Cai Ying, Liu Yang, Qiao Huiyu, Chen Huijun, Li Rui, Zhang Ji, Zhao Xihai
Department of Radiology, Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China.
Suzhou Research Center of Medical School, Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou, China.
Eur Radiol. 2025 Mar 20. doi: 10.1007/s00330-025-11509-0.
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.
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.
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).
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.
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.
本研究旨在使用三维（3D）多对比磁共振（MR）血管壁成像技术，评估无症状老年人颈动脉粥样硬化斑块的形态学和成分特征与脑白质病变（WMLs）之间的关系。
从一项基于社区的研究中招募无症状老年受试者（≥60岁）。在3.0-T MR扫描仪上对颈动脉和脑部进行成像。评估颈动脉粥样硬化斑块的形态学和成分特征。使用Fazekas标准对WMLs进行评分。比较不同WML严重程度下颈动脉斑块的特征，并分析颈动脉斑块特征与WMLs之间的关联。
总共纳入123名老年受试者（平均年龄：71.9±6.0岁，55名男性）。在不同WML严重程度的受试者中，颈动脉平均壁厚度（MWT）、钙化的存在以及高危斑块存在显著差异（均p<0.05）。单因素逻辑回归分析显示，颈动脉斑块钙化（比值比[OR]，5.357；95%置信区间[CI]：1.556-18.437，p=0.008）、斑块内出血（OR，4.952；95%CI：1.089-22.514，p=0.038）和颈动脉高危斑块（OR，7.214；95%CI：1.929-26.974，p=0.003）与严重WML显著相关。在调整混杂因素后，这些关联的显著性减弱，只有高危斑块与严重WML的关联仍具有统计学意义（OR，8.829；95%CI：1.566-49.787；p=0.014）。
颈动脉斑块成分特征，尤其是高危斑块，与WMLs的严重程度显著相关，提示颈动脉易损性动脉粥样硬化斑块可能是无症状老年人脑小血管疾病的独立指标。
问题无症状老年人颈动脉粥样硬化斑块特征与WMLs之间的关系仍不清楚。发现高危颈动脉斑块与无症状老年人WMLs的严重程度显著相关。临床意义识别颈动脉斑块特征，特别是高危斑块，可作为脑小血管疾病的一个指标，有助于在无症状老年人中早期发现和管理相关风险。
