Association between carotid plaque characteristics and cerebral white matter lesions: one-year follow-up study by MRI
Robert M Kwee1, Paul A M Hofman, Ed H B M Gronenschild
1Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands. eline.kooi@mumc.nl
Objective:
To prospectively assess the relation between carotid plaque characteristics and the development of new cerebral white matter lesions (WMLs) at MRI.
Methods:
Fifty TIA/stroke patients with ipsilateral 30-69% carotid stenosis underwent MRI of the plaque at baseline. Total plaque volume and markers of vulnerability to thromboembolism (lipid-rich necrotic core [LRNC] volume, fibrous cap [FC] status, and presence of intraplaque hemorrhage [IPH]) were assessed. All patients also underwent brain MRI at baseline and after one year. Ipsilateral cerebral WMLs were quantified with a semiautomatic method.
Results:
Mean WML volume significantly increased over a one-year period (6.52 vs. 6.97 mm(3), P = 0.005). WML volume at baseline and WML progression did not significantly differ (P>0.05) between patients with 30-49% and patients with 50-69% stenosis. There was a significant correlation between total plaque volume and baseline ipsilateral WML volume (Spearman ρ = 0.393, P = 0.005). There was no significant correlation between total plaque volume and ipsilateral WML progression. There were no significant associations between LRNC volume and WML volume at baseline and WML progression. WML volume at baseline and WML progression did not significantly differ between patients with a thick and intact FC and patients with a thin and/or ruptured FC. WML volume at baseline and WML progression also did not significantly differ between patients with and without IPH.
Conclusion:
The results of this study indicate that carotid plaque burden is significantly associated with WML severity, but that there is no causal relationship between carotid plaque vulnerability and the occurrence of WMLs.
Insights
Carotid plaque burden correlates with white matter lesion severity in stroke patients. However, plaque vulnerability markers like lipid-rich necrotic core or intraplaque hemorrhage do not predict new lesion development.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Medicine
Background:
- Cerebral white matter lesions (WMLs) are associated with stroke and cognitive decline.
- Carotid plaque characteristics may influence WML development.
Purpose of the Study:
- To investigate the relationship between carotid plaque characteristics and new WMLs.
- To assess if plaque vulnerability predicts WML progression.
Main Methods:
- Prospective study of 50 TIA/stroke patients with 30-69% carotid stenosis.
- MRI assessment of plaque volume, lipid-rich necrotic core (LRNC) volume, fibrous cap (FC) status, and intraplaque hemorrhage (IPH).
- Brain MRI at baseline and 1-year follow-up to quantify WMLs.
Main Results:
- Mean WML volume increased significantly over one year.
- Total plaque volume correlated with baseline WML volume (P=0.005).
- No significant correlation found between plaque vulnerability markers (LRNC, FC, IPH) and WML volume or progression.
Conclusions:
- Carotid plaque burden is associated with WML severity.
- Carotid plaque vulnerability markers are not causally related to WML occurrence.
