Brain white matter hyperintensities are associated with carotid intraplaque hemorrhage.
OBJECTIVE
To retrospectively assess the relationship between carotid intraplaque hemorrhage (IPH), which indicates plaque instability, and brain white matter hyperintense lesions (WMHLs) by using a within-patient design.


METHODS
All patients gave written informed consent for the initial magnetic resonance (MR) studies, and the institutional review board and local research ethics committee waived initial informed consent for the pooled analysis. A total of 190 patients with symptomatic carotid artery disease underwent fluid-attenuated inversion-recovery imaging of the brain and fat-suppressed black-blood T1-weighted MR imaging of the carotid arteries. The volumes of periventricular lesions, subcortical lesions, and total WMHLs were calculated and compared between hemispheres in relation to symptoms and IPH, and their interaction was calculated and compared by using repeated measures three-factorial multivariate analysis.


RESULTS
After exclusion of 12 patients, 178 patients (116 men, 62 women; mean age, 70.2 years +/- 8.6 [standard deviation]) remained. There was no significant difference in WMHL volume between the symptomatic and asymptomatic hemispheres, and WMHL volume was not related to the degree of carotid stenosis. The presence of carotid IPH significantly interacted with the interhemispheric WMHL difference (Wilks lambda test, F = 9.95; df = 3; P < .001). Univariate analysis showed larger total and periventricular WMHL volumes (P < .05) in patients with ipsilateral IPH.


CONCLUSIONS
Carotid artery disease and leukoaraiosis were associated with features that indicated plaque instability, namely IPH, whereas the degree of stenosis had no effect.
Department of Academic Radiology, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, England.
Nishath
N
Altaf
Paul S
PS
Morgan
Alan
A
Moody
Shane T
ST
MacSweeney
J R
JR
Gladman
Dorothee P
DP
Auer
D000368:Aged; D002340:Carotid Artery Diseases / Q000150:complications* / Q000175:diagnosis*; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D049292:Leukoaraiosis / Q000150:complications* / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009413:Nerve Fibers, Myelinated / Q000473:pathology*