Relationships of Cerebral MRI Findings to Ultrasonographic Carotid Atherosclerosis in Older Adults

Abstract

Abstract-Cerebral magnetic resonance imaging (MRI) has demonstrated a high prevalence of infarct-like lesions, white matter hyperintensities, and evidence of cerebral atrophy in older adults. While these findings are generally believed to be related to ischemia and atherosclerosis, their relationship to atherosclerosis in the carotid arteries remains to be explored. Study subjects were part of the multicenter Cardiovascular Health Study, a cross-sectional study of 3502 women and men Ն65 years of age undergoing cranial MRI and carotid ultrasonography. MRI infarcts were detected in 1068 participants (29.3%) and measurable carotid plaque in 2745 (75.3%). MRI infarcts, ventricular and sulcal widening, and white matter score were strongly associated with carotid intimal-medial thickness (IMT) and stenosis degree after adjustment for age and sex (all PϽ0.01). Associations with plaque characteristics were less strong and less consistent; MRI infarcts were weakly associated only with surface irregularity, and ventricular size was weakly associated only with lesion density (both PϽ0.04). In contrast, sulcal widening was strongly related to plaque characteristics, with scores being higher in those with heterogeneous and irregular plaque (both PϽ0.009 Key Words: stroke Ⅲ cerebrovascular disorders Ⅲ carotid arteries Ⅲ atherosclerosis Ⅲ aged Ⅲ epidemiology Ⅲ risk factors C erebral magnetic resonance imaging (MRI) has demonstrated a high prevalence of infarct-like lesions, white matter hyperintensities, and evidence of cerebral atrophy in older adults. 1-3 While these findings are related to standard risk factors for cardiovascular disease and are believed to be consequences of ischemia, 4 -6 their relationship to atherosclerosis in the carotid arteries has not been widely explored.Because the carotid arteries provide the majority of the brain's blood supply, detailed information on extent, severity, and characteristics of carotid atherosclerosis can be used to explore its relationships to cerebral MRI findings. Lesion characteristics such as increased density, heterogeneity, and surface irregularity have been shown to relate to prevalent clinically defined transient ischemic attack and stroke, 6 but these associations have not been examined for cerebral MRI findings.The Cardiovascular Health Study (CHS) cohort represents a large, multicenter sample of older men and women examined by both carotid ultrasonography and cerebral MRI. Cross-sectional data from these examinations were analyzed (1) to describe prevalences of MRI-defined infarcts, infarctlike lesions, and gray and white matter changes by quintile of common and internal carotid intimal-medial thickness (IMT); degree of carotid stenosis; and characteristics of carotid plaque; (2) to determine independence of carotid atherosclerosis/MRI abnormality associations from known clinical and subclinical cardiovascular disease and cardiovascular disease risk factors; and (3) to define relationships of MRI infarcts and ipsilateral carotid artery disease. MethodsCHS participants ...

Calcium and vitamin D intakes may be positively associated with brain lesions in depressed and nondepressed elders

“…A combined analysis of the Rotterdam and Zoetermeer Studies confirmed the finding of a significant positive association between carotid atherosclerosis and white matter lesions [40]. The Cardiovascular Health Study (CHS) found a two-fold increase in the prevalence of brain infarcts in elderly individuals (n=3,502) with calcified carotid plaques [41]. The CHS found that coronary artery calcification was also associated with white matter lesions, other brain abnormalities, and cognitive impairment [13].…”

Multifractal analysis of deep white matter microstructural changes on MRI in relation to early-stage atherosclerosis

“…Thus, detection using the multifractal analysis of microstructural changes in the white matter, specifically changes related to the early stages of atherosclerosis, before the appearance of visible changes on T2-MRI, is clinically significant. IMT is a strong predictor of cerebrovascular disease, including stroke (Cao et al, 2003;Manolio et al, 1999;O'Leary et al, 1999;Touboul et al, 2000). Therefore, this study's quantitative analysis of deep white matter by multifractal analysis is likely to be useful for predicting the occurrence or prognosis of cerebrovascular disease.…”

Association between Carotid Hemodynamics and Asymptomatic White and Gray Matter Lesions in Patients with Essential Hypertension

“…The Cardiovascular Health Study previously demonstrated strong relationships between white matter lesions and carotid IMT and stenosis (37). Kitamura et al reported that increased IMT is a risk factor for stroke in Japanese elderly men (38).…”