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<meta name="DC.Title" content="High-resolution MR Angiographic Cerebrovascular Findings in a Tri-Ethnic Population" />
<meta name="DC.Identifier" content="10.3174/ajnr.A8402" />
<meta name="DC.Date" content="2024-07-12" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2024 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Incidental findings on brain MR and variation of the circle of Willis (CoW) are relatively common among the general population. Ethnic differences have been described before, but few studies have explored the prevalence of incidental intracranial cerebrovascular findings and CoW variants in the setting of a single multi-ethnic cohort. The purpose of this investigation is to describe both incidental cerebrovascular findings and the morphology of the CoW on high-resolution 3T time-of-flight MR angiography (ToF MRA) in a UK tri-ethnic population-based cohort and to present updated prevalence estimates and morphologic reference values.

MATERIALS AND METHODS: We studied participants from the UK Southall and Brent Revisited (SABRE) study who underwent 3T brain MRI between 2014–2018. ToF MRA images were assessed for the presence of incidental cerebrovascular imaging findings and used to determine CoW anatomy.

RESULTS: 750 participants (mean age: 71.28 ± 6.46 years, range [46–90], 337 female), 322 White Europeans, 253 South Asians, and 175 African Caribbeans, were included. Incidental cerebrovascular findings were observed in 84 subjects (11.2%, 95% CI [9.0–13.7]; 38 women, 45.24%, 95% CI [34.34–56.48]), cerebral aneurysms being the most frequent, followed by intracranial arterial stenoses (ICAS) with highest prevalence among South Asians compared to White European (OR: 2.72, 95% CI [1.22–6.08], p = .015) and African Caribbean subjects (OR: 2.79, 95% CI [1.00–7.82], p = .051). Other findings included arteriovenous malformations and infundibula. The CoW was found to be more often complete in women than in men (25.22% compared to 18.41%, p = .024), and in African Caribbean (34.86%), compared to White European (19.19%), and South Asian (14.23%) subjects (p &lt;0.001 each).

CONCLUSIONS: ICAS were independently associated with ethnicity after adjusting for vascular risk factors, having the highest prevalence among South Asians. The prevalence of aneurysms was higher than in previous population-based studies. We observed anatomical differences in the CoW configuration between women, men, and ethnicities.

ABBREVIATIONS: BP = Blood pressure; ICAS = Intracranial arterial stenoses; CoW = Circle of Willis; CVM = Cerebral vascular malformations; OR = Odds ratio; ToF MRA = Time-of-flight MR angiography." />
<meta name="DC.Contributor" content="Rafael Rehwald" />
<meta name="DC.Contributor" content="Carole H. Sudre" />
<meta name="DC.Contributor" content="Lorna Smith" />
<meta name="DC.Contributor" content="Magdalena Sokolska" />
<meta name="DC.Contributor" content="Therese Tillin" />
<meta name="DC.Contributor" content="David Atkinson" />
<meta name="DC.Contributor" content="Nishi Chaturvedi" />
<meta name="DC.Contributor" content="Alun D. Hughes" />
<meta name="DC.Contributor" content="Hans R. Jäger" />
<meta name="article:published_time" content="2024-07-03" />
<meta name="article:section" content="ORIGINAL RESEARCH" />
<meta name="citation_title" content="High-resolution MR Angiographic Cerebrovascular Findings in a Tri-Ethnic Population" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;ABSTRACT&lt;/h3&gt;
&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Incidental findings on brain MR and variation of the circle of Willis (CoW) are relatively common among the general population. Ethnic differences have been described before, but few studies have explored the prevalence of incidental intracranial cerebrovascular findings and CoW variants in the setting of a single multi-ethnic cohort. The purpose of this investigation is to describe both incidental cerebrovascular findings and the morphology of the CoW on high-resolution 3T time-of-flight MR angiography (ToF MRA) in a UK tri-ethnic population-based cohort and to present updated prevalence estimates and morphologic reference values.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We studied participants from the UK Southall and Brent Revisited (SABRE) study who underwent 3T brain MRI between 2014–2018. ToF MRA images were assessed for the presence of incidental cerebrovascular imaging findings and used to determine CoW anatomy.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;750 participants (mean age: 71.28 ± 6.46 years, range [46–90], 337 female), 322 White Europeans, 253 South Asians, and 175 African Caribbeans, were included. Incidental cerebrovascular findings were observed in 84 subjects (11.2%, 95% CI [9.0–13.7]; 38 women, 45.24%, 95% CI [34.34–56.48]), cerebral aneurysms being the most frequent, followed by intracranial arterial stenoses (ICAS) with highest prevalence among South Asians compared to White European (OR: 2.72, 95% CI [1.22–6.08], p = .015) and African Caribbean subjects (OR: 2.79, 95% CI [1.00–7.82], p = .051). Other findings included arteriovenous malformations and infundibula. The CoW was found to be more often complete in women than in men (25.22% compared to 18.41%, p = .024), and in African Caribbean (34.86%), compared to White European (19.19%), and South Asian (14.23%) subjects (p &amp;lt;0.001 each).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;ICAS were independently associated with ethnicity after adjusting for vascular risk factors, having the highest prevalence among South Asians. The prevalence of aneurysms was higher than in previous population-based studies. We observed anatomical differences in the CoW configuration between women, men, and ethnicities.&lt;/p&gt;&lt;p&gt;ABBREVIATIONS: BP = Blood pressure; ICAS = Intracranial arterial stenoses; CoW = Circle of Willis; CVM = Cerebral vascular malformations; OR = Odds ratio; ToF MRA = Time-of-flight MR angiography.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
<meta name="citation_publisher" content="American Journal of Neuroradiology" />
<meta name="citation_publication_date" content="2024/07/03" />
<meta name="citation_mjid" content="ajnr;ajnr.A8402v1" />
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<meta name="citation_article_type" content="Research Article" />
<meta name="citation_section" content="ORIGINAL RESEARCH" />
<meta name="citation_author" content="Rafael Rehwald" />
<meta name="citation_author_institution" content="From the Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (R.R., M.S., H.R.J.), MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, University College London, London, United Kingdom (C.H.S., T.T., N.C., A.D.H.), Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom (C.H.S.), School of Biomedical Engineering, King's College, London, United Kingdom (C.H.S.), Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom (L.S., D.A.), Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, London, United Kingdom (M.S.), Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, Holborn, London, United Kingdom (H.R.J)" />
<meta name="citation_author" content="Carole H. Sudre" />
<meta name="citation_author_institution" content="From the Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (R.R., M.S., H.R.J.), MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, University College London, London, United Kingdom (C.H.S., T.T., N.C., A.D.H.), Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom (C.H.S.), School of Biomedical Engineering, King's College, London, United Kingdom (C.H.S.), Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom (L.S., D.A.), Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, London, United Kingdom (M.S.), Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, Holborn, London, United Kingdom (H.R.J)" />
<meta name="citation_author" content="Lorna Smith" />
<meta name="citation_author_institution" content="From the Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (R.R., M.S., H.R.J.), MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, University College London, London, United Kingdom (C.H.S., T.T., N.C., A.D.H.), Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom (C.H.S.), School of Biomedical Engineering, King's College, London, United Kingdom (C.H.S.), Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom (L.S., D.A.), Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, London, United Kingdom (M.S.), Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, Holborn, London, United Kingdom (H.R.J)" />
<meta name="citation_author" content="Magdalena Sokolska" />
<meta name="citation_author_institution" content="From the Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (R.R., M.S., H.R.J.), MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, University College London, London, United Kingdom (C.H.S., T.T., N.C., A.D.H.), Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom (C.H.S.), School of Biomedical Engineering, King's College, London, United Kingdom (C.H.S.), Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom (L.S., D.A.), Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, London, United Kingdom (M.S.), Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, Holborn, London, United Kingdom (H.R.J)" />
<meta name="citation_author" content="Therese Tillin" />
<meta name="citation_author_institution" content="From the Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (R.R., M.S., H.R.J.), MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, University College London, London, United Kingdom (C.H.S., T.T., N.C., A.D.H.), Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom (C.H.S.), School of Biomedical Engineering, King's College, London, United Kingdom (C.H.S.), Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom (L.S., D.A.), Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, London, United Kingdom (M.S.), Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, Holborn, London, United Kingdom (H.R.J)" />
<meta name="citation_author" content="David Atkinson" />
<meta name="citation_author_institution" content="From the Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (R.R., M.S., H.R.J.), MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, University College London, London, United Kingdom (C.H.S., T.T., N.C., A.D.H.), Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom (C.H.S.), School of Biomedical Engineering, King's College, London, United Kingdom (C.H.S.), Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom (L.S., D.A.), Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, London, United Kingdom (M.S.), Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, Holborn, London, United Kingdom (H.R.J)" />
<meta name="citation_author" content="Nishi Chaturvedi" />
<meta name="citation_author_institution" content="From the Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (R.R., M.S., H.R.J.), MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, University College London, London, United Kingdom (C.H.S., T.T., N.C., A.D.H.), Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom (C.H.S.), School of Biomedical Engineering, King's College, London, United Kingdom (C.H.S.), Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom (L.S., D.A.), Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, London, United Kingdom (M.S.), Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, Holborn, London, United Kingdom (H.R.J)" />
<meta name="citation_author" content="Alun D. Hughes" />
<meta name="citation_author_institution" content="From the Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (R.R., M.S., H.R.J.), MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, University College London, London, United Kingdom (C.H.S., T.T., N.C., A.D.H.), Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom (C.H.S.), School of Biomedical Engineering, King's College, London, United Kingdom (C.H.S.), Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom (L.S., D.A.), Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, London, United Kingdom (M.S.), Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, Holborn, London, United Kingdom (H.R.J)" />
<meta name="citation_author" content="Hans R. Jäger" />
<meta name="citation_author_institution" content="From the Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (R.R., M.S., H.R.J.), MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, University College London, London, United Kingdom (C.H.S., T.T., N.C., A.D.H.), Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom (C.H.S.), School of Biomedical Engineering, King's College, London, United Kingdom (C.H.S.), Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom (L.S., D.A.), Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, London, United Kingdom (M.S.), Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, Holborn, London, United Kingdom (H.R.J)" />
<meta name="twitter:title" content="High-resolution MR Angiographic Cerebrovascular Findings in a Tri-Ethnic Population" />
<meta name="twitter:card" content="summary" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Incidental findings on brain MR and variation of the circle of Willis (CoW) are relatively common among the general population. Ethnic differences have been described before, but few studies have explored the prevalence of incidental intracranial cerebrovascular findings and CoW variants in the setting of a single multi-ethnic cohort. The purpose of this investigation is to describe both incidental cerebrovascular findings and the morphology of the CoW on high-resolution 3T time-of-flight MR angiography (ToF MRA) in a UK tri-ethnic population-based cohort and to present updated prevalence estimates and morphologic reference values.

MATERIALS AND METHODS: We studied participants from the UK Southall and Brent Revisited (SABRE) study who underwent 3T brain MRI between 2014–2018. ToF MRA images were assessed for the presence of incidental cerebrovascular imaging findings and used to determine CoW anatomy.

RESULTS: 750 participants (mean age: 71.28 ± 6.46 years, range [46–90], 337 female), 322 White Europeans, 253 South Asians, and 175 African Caribbeans, were included. Incidental cerebrovascular findings were observed in 84 subjects (11.2%, 95% CI [9.0–13.7]; 38 women, 45.24%, 95% CI [34.34–56.48]), cerebral aneurysms being the most frequent, followed by intracranial arterial stenoses (ICAS) with highest prevalence among South Asians compared to White European (OR: 2.72, 95% CI [1.22–6.08], p = .015) and African Caribbean subjects (OR: 2.79, 95% CI [1.00–7.82], p = .051). Other findings included arteriovenous malformations and infundibula. The CoW was found to be more often complete in women than in men (25.22% compared to 18.41%, p = .024), and in African Caribbean (34.86%), compared to White European (19.19%), and South Asian (14.23%) subjects (p &lt;0.001 each).

CONCLUSIONS: ICAS were independently associated with ethnicity after adjusting for vascular risk factors, having the highest prevalence among South Asians. The prevalence of aneurysms was higher than in previous population-based studies. We observed anatomical differences in the CoW configuration between women, men, and ethnicities.

ABBREVIATIONS: BP = Blood pressure; ICAS = Intracranial arterial stenoses; CoW = Circle of Willis; CVM = Cerebral vascular malformations; OR = Odds ratio; ToF MRA = Time-of-flight MR angiography." />
<meta name="og-title" property="og:title" content="High-resolution MR Angiographic Cerebrovascular Findings in a Tri-Ethnic Population" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2024/07/03/ajnr.A8402" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Incidental findings on brain MR and variation of the circle of Willis (CoW) are relatively common among the general population. Ethnic differences have been described before, but few studies have explored the prevalence of incidental intracranial cerebrovascular findings and CoW variants in the setting of a single multi-ethnic cohort. The purpose of this investigation is to describe both incidental cerebrovascular findings and the morphology of the CoW on high-resolution 3T time-of-flight MR angiography (ToF MRA) in a UK tri-ethnic population-based cohort and to present updated prevalence estimates and morphologic reference values.

MATERIALS AND METHODS: We studied participants from the UK Southall and Brent Revisited (SABRE) study who underwent 3T brain MRI between 2014–2018. ToF MRA images were assessed for the presence of incidental cerebrovascular imaging findings and used to determine CoW anatomy.

RESULTS: 750 participants (mean age: 71.28 ± 6.46 years, range [46–90], 337 female), 322 White Europeans, 253 South Asians, and 175 African Caribbeans, were included. Incidental cerebrovascular findings were observed in 84 subjects (11.2%, 95% CI [9.0–13.7]; 38 women, 45.24%, 95% CI [34.34–56.48]), cerebral aneurysms being the most frequent, followed by intracranial arterial stenoses (ICAS) with highest prevalence among South Asians compared to White European (OR: 2.72, 95% CI [1.22–6.08], p = .015) and African Caribbean subjects (OR: 2.79, 95% CI [1.00–7.82], p = .051). Other findings included arteriovenous malformations and infundibula. The CoW was found to be more often complete in women than in men (25.22% compared to 18.41%, p = .024), and in African Caribbean (34.86%), compared to White European (19.19%), and South Asian (14.23%) subjects (p &lt;0.001 each).

CONCLUSIONS: ICAS were independently associated with ethnicity after adjusting for vascular risk factors, having the highest prevalence among South Asians. The prevalence of aneurysms was higher than in previous population-based studies. We observed anatomical differences in the CoW configuration between women, men, and ethnicities.

ABBREVIATIONS: BP = Blood pressure; ICAS = Intracranial arterial stenoses; CoW = Circle of Willis; CVM = Cerebral vascular malformations; OR = Odds ratio; ToF MRA = Time-of-flight MR angiography." />
<meta name="og-type" property="og:type" content="article" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node108740--5" data-node-nid="108740" id="top-node-108740--6844283288" data-pisa="ajnr;ajnr.A8402v1" data-pisa-master="ajnr;ajnr.A8402" data-apath="/ajnr/early/2024/07/03/ajnr.A8402.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">ORIGINAL RESEARCH</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">High-resolution MR Angiographic Cerebrovascular Findings in a Tri-Ethnic Population</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Rafael Rehwald</span>, <span class="highwire-citation-author" data-delta="1">Carole H. Sudre</span>, <span class="highwire-citation-author" data-delta="2">Lorna Smith</span>, <span class="highwire-citation-author" data-delta="3">Magdalena Sokolska</span>, <span class="highwire-citation-author" data-delta="4">Therese Tillin</span>, <span class="highwire-citation-author" data-delta="5">David Atkinson</span>, <span class="highwire-citation-author" data-delta="6">Nishi Chaturvedi</span>, <span class="highwire-citation-author" data-delta="7">Alun D. Hughes</span> and <span class="highwire-citation-author" data-delta="8">Hans R. Jäger</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">July 2024,  </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">ajnr.A8402; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A8402 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-108740--6844283288" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Rafael Rehwald </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (R.R., M.S., H.R.J.), MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, University College London, London, United Kingdom (C.H.S., T.T., N.C., A.D.H.), Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom (C.H.S.), School of Biomedical Engineering, King's College, London, United Kingdom (C.H.S.), Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom (L.S., D.A.), Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, London, United Kingdom (M.S.), Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, Holborn, London, United Kingdom (H.R.J)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Rafael%2BRehwald%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Rehwald%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ARafael%2BRehwald%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Carole H. Sudre </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (R.R., M.S., H.R.J.), MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, University College London, London, United Kingdom (C.H.S., T.T., N.C., A.D.H.), Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom (C.H.S.), School of Biomedical Engineering, King's College, London, United Kingdom (C.H.S.), Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom (L.S., D.A.), Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, London, United Kingdom (M.S.), Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, Holborn, London, United Kingdom (H.R.J)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Carole%2BH.%2BSudre%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Sudre%20CH&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ACarole%2BH.%2BSudre%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">Lorna Smith </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (R.R., M.S., H.R.J.), MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, University College London, London, United Kingdom (C.H.S., T.T., N.C., A.D.H.), Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom (C.H.S.), School of Biomedical Engineering, King's College, London, United Kingdom (C.H.S.), Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom (L.S., D.A.), Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, London, United Kingdom (M.S.), Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, Holborn, London, United Kingdom (H.R.J)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Lorna%2BSmith%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Smith%20L&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ALorna%2BSmith%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">Magdalena Sokolska </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (R.R., M.S., H.R.J.), MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, University College London, London, United Kingdom (C.H.S., T.T., N.C., A.D.H.), Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom (C.H.S.), School of Biomedical Engineering, King's College, London, United Kingdom (C.H.S.), Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom (L.S., D.A.), Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, London, United Kingdom (M.S.), Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, Holborn, London, United Kingdom (H.R.J)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Magdalena%2BSokolska%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Sokolska%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AMagdalena%2BSokolska%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">Therese Tillin </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (R.R., M.S., H.R.J.), MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, University College London, London, United Kingdom (C.H.S., T.T., N.C., A.D.H.), Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom (C.H.S.), School of Biomedical Engineering, King's College, London, United Kingdom (C.H.S.), Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom (L.S., D.A.), Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, London, United Kingdom (M.S.), Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, Holborn, London, United Kingdom (H.R.J)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Therese%2BTillin%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Tillin%20T&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ATherese%2BTillin%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">David Atkinson </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (R.R., M.S., H.R.J.), MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, University College London, London, United Kingdom (C.H.S., T.T., N.C., A.D.H.), Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom (C.H.S.), School of Biomedical Engineering, King's College, London, United Kingdom (C.H.S.), Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom (L.S., D.A.), Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, London, United Kingdom (M.S.), Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, Holborn, London, United Kingdom (H.R.J)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=David%2BAtkinson%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Atkinson%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ADavid%2BAtkinson%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">Nishi Chaturvedi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (R.R., M.S., H.R.J.), MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, University College London, London, United Kingdom (C.H.S., T.T., N.C., A.D.H.), Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom (C.H.S.), School of Biomedical Engineering, King's College, London, United Kingdom (C.H.S.), Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom (L.S., D.A.), Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, London, United Kingdom (M.S.), Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, Holborn, London, United Kingdom (H.R.J)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Nishi%2BChaturvedi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Chaturvedi%20N&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ANishi%2BChaturvedi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">Alun D. Hughes </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (R.R., M.S., H.R.J.), MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, University College London, London, United Kingdom (C.H.S., T.T., N.C., A.D.H.), Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom (C.H.S.), School of Biomedical Engineering, King's College, London, United Kingdom (C.H.S.), Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom (L.S., D.A.), Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, London, United Kingdom (M.S.), Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, Holborn, London, United Kingdom (H.R.J)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Alun%2BD.%2BHughes%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Hughes%20AD&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AAlun%2BD.%2BHughes%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">Hans R. Jäger </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom (R.R., M.S., H.R.J.), MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science, University College London, London, United Kingdom (C.H.S., T.T., N.C., A.D.H.), Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom (C.H.S.), School of Biomedical Engineering, King's College, London, United Kingdom (C.H.S.), Centre for Medical Imaging, Division of Medicine, University College London, London, United Kingdom (L.S., D.A.), Department of Medical Physics and Biomedical Engineering, University College London Hospitals National Health Service (NHS) Foundation Trust, London, United Kingdom (M.S.), Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, Holborn, London, United Kingdom (H.R.J)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Hans%2BR.%2BJ%C3%A4ger%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=J%C3%A4ger%20HR&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AHans%2BR.%2BJ%25C3%25A4ger%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2 class="">ABSTRACT</h2><div id="sec-1" class="subsection"><p id="p-2"><strong>BACKGROUND AND PURPOSE:</strong> Incidental findings on brain MR and variation of the circle of Willis (CoW) are relatively common among the general population. Ethnic differences have been described before, but few studies have explored the prevalence of incidental intracranial cerebrovascular findings and CoW variants in the setting of a single multi-ethnic cohort. The purpose of this investigation is to describe both incidental cerebrovascular findings and the morphology of the CoW on high-resolution 3T time-of-flight MR angiography (ToF MRA) in a UK tri-ethnic population-based cohort and to present updated prevalence estimates and morphologic reference values.</p></div><div id="sec-2" class="subsection"><p id="p-3"><strong>MATERIALS AND METHODS:</strong> We studied participants from the UK Southall and Brent Revisited (SABRE) study who underwent 3T brain MRI between 2014–2018. ToF MRA images were assessed for the presence of incidental cerebrovascular imaging findings and used to determine CoW anatomy.</p></div><div id="sec-3" class="subsection"><p id="p-4"><strong>RESULTS:</strong> 750 participants (mean age: 71.28 ± 6.46 years, range [46–90], 337 female), 322 White Europeans, 253 South Asians, and 175 African Caribbeans, were included. Incidental cerebrovascular findings were observed in 84 subjects (11.2%, 95% CI [9.0–13.7]; 38 women, 45.24%, 95% CI [34.34–56.48]), cerebral aneurysms being the most frequent, followed by intracranial arterial stenoses (ICAS) with highest prevalence among South Asians compared to White European (OR: 2.72, 95% CI [1.22–6.08], p = .015) and African Caribbean subjects (OR: 2.79, 95% CI [1.00–7.82], p = .051). Other findings included arteriovenous malformations and infundibula. The CoW was found to be more often complete in women than in men (25.22% compared to 18.41%, p = .024), and in African Caribbean (34.86%), compared to White European (19.19%), and South Asian (14.23%) subjects (p &lt;0.001 each).</p></div><div id="sec-4" class="subsection"><p id="p-5"><strong>CONCLUSIONS:</strong> ICAS were independently associated with ethnicity after adjusting for vascular risk factors, having the highest prevalence among South Asians. The prevalence of aneurysms was higher than in previous population-based studies. We observed anatomical differences in the CoW configuration between women, men, and ethnicities.</p><p id="p-6">ABBREVIATIONS: BP = Blood pressure; ICAS = Intracranial arterial stenoses; CoW = Circle of Willis; CVM = Cerebral vascular malformations; OR = Odds ratio; ToF MRA = Time-of-flight MR angiography.</p></div></div><div class="section fn-group" id="fn-group-1"><h2>Footnotes</h2><ul><li class="fn-conflict" id="fn-1"><p id="p-1">The authors declare no conflicts of interest related to the content of this article.</p></li></ul></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2024 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div>  </div>

  
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jul 2024, </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">ajnr.A8402; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A8402 </span></div>
  
  
  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">Rafael</span> <span class="nlm-surname">Rehwald</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">Carole H.</span> <span class="nlm-surname">Sudre</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">Lorna</span> <span class="nlm-surname">Smith</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">Magdalena</span> <span class="nlm-surname">Sokolska</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">Therese</span> <span class="nlm-surname">Tillin</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">David</span> <span class="nlm-surname">Atkinson</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">Nishi</span> <span class="nlm-surname">Chaturvedi</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">Alun D.</span> <span class="nlm-surname">Hughes</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">Hans R.</span> <span class="nlm-surname">Jäger</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jul 2024, </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">ajnr.A8402; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A8402 </span></div>
  
  
  
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