Journal of stroke · 2026
Intracranial Vessel Morphology in <I>RNF213</I>-Related Vasculopathy: A Quantitative Imaging Study in Ischemic Stroke Patients.
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Han I Joon, Kim Hyung Jun, Kim Hyun Kyung, Song Ha-Na, Lee Seong-Hoon, Ha Yun-Hwa, Baek In-Young, Lee Ji-Eun, Ju Seongvin, Chung Jong-Won, Kim Gyeong-Moon, Bang Oh Young, Seo Woo-Keun
Аннотация
BACKGROUND AND PURPOSE: The RNF213 p.R4810K variant is a major susceptibility allele for moyamoya disease (MMD) in East Asians. This study investigated the relationship between RNF213 variants and intracranial vessel morphology in acute ischemic stroke.
METHODS: Patients from the Samsung Medical Center (SMC) Stroke Registry (2017-2019) were included. Quantitative vessel features were extracted from magnetic resonance angiography, including the basal global tortuosity index (GTIb), internal carotid artery (ICA) area, and basal minimum-to-maximum diameter ratio (MMRb). Genome-wide association analyses of GTIb, ICA area, and MMRb were performed (n=945). Validation was conducted in an independent Korea University Medical Center (KUMC) cohort. Groupwise comparisons were performed across three predefined groups: MMD+/variant+, MMD-/variant+, and MMD-/variant-. Adjusted linear regressions for ICA area were performed. Receiver operating characteristic (ROC) analyses evaluated GTIb, ICA area, and a combined model for identifying RNF213 carriers.
RESULTS: GTIb and ICA area showed genome-wide significance at the RNF213 locus (p.R4810K), whereas MMRb did not. In the KUMC cohort, ICA area differed between variant+ and variant-groups, while GTIb and MMRb did not. Across SMC groups (MMD+/variant+ [n=14], MMD-/variant+ [n=37], MMD-/variant- [n=888]), GTIb was highest and ICA area and MMRb smallest in MMD+/variant+, intermediate in MMD-/variant+, and lowest/largest in MMD-/variant- (P<0.001). ICA area differences remained significant after multivariable adjustment. In ROC analyses, ICA area provided significant incremental discrimination beyond clinical variables.
CONCLUSIONS: The RNF213 variant was consistently associated with smaller ICA area in patients with ischemic stroke. The association with intracranial tortuosity was not reproduced in the validation cohort.
METHODS: Patients from the Samsung Medical Center (SMC) Stroke Registry (2017-2019) were included. Quantitative vessel features were extracted from magnetic resonance angiography, including the basal global tortuosity index (GTIb), internal carotid artery (ICA) area, and basal minimum-to-maximum diameter ratio (MMRb). Genome-wide association analyses of GTIb, ICA area, and MMRb were performed (n=945). Validation was conducted in an independent Korea University Medical Center (KUMC) cohort. Groupwise comparisons were performed across three predefined groups: MMD+/variant+, MMD-/variant+, and MMD-/variant-. Adjusted linear regressions for ICA area were performed. Receiver operating characteristic (ROC) analyses evaluated GTIb, ICA area, and a combined model for identifying RNF213 carriers.
RESULTS: GTIb and ICA area showed genome-wide significance at the RNF213 locus (p.R4810K), whereas MMRb did not. In the KUMC cohort, ICA area differed between variant+ and variant-groups, while GTIb and MMRb did not. Across SMC groups (MMD+/variant+ [n=14], MMD-/variant+ [n=37], MMD-/variant- [n=888]), GTIb was highest and ICA area and MMRb smallest in MMD+/variant+, intermediate in MMD-/variant+, and lowest/largest in MMD-/variant- (P<0.001). ICA area differences remained significant after multivariable adjustment. In ROC analyses, ICA area provided significant incremental discrimination beyond clinical variables.
CONCLUSIONS: The RNF213 variant was consistently associated with smaller ICA area in patients with ischemic stroke. The association with intracranial tortuosity was not reproduced in the validation cohort.