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Relationship between leukoaraiosis, carotid intima-media thickness and intima-media thickness variability: Preliminary results

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To assess the relationship between the degree of leukoaraiosis (LA), carotid intima-media thickness (IMT) and intima-media thickness variability (IMTV).

Materials and methods

Sixty-one consecutive patients, who underwent a brain MRI examination and a carotid artery ultrasound, were included in this retrospective study, which conformed with the Declaration of Helsinki. Written informed consent was waived. In each patient, right/left carotid arteries and brain hemispheres were assessed using automated software for IMT, IMTV and LA volume.


The mean hemispheric LA volume was 2,224 mm3 (SD 2,702 mm3) and there was no statistically significant difference in LA volume between the right and left hemispheres (p value = 0.628). The mean IMT and IMTV values were 0.866 mm (SD 0.170) and 0.143 mm (SD 0.100), respectively, without significant differences between the right and left sides (p values 0.733 and 0.098, respectively). The correlation coefficient between IMTV and LA volume was 0.41 (p value = 0.0001), and 0.246 (p value = 0.074) between IMT and LA volume.


IMTV significantly correlates with LA volume. Further studies are warranted to verify whether this parameter can be used clinically as a marker of cerebrovascular risk.

Key Points

Intima-media thickness variability (IMTV) significantly correlates with leukoaraiosis volume.

IMTV could be used as a marker for cerebrovascular risk.

IMTV seems to be a better predictor of weighted mean difference than IMT.

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The scientific guarantor of this publication is Luca Saba. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. No study subjects or cohorts have been previously reported. Methodology: retrospective, observational, performed at one institution.

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Correspondence to Luca Saba.

Appendix 1

Appendix 1

The carotid intima-media thickness (IMT) value was measured as the distance between the LI and the MA boundaries. We used the Polyline Distance as computation metric. We summarize here in brief the concept of the Polyline Distance metric (PDM), which is also required to define the IMT variability (IMTV) measurement.

The Polyline Distance metric is a robust metric used to define the distance between two boundaries or interfaces. The basic idea is to measure the distance of each vertex of a boundary to the line segments (a line joining the two successive points make a line segment) of the other boundary. Briefly, consider two boundaries B 1 and B 2 . We consider a vertex v i of the boundary B 1 . The Polyline Distance from the vertex v i to the boundary B 2 can be defined as the minimum distance between v i and the segments of B 2 . Let us call this distance d(v i , B 2). The overall distance between the vertices of B 1 to the segments of B 2 is then defined as the sum of the distances from the vertexes of B 1 to the closest segment of B 2 , and is therefore defined as:

$$ d\left({B}_1,{B}_2\right)={\displaystyle \sum_id\left({v}_i,{B}_2\right)} $$

The two boundaries are now swapped, so that it is possible to compute the distance between the vertices of B 2 to the closest segment of B 1 . The distance of each vertex v j of B 2 from the segments of the boundary B 1 can be indicated by d(v j , B 1). The distance between the vertices of B 2 and the segments of B 1 can be expressed as:

$$ d\left({B}_2,{B}_1\right)={\displaystyle \sum_jd\left({v}_j,{B}_1\right)} $$

The polyline distance between boundaries is the defined as:

$$ D\left({B}_1,{B}_2\right)=PDM\left({B}_1,{B}_2\right)=\frac{d\left({B}_1,{B}_2\right)+d\left({B}_2,{B}_1\right)}{N_{B_1}+{N}_{B_2}} $$

where \( {N}_{B_1} \) and \( {N}_{B_2} \) are the number of vertices of B 1 and B 2 , respectively. In our study, B 1 was the LI boundary, whereas B 2 was the MA. Therefore, the IMT value was the PDM distance between the LI and MA boundary:

$$ IMT=PDM\left(LI,MA\right) $$

We also measured the variability of the IMT, which we indicated as IMTV. This value is a measure of how variable is the distance between the vertices of LI from the segments of MA, and vice versa. Hence, if we define σ LI the standard deviation of the distances d(v i , MA) (i.e. the distances of the vertex v i of LI to the segments of MA), and σ MA the standard deviation of the distances d(v j , LI) (i.e. the distances of the vertex v j of MA to the segments of LI), the IMTV can be defined as:

$$ IMTV=\sqrt{\frac{\sigma_{LI}^2+{\sigma}_{MA}^2}{N_{LI}+{N}_{MA}}} $$

where N LI and N MA are the number of vertices of LI and MA, respectively. Conceptually, the PDM metric was used because it ensured a robust estimation of the actual distance between two boundaries even in presence of curved or inclined profiles (as might happen in ultrasound carotid images). The IMTV is a measure of variability of the distance between LI/MA interfaces of the distal wall.

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Lucatelli, P., Raz, E., Saba, L. et al. Relationship between leukoaraiosis, carotid intima-media thickness and intima-media thickness variability: Preliminary results. Eur Radiol 26, 4423–4431 (2016). https://doi.org/10.1007/s00330-016-4296-4

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  • IMT
  • Arterial intima
  • Leukoaraiosis
  • MRI
  • Ultrasound