Association of Intracranial Plaque Features with the Severity of White Matter Hyperintensities in Middle-Aged and Older Community-Dwelling Adults

<b>Background/Objectives</b>: Despite the reported correlation between white matter hyperintensity (WMH) and intracranial atherosclerosis (ICAS), little is known about the association between intracranial plaque imaging characteristics and the severity of WMH. This study aimed to investigate the relationship between plaque imaging features in the major intracranial large arteries and the severity of WMH by high-resolution magnetic resonance imaging (HR-MRI) in a local community-based cohort. <b>Methods</b>: Stroke-free Chinese aged over 45 years old were recruited. Plaque imaging features of intracranial arteries identified in middle cerebral arteries (MCAs), vertebral arteries (VAs), and basilar arteries (BAs) were analyzed. The plaque characteristics were compared between subjects with or without moderate-to-severe WMH (Fazekas score > 2), and their independent association with the severity of WMH was also assessed using multivariate logistic regression analysis. <b>Results</b>: In the cohort of 272 subjects (mean age, 63.4 ± 6.8 years old; males, <i>n</i> = 118), 24.6% with moderate-to-severe WMH had a significantly higher prevalence of ICAS, eccentric lesions, diffuse thickening pattern, and a heavier plaque burden in the intracranial major arteries compared to those without moderate-to-severe WMH. After adjusting for confounding factors, multivariate logistic regression analysis showed that an eccentric pattern of plaque lesion was independently associated with moderate-to-severe WMH. <b>Conclusions</b>: Eccentric lesions in the major intracranial large arteries, but not diffuse thickening patterns, luminal stenosis, and plaque burden, were independently associated with a greater burden of WMHs among middle-aged or older adults. Eccentricity of major intracranial large artery lesions may be a potential imaging marker to assess WMH burden. Understanding the correlation between atherosclerotic patterns and the severity of WMH would aid in early stratifying the future clinical risk of cerebrovascular events and support the development of individualized treatment strategies. Further studies are warranted to investigate its value in predicting future cerebrovascular events.