This study was done to clarify relationships between the degree of periventricular lucency (PVL), and lesions in the carotid arteries and the legs as detected with B-mode ultrasonography and the ankle pressure index, respectively. According to the distribution of PVL on computed tomography, 45 patients were divided into 2 groups: 22 patients with diffuse PVL (from the periventricular white matter to the subcortical area, DPVL group) and 23 patients with PVL localized in the frontal deep white matter (LPVL group). Plaque, defined as a thickened intima-media complex of 2.1 mm or more, was divided into two types; mural plaque and nodular plaque. Hypertension was more common in the DPVL group than in control groups, which consisted of 70 age-matched patients with cerebral thrombosis without PVL (CTH group) and 50 controls with neither PVL nor cerebrovascular lesions (NCT group). All patients in the DPVL group met the diagnostic criteria for Binswanger's disease proposed by Bennett DA. The incidence of low API indices (< 0.9) in the DPVL group (45%) was significantly higher than that in the NCT group, and it was slightly higher than that in the LPVL group. Carotid lesions, mainly nodular plaques, were seen in 82% of patients in the DPVL group and in 74% of those in the LPVL group; these percentages were significantly higher than those in the CTH (49%) and NCT (40%) groups. In particular, bilateral carotid lesions were more common in the DPVL group than in the other three groups. The degree of PVL correlated with lesions in the carotid arteries and the legs. These correlations suggest that the arterial lesions not only resulted from a risk factor (hypertension) for PVL, but also promoted PVL by causing extra- and intra-cranial arterial lesions. Furthermore, they imply that LPVL is a precusor to DPVL.