Background and aims: Covert magnetic resonance imaging (MRI) markers of cerebral small vessel disease (CSVD) can coexist with large artery atherosclerosis. We aimed to explore whether the spatial distributions of these markers were diverse in people with or without intracranial artery stenosis (ICAS). Methods: This cross-sectional analysis included 1206 stroke-free participants (aged 55.69 ± 9.27, 62.94% female) with brain MRI and MR angiography from Shunyi cohort. We analyzed the relationships between ICAS and CSVD markers. We also compared the probability maps of lacunes, cerebral microbleeds (CMB), white matter hyperintensities (WMH) and vertex-wise cortex maps at a voxel/vertex-wise level in groups with and without ICAS. Results: ICAS was significantly correlated with lacunes (OR = 2.95, 95% CI = 1.97-4.43, p < 0.001), WMH (β = 0.333, SE = 0.058, p < 0.001) and BPF (β = -0.011, SE = 0.002, p < 0.001) independently, but not with CMB. Lacunes coexist ICAS were prone in basal ganglia, while the lacunes without ICAS appeared in centrum semiovale more often. WMH with ICAS were likely to present in deep white matter involving the bilateral pyramidal tracts and superior thalamic radiation. People with ICAS were susceptible to worse cortical atrophy of right superior frontal and left rostral anterior cingulate. No obvious distributional differences were found for CMB between the two groups. Conclusions: Since ICAS may involve in the upstream pathogenesis of lacunes, white matter lesion and cortical atrophy, the impact of ICAS should not be ignored when evaluate MRI markers of CSVD.
Pan et al. (2026) studied this question.