Intracranial internal carotid artery changes in acromegaly: a quantitative magnetic resonance angiography study

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. One hundred seventy six acromegalic patients (mean-age 55 +/- A 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. Mean ICA tortuosity and ectasia indices were increased in acromegalic patients compared with controls (1.06 +/- A 0.29 vs 0.93 +/- A 0.26, p < 0.001; 1.02 +/- A 0.10 vs 0.92 +/- A 0.09, p < 0.001). Mean intercarotid distance was reduced at C3 and increased at C4 in acromegalic patients (16.7 +/- A 3.4 vs 17.9 +/- A 2.5 mm, p < 0.001; 16.7 +/- A 4.6 vs 15.4 +/- A 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. Intracranial ICA changes are common findings in acromegaly, and further studies focused on their possible clinical impact are needed.