• Laszlo Szalontai, Zsofia Jokkel, Tamas Horvath, Bianka Forgo, Ildiko Kalina, Pal Maurovich-Horvat, Philip L Auyang, M Mujeeb Zubair, Zsolt Garami, David Laszlo Tarnoki, and Adam Domonkos Tarnoki.
• Laszlo Szalontai, Korányi Sándor utca 2, H-1082 Budapest, VIII, Hungary, laszlo.szalontai.med@gmail.com.
• Croat. Med. J. 2021 Aug 31; 62 (4): 360-366.

AimTo investigate whether vertebrobasilar geometry contributes to the presence, severity, and laterality of white matter hyperintensities (WMH).MethodsWe retrospectively reviewed 290 cerebral scans of patients who underwent time-of-flight and fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) between 2017 and 2018. WMH were counted, localized, and grouped according to laterality on the FLAIR sequence. A 3D mesh of the posterior circulation was reconstructed (with ITK SNAP software) and the morphology of the vertebrobasilar system analyzed with an in-house software written in Python.ResultsPatients were assigned into a group with WMH (n=204) and a group without WMH (n=86). The severity of WMH burden was mainly affected by age and hypertension, while the localization of the WMH (or laterality) was mainly affected by the vertebrobasilar system morphology. Basilar artery morphology only affected the parieto-occipital region significantly if both posterior communicating arteries were hypoplastic or absent. The dominant vertebral artery and basilar artery curve had an opposite directional relationship.ConclusionsAn unequal vertebral artery flow is an important hemodynamic contributor to basilar bending. Increased basilar artery curvature and increased infratentorial WMH burden may signal inadequate blood flow and predict cerebrovascular events.

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