A Novel Framework for Early Detection of Hypertension using Magnetic Resonance Angiography

Hypertension is a leading mortality cause of 410,000 patients in USA. Cerebrovascular structural changes that occur as a result of chronically elevated cerebral perfusion pressure are hypothesized to precede the onset of systemic hypertension. A novel framework is presented in this manuscript to detect and quantify cerebrovascular changes (i.e. blood vessel diameters and tortuosity changes) using magnetic resonance angiography (MRA) data. The proposed framework consists of: 1) A novel adaptive segmentation algorithm to delineate large as well as small blood vessels locally using 3-D spatial information and appearance features of the cerebrovascular system; 2) Estimating the cumulative distribution function (CDF) of the 3-D distance map of the cerebrovascular system to quantify alterations in cerebral blood vessels' diameters; 3) Calculation of mean and Gaussian curvatures to quantify cerebrovascular tortuosity; and 4) Statistical and correlation analyses to identify the relationship between mean arterial pressure (MAP) and cerebral blood vessels' diameters and tortuosity alterations. The proposed framework was validated using MAP and MRA data collected from 15 patients over a 700-days period. The novel adaptive segmentation algorithm recorded a 92.23% Dice similarity coefficient (DSC), a 94.82% sensitivity, a 99.00% specificity, and a 10.00% absolute vessels volume difference (AVVD) in delineating cerebral blood vessels from surrounding tissues compared to the ground truth. Experiments demonstrated that MAP is inversely related to cerebral blood vessel diameters (p-value < 0.05) globally (over the whole brain) and locally (at circle of Willis and below). A statistically significant direct correlation (p-value < 0.05) was found between MAP and tortuosity (medians of Gaussian and mean curvatures, and average of mean curvature) globally and locally (at circle of Willis and below). Quantification of the cerebrovascular diameter and tortuosity changes may enable clinicians to predict elevated blood pressure before its onset and optimize medical treatment plans of pre-hypertension and hypertension.