Sex and level differences in the diameters of extradural segment of vertebral artery: computed tomography angiographic study
Abstract
Background: We investigated diameters of prevertebral — V1, and atlantic — V3 parts of extradural segment of vertebral artery (VA). Variable results from the literaturę about VA diameters reflect variety of diagnostic and imaging methods, various sample sizes, different levels of measurements, and lack of possible specific ethnic, regional or genetic data. Additionally, the data are often without distinctions of left-right or of sex.
Materials and methods: For this computed tomography (CT) angiographic study 91 adult people (182 VAs) of both sexes (47 males and 44 females) and of age between 33 and 75 years were selected. Diameters were measured at fixed predefined points of VA, marked as inferior (A) point (at V1 part in region of VA origin), as middle (B) point (the end of V1 part), and superior (C) point, at V3 part — 5 mm before VA penetrated the dura. Inferior (A) and middle (B) points actually represent locations at beginning (A) and at terminal (B) regions of V1 part of VA, and superior point C represents terminal part of V3.
Results: In total sample ipsilateral (both left [L] and right [R] sided) diameters on investigated levels of VA showed progressive and highly significant decreases. The mean values were on the right side at point A — 3.63 mm, at B point — 3.31 mm, and at C point — 3.08 mm. On the left side, mean values were at point A — 3.76 mm, at B point — 3.50 mm, and at point C — 3.21 mm. Pattern of increasing sex differences in diameters of VA, was ranging from no differences (point A), trough significant (point B), to highly significant differences (point C). For inferior point (A) we did not find significant differences in VA diameters between males (R 3.78 mm; L 3.89 mm) and females (R 3.50 mm; L 3.62 mm), in middle (B) point sex differences were significant (males: R 3.44 mm, L 3.66 mm; females: R 3.18 mm, L 3.33 mm) and in most superior point (C) differences were highly significant (males: R 3.278 mm, L 3.39 mm; females: R 2.88 mm, L 3.01 mm). However, we did not find significant intrasex (in males or in females) left-right differences in mean values of VA diameters for all three investigated levels.
Conclusions: Our findings, as the first data about diameters of VA systematically obtained by CT angiography in the population of western Balkans and wider, suggest that in design of future studies of VA diameters is necessary to analyse separately the data for sex, as well as to use defined standard levels.
Keywords: vertebral arterydiametersleft-right differencessex differences
References
- Ergun O, Gunes Tatar I, Birgi E, et al. Evaluation of vertebral artery dominance, hypoplasia and variations in the origin: angiographic study in 254 patients. Folia Morphol. 2016; 75(1): 33–37.
- Federative Committee on Anatomical Terminology. Terminologia anatomica. Thieme, Stuttgart, New York. 1998: 84.
- Henry BM, Tomaszewski KA, Walocha JA. Methods of Evidence-Based Anatomy: a guide to conducting systematic reviews and meta-analysis of anatomical studies. Ann Anat. 2016; 205: 16–21.
- Hong JM, Chung CS, Bang OY, et al. Vertebral artery dominance contributes to basilar artery curvature and peri-vertebrobasilar junctional infarcts. J Neurol Neurosurg Psychiatry. 2009; 80(10): 1087–1092.
- Jeng JS, Yip PK. Evaluation of vertebral artery hypoplasia and asymmetry by color-coded duplex ultrasonography. Ultrasound Med Biol. 2004; 30(5): 605–609.
- Jovanikić O, Lepić T, Raicević R, et al. [Intimomedial thickness of the vertebral arteries complex: a new useful parameter for the assessment of atheroclerotic process?]. Vojnosanit Pregl. 2011; 68(9): 733–738.
- Kellawan JM, Harrell JW, Roldan-Alzate A, et al. Regional hypoxic cerebral vasodilation facilitated by diameter changes primarily in anterior versus posterior circulation. J Cereb Blood Flow Metab. 2017; 37(6): 2025–2034.
- Khan MA, Liu J, Tarumi T, et al. Measurement of cerebral blood flow using phase contrast magnetic resonance imaging and duplex ultrasonography. J Cereb Blood Flow Metab. 2017; 37(2): 541–549.
- Lovrencić-Huzjan A, Demarin V, Bosnar M, et al. Color Doppler flow imaging (CDFI) of the vertebral arteries: the normal appearance, normal values and the proposal for the standards. Coll Antropol. 1999; 23(1): 175–181.
- Macchi V, Porzionato A, Morra A, et al. Anatomico-radiologic study of the distribution of the suboccipital artery of Salmon. Clin Neurol Neurosurg. 2014; 117: 80–85.
- Mehinović A, Isaković E, Delić J, et al. Variations in diameters of vertebro-basilar tree in patients with or with no aneurysm. Med Arch. 2014; 68(1): 27–29.
- Morović S, Škarić-Jurić T, Demarin V. Vertebral artery hypoplasia: characteristics in a croatian populatin sample. Acta Clin Croat. 2006; 45: 325–329.
- Mysior M, Stefańczyk L. Doppler ultrasound criteria of physiological flow in asymmetrical vertebral arteries. Med Sci Monit. 2007; 13 Suppl 1: 73–77.
- Narata A, Yilmaz H, Schaller K, et al. Flow-Diverting stent for ruptured intracranial dissecting aneurysm of vertebral artery. Neurosurgery. 2012; 70(4): 982–989.
- Nemati M, Bavil AS, Taheri N. Comparison of normal values of Duplex indices of vertebral arteries in young and elderly adults. Cardiovasc Ultrasound. 2009; 7: 2.
- Ozgen S, Pait TG, Cağlar YS. The V2 segment of the vertebral artery and its branches. J Neurosurg Spine. 2004; 1(3): 299–305.
- Rankin G, Stokes M, Newham DJ. Size and shape of the posterior neck muscles measured by ultrasound imaging: normal values in males and females of different ages. Man Ther. 2005; 10(2): 108–115.
- Rawal JD, Jadav HR. Histomorphometric comparisons of right and left vertebral arteries. Nat J Med Res. 2012; 2(3): 260–263.
- Richter HR. Collaterals between the external carotid artery and the vertebral artery in cases of thrombosis of the internal carotid artery. Acta Radiol. 1953; 40(2-3): 108–112.
- Rustagi SM, Bharihoke V. Intracranial Human Vertebral Artery: A Histomorphological Study. Int J Cur Res Rev. 2013; 05(12): 89–96.
- Seidel E, Eicke BM, Tettenborn B, et al. Reference values for vertebral artery flow volume by duplex sonography in young and elderly adults. Stroke. 1999; 30(12): 2692–2696.
- Sureka B, Mittal MK, Mittal A, et al. Morphometric analysis of diameter and relationship of vertebral artery with respect to transverse foramen in Indian population. Indian J Radiol Imaging. 2015; 25(2): 167–172.
- Tarnoki AD, Fejer B, Tarnoki DL, et al. Vertebral Artery Diameter and Flow: Nature or Nurture. J Neuroimaging. 2017; 27(5): 499–504.
- Tetiker H, Cimen M, Kosar MI. Evaluation of vertebral artery by D digital subtraction angiography. Int. J Morphol. 2014; 32(3): 798–802.
- Tubbs RS, Shah NA, Sullivan BP, et al. Surgical anatomy and quantitation of the branches of the V2 and V3 segments of the vertebral artery. Laboratory investigation. J Neurosurg Spine. 2009; 11(1): 84–87.
- Vujmilović S, Spasojević G, Vujnović S, et al. Variability of the vertebral artery origin and transverse foramen entrance level - CT angiographic study. Folia Morphol. 2018; 77(4): 687–692.
- Wenbo Ha, DeLin Y, Shixin Gu, et al. Anatomical study of suboccipital vertebral arteries and surrounding bony structures using virtual reality technology. Med Sci Monit. 2014; 20: 802–806.
- World Medical Association Declaration Of Helsinki: Ethical Principles for Medical Research Involving Human Subjects, 64th WMA General Assembly, Fortaleza, Brazil, October 2013. https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/.
