Relationship between white matter hyperintensities volume and the circle of Willis configurations in patients with carotid artery pathology

Eur J Radiol. 2017 Apr;89:111-116. doi: 10.1016/j.ejrad.2017.01.031. Epub 2017 Feb 1.


Purpose: We aimed to assess if there is a difference of distribution and volume of white matter hyperintensities (WMH) in the brain according to the Circle of Willis (CoW) configuration in patients with carotid artery pathology.

Material and methods: One-hundred consecutive patients (79 males, 21 females; mean age 70 years; age range 46-84 years) that underwent brain MRI before carotid endarterectomy (CEA) were included. FLAIR-WMH lesion volume was performed using a semi-automated segmentation technique and the status of the circle of Willis was assessed by two neuroradiologists in consensus.

Results: We found a prevalence of 55% of variants in the CoW configuration; 22 cases had one variants (40%); 25 cases had two variants (45.45%) and 8 cases showed 3 variants (14.55%). The configuration that was associated with the biggest WMH volume and number of lesions was the A1+PcoA+PcoA. The PcoA variants were the most prevalent and there was no statistically significant difference in number of lesions and WMH for each vascular territory assessed and the same results were found for AcoA and A1 variants.

Conclusion: Results of our study suggest that the more common CoW variants are not associated with the presence of an increased WMH or number of lesions whereas uncommon configurations, in particular when 2 or more segment are missing increase the WMH volume and number of lesions. The WHM volume of the MCA territory seems to be more affected by the CoW configuration.

Keywords: Carotid artery pathology; Circle of Willis; White matter hyperintensities.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Brain / blood supply
  • Brain Diseases / pathology*
  • Carotid Arteries / pathology
  • Carotid Artery Diseases / pathology*
  • Carotid Artery Diseases / surgery
  • Circle of Willis / pathology*
  • Endarterectomy, Carotid / methods
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Organ Size
  • White Matter / pathology*
  • Young Adult