quantitative assessment of vascular morphology in healthy and diseased adults including changes during aging and the anatomical variations in the Circle of Willis (CoW). Methods: We used our automatic method to segment and extract novel geometric features of the cerebral vasculature from MRA scans of 175 healthy subjects, 45 AIS, and 50 AD patients after spatial registration. This is followed by quantification and statistical analysis of vascular alterations in acute ischemic stroke (AIS) and Alzheimer's disease (AD), the biggest cerebrovascular and neurodegenerative disorders. Results: We determined that the CoW is fully formed in only 35 percent of healthy adults and found significantly increased tortuosity and fractality, with increasing age and with disease -- both AIS and AD. We also found significantly decreased vessel length, volume and number of branches in AIS patients. Lastly, we found that AD cerebral vessels exhibited significantly smaller diameter and more complex branching patterns, compared to age-matched healthy adults. These changes were significantly heightened with progression of AD from early onset to moderate-severe dementia. Conclusion: Altered vessel geometry in AIS patients shows that there is pathological morphology coupled with stroke. In AD due to pathological alterations in the endothelium or amyloid depositions leading to neuronal damage and hypoperfusion, vessel geometry is significantly altered even in mild or early dementia. The specific geometric features and quantitative comparisons demonstrate potential for using vascular morphology as a non-invasive imaging biomarker for neurologic disorders.