To investigate whether vertebrobasilar geometry contributes to the presence, severity,
and laterality of white matter hyperintensities (WMH).We 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.Patients 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.An 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.
