Smoker's criteria

Last revised by Francis Deng on 15 Feb 2022

Smoker’s criteria use three quantitative measures of basilar artery morphology to diagnose dolichoectasia

  • laterality
  • bifurcation height
    • surrogate measures for tortuosity and elongation
  • basilar artery diameter represents the degree of dilatation

The application of Smoker’s criteria provides a means to diagnose dolichoectasia of the basilar artery 1,2. Elongation is indicated by abnormal laterality or height, ectasia is indicated by abnormal diameter, and doliechoectasia is indicated by the presence of both elongation and ectasia 6.


Basilar artery diameter

Score of 1 is abnormal:

  • 0: 1.9–4.5 mm
  • 1: >4.5 mm

Score ≥2 is abnormal:

  • 0: midline throughout
  • 1: medial to the lateral margin of the clivus or dorsum sellae
  • 2: lateral to lateral margin of clivus or dorsum sellae
  • 3: at the cerebellopontine angle
Height of bifurcation

Score ≥2 is abnormal:

  • 0: at or below the dorsum sellae
  • 1: within the suprasellar cistern (one cut above dorsum)
  • 2: at the 3rd ventricle floor (one cut above suprasellar cistern)
  • 3: indenting and elevating the floor of the 3rd ventricle (two or more cuts above suprasellar cistern)

The above criteria were defined on 5 mm thick slices 1.

History and etymology

Wendy R K Smoker (fl. 2020) is an American neuroradiologist who developed her eponymous criteria in the mid-1980s 1,2.

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