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• Clinical Article •
Research on the correlation among white matter hyperintensities, cerebral blood flow, and collateral circulation in patients with unilateral middle cerebral artery atherosclerotic stenosis
LI Zhongxin  HE Yexin 

DOI:10.12015/issn.1674-8034.2026.02.009.


[Abstract] Objective To investigate the association between white matter hyperintensities (WMH) and collateral circulation in patients with unilateral middle cerebral artery atherosclerotic stenosis (ICAS) using three-dimensional pseudo-continuous arterial spin labeling (3D-pCASL) technique. Meanwhile, to explore the correlations of WMH with the degree of vascular stenosis and cerebral blood flow (CBF).Materials and Methods A retrospective analysis was performed on data from 100 patients with moderate to severe unilateral ICAS admitted to Shanxi Provincial People's Hospital from January 2022 to February 2025. Patients were divided into two groups based on the distribution range of arterial transit artifacts (ATA) in 3D-pCASL images: the good collateral circulation group (58 cases) and the poor collateral circulation group (42 cases). Independent risk factors for poor collateral circulation were identified through univariate and multivariate Logistic regression analyses. Stratified by the degree of vascular stenosis, the relationship between WMH and collateral circulation under different stenosis degrees was analyzed. CBF in the blood supply area of the affected middle cerebral artery was measured to calculate collateral blood flow and perfusion level. Combined with total WMH score grouping, the relationship between WMH and CBF was studied.Results Statistically significant differences were found between the good and poor collateral circulation groups in gender (χ2 = 5.939), total cholesterol (t = 0.211) and low-density lipoprotein (t = 2.891) (all P < 0.05), as well as in vascular stenosis degree (χ2 = 18.138), total WMH score (χ2 = 20.596), deep WMH score (χ2 = 27.063), and periventricular WMH score (χ2 = 20.783) (all P < 0.001), all of which were statistically significant. Deep WMH scores have a higher correlation with poor collateral circulation (r = 0.565, P < 0.001). After adjusting for confounding factors, the degree of vascular stenosis (P = 0.006), deep WMH (P = 0.008), periventricular WMH (P = 0.017), and total WMH score (P = 0.044) were identified as independent risk factors for poor collateral circulation. Stratified analysis demonstrated that poor collateral circulation and the total WMH score were associated in patients with severe stenosis (P = 0.020), but no such association was found in patients with moderate stenosis (P = 0.125). Compared with the mild WMH group, the moderate to severe WMH group had significantly lower CBF in the affected side (P < 0.001) and forward flow ratio (Z = -3.720, P < 0.001), as well as more severe vascular stenosis (χ2 = 5.850, P = 0.016). Multivariate regression analysis showed that the reduced ratio of forward flow was independently associated with moderate to severe WMH (P = 0.045).Conclusions For patients with unilateral middle cerebral artery atherosclerotic stenosis, WMH is identified as an independent risk factor associated with poor collateral circulation.especially in those with severe vascular stenosis, where severe WMH may impede collateral circulation formation. WMH is associated with decreased cerebral blood flow and hypoperfusion caused by vascular stenosis, but not with the stenosis degree itself. The aforementioned relationships between WMH and intracranial large-vessel stenosis may contribute to the poor prognosis of patients with coexisting ICAS and WMH, providing new insights for the treatment of such patients.
[Keywords] intracranial atherosclerotic stenosis；magnetic resonance imaging；three-dimensional pseudo-continuous arterial spin labeling；white matter hyperintensities；cerebral blood flow；collateral circulation；cerebral blood flow

LI Zhongxin1   HE Yexin2*  

1 Department of Medical Imaging, Shanxi Medical University, Taiyuan 030001, China

2 Department of Radiology, Shanxi Provincial People's Hospital, Affiliate of Shanxi Medical University, Taiyuan 030012, China

Corresponding author: HE Y X, E-mail: heyexinty2000@sina.com

Conflicts of interest   None.

Received  2025-11-11
Accepted  2026-01-05
DOI: 10.12015/issn.1674-8034.2026.02.009
DOI:10.12015/issn.1674-8034.2026.02.009.

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