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Objective  To preliminarily explore subclinical brain alterations in an asymptomatic carotid vulnerable plaque group based on intravoxel incoherent motion (IVIM) imaging through voxelwise comparison in the whole brain.    Materials and Methods  Forty-nine elderly participants underwent multi- b -value DWI, of whom 24 participants with asymptomatic carotid vulnerable plaques and <50% stenosis served as the test group, while the rest served as the healthy control group. After fitting the double-exponential model, slow ADC (Ds) and the fraction of fast ADC ( f ) values of the whole brain were obtained, which then were compared in a voxelwise manner by two-sample  t -test. Multiple comparisons were corrected by the family-wise error (FWE) method with a corrected threshold of  P  < 0.05. Pearson correlations between IVIM parameters in altered brain regions and blood pressure, glucose, lipid, and homocysteine were calculated.    Results  For the test group, the  Z -normalized Ds values were significantly higher in the left median cingulate and paracingulate gyrus (DCG.L), posterior cingulate gyrus (PCG. L), and left precuneus gyrus (PCUN.L) (cluster size = 156) and in the left middle frontal gyrus (MFG.L), orbital middle frontal gyrus (ORBmid.L), and superior frontal gyrus (SFG.L) (cluster size = 165); the  Z -normalized Ds values were significantly lower in the right middle temporal gyrus (MTG.R) and inferior temporal gyrus (ITG.R) (cluster size = 116); and the  Z -normalized  f -values were significantly lower in the MTG.R and ITG.R (cluster size = 85) ( p  < 0.05, FWE correction). LDL-C was negatively correlated with the  Z -normalized Ds values in the DCG.L, PCG.L, and PCUN.L ( r  = 0.601,  p  = 0.002). LDL-C was positively correlated with the  Z -normalized  f -value in the MTG.R and ITG.R ( r  = 0.405,  p  = 0.05). Systolic blood pressure was positively correlated with the  Z -normalized Ds values in the MFG.L, ORBmid.L, and SFG.L ( r  = 0.433,  p  = 0.035).    Conclusion  This study was the first to detect subclinical brain alterations in asymptomatic carotid vulnerable plaque group through IVIM using whole-brain voxelwise comparisons, which were partially correlated with blood pressure and lipids. Thus, IVIM might be utilized as a noninvasive biomarker of microvascular and microstructural brain changes in the asymptomatic carotid vulnerable plaque group.

frontiers in neuroscience

Preliminary Study of Subclinical Brain Alterations in Patients With Asymptomatic Carotid Vulnerable Plaques Using Intravoxel Incoherent Motion Imaging by Voxelwise Comparison: A Study of Whole-Brain Imaging Measures