the subjects included 226 consecutive patients with type 2 diabetes who visited our hospital during 20032006 . patients with history of stroke or other neurological disease or who had cardioembolic risk factors including atrial fibrillation , valvular heart disease , and myocardial infarction were excluded . brain mri was performed using a 1.5-t novadual ( philips , best , the netherlands ) to obtain t1- and t2-weighted and fluid - attenuated inversion recovery ( flair ) images . sci was defined as an area of focal hyperintensity on t2-weighted images with corresponding low signal intensity on t1-weighted images , which was 3 mm in diameter . the diagnosis was made when a lesion was surrounded by a hyperintense gliotic rim on fluid - attenuated inversion recovery images to exclude dilated perivascular space ( 6 ) . the cca - imt was measured with high - resolution b - mode ultrasonography ( ssa-770a ; toshiba , tokyo , japan ) with a 7.5-mhz linear transducer , as previously reported ( 4 ) . any focal thickening of the intima - media ( 2.0 mm ) was excluded . brachial - ankle pulse wave velocity was measured using an automated device ( omron - colin , tokyo , japan ) ( 7,8 ) . ankle brachial pressure index was the ratio of ankle systolic blood pressure ( sbp ) to brachial sbp . results are expressed as the mean  sd . the relationship between sci and various factors were examined by univariate and multiple logistic analyses . brain mri was performed using a 1.5-t novadual ( philips , best , the netherlands ) to obtain t1- and t2-weighted and fluid - attenuated inversion recovery ( flair ) images . sci was defined as an area of focal hyperintensity on t2-weighted images with corresponding low signal intensity on t1-weighted images , which was 3 mm in diameter . the diagnosis was made when a lesion was surrounded by a hyperintense gliotic rim on fluid - attenuated inversion recovery images to exclude dilated perivascular space ( 6 ) . the cca - imt was measured with high - resolution b - mode ultrasonography ( ssa-770a ; toshiba , tokyo , japan ) with a 7.5-mhz linear transducer , as previously reported ( 4 ) . brachial - ankle pulse wave velocity was measured using an automated device ( omron - colin , tokyo , japan ) ( 7,8 ) . ankle brachial pressure index was the ratio of ankle systolic blood pressure ( sbp ) to brachial sbp . results are expressed as the mean  sd . the relationship between sci and various factors were examined by univariate and multiple logistic analyses . analysis , age , pulse wave velocity , sbp , and cca - imt were significantly higher in the subjects with sci than in those without it ( 69.3 vs. 63.7 years , 1,906.7 vs. 1,718.0 cm / s , 140.6 vs. 129.4 mmhg , 1.27 vs. 1.10 mm , respectively , p < 0.01 ) . furthermore , multiple logistic regression analyses indicated that age ( odds ratio 1.09 , 95% ci 1.041.15 ) , sbp ( 1.06 , 1.021.08 ) , and cca - imt ( 4.16 , 1.3712.62 ) were independent risk factors of sci ( table 1 ) . the clinical characteristics of the subjects and association between sci and various risk factors on multiple logistic regression analysis data are means  sd unless otherwise indicated . p < 0.05 . the odds ratios and 95% cis for sci were calculated by multiple logistic regression analysis . it seems likely that sci exists more frequently in subjects with type 2 diabetes than in subjects without it , since a frequency of sci was reported to be 42% in general japanese patients ( 9 ) and 47.5% in nondiabetic subjects ( our unpublished data ) . several risk factors have been identified for the occurrence of sci , including age , hypertension , diabetes , and carotid atherosclerosis ( 10 ) . it was reported that type 2 diabetes showed a tendency to be associated with sci ( 11 ) . another study reported that cca - imt was associated with symptomatic ischemic stroke in japanese patients with type 2 diabetes ( 12 ) . in the present study , we found that cca - imt was thicker in the subjects with sci than in those without it and that increased cca - imt correlated significantly with sci in the diabetic subjects after the various risk factors were adjusted . this is in line with our previous report that cca - imt is a better tool than pulse wave velocity to detect early atherosclerotic changes ( 8) . in previous reports , eguchi et al . ( 2 ) reported that the prevalence of sci increased threefold in japanese hypertensive patients with diabetes , whereas johnsen et al . ( 13 ) concluded that cca - imt was associated with hypertensive vascular disease rather than atherosclerosis , especially at an early stage . these studies suggest a possibility that cca - imt may be related to sci through hypertension . however , our results with multiple logistic regression analysis clearly showed that cca - imt was a risk factor for sci independently of hypertension in japanese diabetic subjects . first , the current study is a cross - sectional one , making it impossible to draw any definite conclusion about the causal relationships . second , it is often difficult to differentiate the perivascular space from infarcts in the basal ganglia ( 14 ) . finally , we could not get any information on smoking , which is an important risk factor . despite these limitations , the present study suggests that sci is associated with age , sbp , and cca - imt in japanese subjects with type 2 diabetes .
objectivewe examined the relationship between intima - media thickness of common carotid artery ( cca - imt ) and silent cerebral infarction ( sci ) with the magnetic resonance imaging ( mri ) study in japanese subjects with type 2 diabetes.research design and methodsthe brain mri study and the carotid ultrasonography were performed in a total of 217 consecutive japanese subjects with type 2 diabetes . 
 various risk factors for sci were examined using multiple logistic analyses.resultsthe sci was found in 60.4% of the diabetic subjects . in the diabetic subjects , age , systolic blood pressure ( sbp ) , pulse wave velocity , and cca - imt 
 were significantly higher in the subjects with sci than in those without it . 
 multiple logistic analyses indicated that age , sbp , and cca - imt were significant and independent risk factors of sci in the diabetic subjects.conclusionscca-imt , but not pulse wave velocity , was independently associated with sci in japanese subjects with type 2 diabetes .