A fetal circle of Willis is associated with a decreased deep white matter lesion load

Area of Science:

• Neuroimaging
• Vascular Neurology
• Cerebrovascular Anatomy

Background:

• White matter lesions (WMLs) are associated with cognitive decline and cerebrovascular disease.
• The circle of Willis, a key arterial structure at the base of the brain, exhibits variations in its configuration.
• Understanding the relationship between circle of Willis anatomy and WMLs is crucial for stroke prevention and management.

Purpose of the Study:

• To investigate the association between morphologic variations of the circle of Willis and the presence and distribution of white matter lesions.
• To determine if a fetal configuration of the circle of Willis influences the burden of WMLs.

Main Methods:

• Brain MRI and MR angiography of the circle of Willis were performed on 243 patients with clinical manifestations of atherosclerotic disease.
• Patients were categorized based on the configuration of the circle of Willis, specifically noting fetal versus nonfetal posterior circulation patterns.
• White matter lesions were quantified and analyzed in relation to circle of Willis morphology.

Main Results:

• A fetal configuration of the circle of Willis was associated with a significantly decreased load of small and medium deep white matter lesions (p < 0.01 for both).
• This protective association was observed when comparing subjects with a fetal posterior circle of Willis to those with a nonfetal configuration.
• No significant differences were noted for other WML types or locations in this analysis.

Conclusions:

• The fetal configuration of the posterior part of the circle of Willis may serve as a protective factor against the development of white matter lesions.
• These findings suggest that variations in cerebrovascular anatomy could play a role in the etiology of WMLs.
• Further research is warranted to explore the underlying mechanisms and clinical implications of this association.