de Havenon A, et al. - Via a secondary analysis of the Atherosclerosis Risk in the Community study (n = 1,402), researchers ascertained whether common carotid artery stiffness on sonography accurately prognosticated white matter hyperintensity volume and total brain volume on MR imaging more than 20 years later. A notable association between rising carotid artery stiffness and both greater white matter hyperintensity volume and lower total brain volume on MR imaging, measured at a mean of 21.5 years later was noted. The carotid strain, distensibility, stiffness index, and pressure-strain elastic modulus were related to white matter hyperintensity volume in multivariable linear regression models. In the multivariate models, only compliance was correlated with total brain volume. Thus, on MR imaging, more than 20 years later, sonography measurements of carotid artery stiffness were predictive of white matter hyperintensity volume and total brain volume. For white matter hyperintensity volume vs total brain volume, the relationship was more robust. These conclusions support the role of arterial stiffness as a method for recognition of at risk individuals of developing white matter hyperintensity volume and as a viable mechanism resulting in small-artery disease of the brain.