title: Relationship between white matter hyperintensities volume and the circle of Willis configurations in patients with carotid artery pathology.
abstract: We aimed to assess if there is a difference of distribution and volume of white matter hyperintensities (WMH) in the brain according to the Circle of Willis (CoW) configuration in patients with carotid artery pathology.
  
  
  
  One-hundred consecutive patients (79 males, 21 females; mean age 70 years; age range 46-84 years) that underwent brain MRI before carotid endarterectomy (CEA) were included. FLAIR-WMH lesion volume was performed using a semi-automated segmentation technique and the status of the circle of Willis was assessed by two neuroradiologists in consensus.
  
  
  
  We found a prevalence of 55% of variants in the CoW configuration; 22 cases had one variants (40%); 25 cases had two variants (45.45%) and 8 cases showed 3 variants (14.55%). The configuration that was associated with the biggest WMH volume and number of lesions was the A1+PcoA+PcoA. The PcoA variants were the most prevalent and there was no statistically significant difference in number of lesions and WMH for each vascular territory assessed and the same results were found for AcoA and A1 variants.
  
  
  
  Results of our study suggest that the more common CoW variants are not associated with the presence of an increased WMH or number of lesions whereas uncommon configurations, in particular when 2 or more segment are missing increase the WMH volume and number of lesions. The WHM volume of the MCA territory seems to be more affected by the CoW configuration.
authors.affiliation: Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato, Cagliari 09045, Italy. Electronic address: lucasaba@tiscali.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Saba
authors.affiliation: Department of Vascular Surgery, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato, Cagliari 09045, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Sanfilippo
authors.affiliation: Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato, Cagliari 09045, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Porcu
authors.affiliation: Department of Radiology, University la Sapienza, Rome, Italy.
authors.forename: Pierleone
authors.initials: P
authors.lastname: Lucatelli
authors.affiliation: Department of Vascular Surgery, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato, s.s. 554 Monserrato, Cagliari 09045, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Montisci
authors.affiliation: Department of Radiology, University la Sapienza, Rome, Italy.
authors.forename: Fulvio
authors.initials: F
authors.lastname: Zaccagna
authors.affiliation: Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA; Point-of-Care Devices, Global Biomedical Technologies, Inc., Roseville, CA, USA; Department of Electrical Engineering, University of Idaho (Affl.), ID, USA.
authors.forename: Jasjit S
authors.initials: JS
authors.lastname: Suri
authors.affiliation: Department of Radiology, University la Sapienza, Rome, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Anzidei
authors.affiliation: Department of Radiology, Stanford University, USA.
authors.forename: Max
authors.initials: M
authors.lastname: Wintermark
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply; D001927:Brain Diseases / Q000473:pathology*; D002339:Carotid Arteries / Q000473:pathology; D002340:Carotid Artery Diseases / Q000473:pathology* / Q000601:surgery; D002941:Circle of Willis / Q000473:pathology*; D016894:Endarterectomy, Carotid / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D066127:White Matter / Q000473:pathology*; D055815:Young Adult
keywords: Carotid artery pathology; Circle of Willis; White matter hyperintensities