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. 2025 Sep;35(9):5561-5568.
doi: 10.1007/s00330-025-11509-0. Epub 2025 Mar 20.

Carotid artery atherosclerosis and white matter lesions in the elderly: a community-based MR imaging study

Ying Cai  1 , Yang Liu  2 , Huiyu Qiao  3 , Huijun Chen  4 , Rui Li  4 , Ji Zhang #  5 , Xihai Zhao #  6
Affiliations

Carotid artery atherosclerosis and white matter lesions in the elderly: a community-based MR imaging study

Ying Cai et al. Eur Radiol. 2025 Sep.

Abstract

Objectives: This study sought to evaluate the relationship between morphological and compositional characteristics of carotid atherosclerotic plaques and white matter lesions (WMLs) in asymptomatic elderly adults using three-dimensional (3D) multicontrast magnetic resonance (MR) vessel wall imaging.

Materials and methods: Asymptomatic elderly subjects (≥ 60 years) were recruited from a community-based study. Carotid arteries and the brain were imaged on a 3.0-T MR scanner. The morphological and compositional features of carotid atherosclerotic plaques were evaluated. The WMLs were scored using the Fazekas criteria. The characteristics of carotid plaque were compared among different WML severities and the associations between carotid plaque characteristics and WMLs were analyzed.

Results: In total, 123 elderly subjects (mean age: 71.9 ± 6.0 years, 55 males) were included. A significant difference was found in carotid MWT, presence of calcification, and high-risk plaque among subjects with different severity of WMLs (all p < 0.05). Univariate logistic regression analysis showed that carotid plaque calcification (OR, 5.357; 95% CI: 1.556-18.437, p = 0.008), intraplaque hemorrhage (OR, 4.952; 95% CI: 1.089-22.514, p = 0.038), and high-risk plaque (OR, 7.214; 95% CI: 1.929-26.974, p = 0.003) in carotid arteries were significantly associated with severe WML. After adjusting for the confounding factors, the significance of these associations was attenuated and only the association of high-risk plaque with severe WML remained statistically significant (OR, 8.829; 95% CI: 1.566-49.787; p = 0.014).

Conclusion: Carotid artery plaque compositional characteristics, especially high-risk plaque, were significantly associated with the severity of WMLs, suggesting that carotid vulnerable atherosclerotic plaque might be an independent indicator for cerebral small vessel disease in asymptomatic elderly adults.

Key points: Question The relationship between carotid atherosclerotic plaque characteristics and WMLs in asymptomatic elderly adults remains unclear. Findings High-risk carotid plaques are significantly associated with the severity of WMLs in the asymptomatic elderly. Clinical relevance Identifying carotid plaque characteristics, particularly high-risk plaques, may serve as an indicator for cerebral small vessel disease, aiding in early detection and management of related risks in the asymptomatic elderly.

Keywords: Atherosclerotic plaque; Carotid artery; Cerebral small vessel disease; Magnetic resonance imaging; White matter lesions.

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Conflict of interest statement

Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is Dr. Xihai Zhao. Conflict of interest: The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. Statistics and biometry: No complex statistical methods were necessary for this paper. Informed consent: Written informed consent was obtained from all subjects (patients) in this study. Ethical approval: Institutional Review Board approval was obtained. Study subjects or cohorts overlap: Some study subjects or cohorts have been previously reported in the article “Atherosclerotic plaque features and distribution in bilateral carotid arteries of the asymptomatic elderly population: a 3D multicontrast MR vessel wall imaging study,” published in the European Journal of Radiology, volume 96, pages 6–11; https://doi.org/10.1016/j.ejrad.2017.09.004 . The current study leverages a partially overlapping patient population from this prior work, specifically utilizing the data on carotid atherosclerotic plaque distribution features. However, the novel aspect of the current investigation lies in the addition of data on WMLs in the brain, aiming to explore the relationship between these plaque characteristics and the severity of WMLs in asymptomatic elderly individuals. The overlap in plaque distribution data allows for a more comprehensive understanding of how specific plaque features may contribute to cerebral small vessel disease, as evidenced by WMLs, in these asymptomatic elderly. Methodology: Retrospective Cross-sectional study Performed at one institution

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