Altered Callosal Morphology and Connectivity in Asymptomatic Carotid Stenosis

Background Carotid stenosis, even in the clinically asymptomatic stage, causes cognitive impairment, silent lesions, and hemispheric changes. The corpus callosum (CC) is crucial for hemispheric cortical integration and specialization. Purpose To examine if CC morphology and connectivity relate to cognitive decline and lesion burden in asymptomatic carotid stenosis (ACS). Study Type Retrospective, cross‐sectional. Population 33 patients with unilaterally severe (70%) ACS and 28 demographically and comorbidity‐matched controls. A publicly available healthy adult lifespan (ages between 18 and 80; n = 483) MRI dataset was also included. Field Strength/Sequence A 3.0 T; T1 MPRAGE and diffusion weighted gradient echo‐planar imaging sequences. Assessment Structural MRI and multidomain cognitive data were obtained. Midsagittal CC area, circularity, thickness, integrity, and probabilistic tractography were calculated and correlated with cognitive tests and white matter hyperintensity. Fractional anisotropy, mean diffusivity (MD), and radial diffusivity were determined from DTI. Statistical Tests Independent two‐sample t ‐tests, χ 2 tests, Mann–Whitney U, locally weighted scatterplot smoothing (LOWESS) curve fit, and Pearson correlation. A P value < 0.05 was considered statistically significant. Results Patients with ACS demonstrated significant reductions in callosal area, circularity, and thickness compared to controls. The callosal atrophy was significantly correlated with white matter hyperintensity size ( r = −0.629, P < 0.001). Voxel‐wise analysis of diffusion measures in the volumetric CC showed that ACS patients exhibited significantly lower fractional anisotropy and higher MD and radial diffusivity in the genu and splenium of the CC than controls. Further lifespan trajectory analysis showed that although the midsagittal callosal area, circularity, and thickness exhibited age‐related decreases, the values in the ACS patients were significantly lower in all age groups. Data Conclusion Midsagittal callosal atrophy and connectivity reflect the load of silent lesions and the severity of cognitive decline, respectively, suggesting that CC degeneration has potential to serve as an early marker in ACS. Level of Evidence 3 Technical Efficacy Stage 2