MDCT angiography may help risk-stratify patients with asymptomatic carotid artery stenosis. Extracranial carotid artery calcified plaques causing stenosis are significantly less likely to be symptomatic and thus may be more stable than noncalcified plaques. This finding may have implications for the interpretation of calcification of atherosclerotic plaque in other vascular beds.

OBJECTIVE-The purpose of our study was to quantitatively evaluate calcified atherosclerotic burden in the cervical carotid arteries using MDCT to determine the relationship of scores with luminal stenosis and symptomatology.MATERIALS AND METHODS-Calcium plaque volume was measured in 106 cervical carotid arteries (53 patients) using MDCT angiography. The study group included 32 asymptomatic patients (mean age, 70.2 ± 8.7 [SD] years; 15 women, 17 men) and 21 patients with ischemic neurologic symptoms (69.6 ± 12.9 years; eight women, 13 men). By vessel, there were 43 high-grade stenotic (≥ 60% by North American Symptomatic Carotid Endarterectomy Trial [NASCET] criteria), 15 moderate-grade stenotic (30-59%), and 44 mild-grade stenotic or normal (0-29%) vessels, with four excluded for prior carotid endarterectomy. Volume scores were calculated by summing the area of calcium in the common and extracranial internal carotid arteries on axial slices and multiplying by the slice increment.RESULTS-Controlling for cardiovascular risk factors and luminal stenosis, we found that scores were significantly related to the occurrence of symptoms (p = 0.003). Even with patient age as a covariant, patients with high-grade stenosis had significantly higher scores than those without highgrade disease (p = 0.004). Moreover, quantitative burden was associated with luminal stenosis on adjusted multivariate analysis (p = 0.034). The specificity and positive predictive value for highgrade luminal narrowing were notably lower on individual vessel analysis than on total score analysis, likely secondary to variability in vascular remodeling.CONCLUSION-Calcium scores in the cervical carotid arteries may represent an independent marker for luminal stenosis and ischemic symptoms. A prospective longitudinal study examining calcium levels and morbidity may be warranted to examine whether burden has a role in risk stratification. KeywordsCT arteriography; calcium; carotid; stroke Vascular calcium deposits have recently become a major research and public interest secondary to increasing evidence of the relationship of calcium scores with atherosclerotic burden and clinical outcome. The prevailing example involves coronary calcium scores measured on CT, which have been associated with luminal stenosis [1], overall coronary atherosclerotic load

Background-Carotid atherosclerotic plaque rupture is thought to cause transient ischemic attack (TIA) and ischemic stroke (IS). Pathological hallmarks of these plaques have been identified through observational studies. Although generally accepted, the relationship between cerebral thromboembolism and in situ atherosclerotic plaque morphology has never been directly observed noninvasively in the acute setting. Methods and Results-Consecutive acutely symptomatic patients referred for stroke protocol magnetic resonance imaging/angiography underwent additional T1-and T2-weighted carotid bifurcation imaging with the use of a 3-dimensional technique with blood signal suppression. Two blinded reviewers performed plaque gradings according to the American Heart Association classification system. Discharge outcomes and brain magnetic resonance imaging results were obtained. Image quality for plaque characterization was adequate in 86 of 106 patients (81%

Background and Purpose-Calcification has been associated with carotid plaque stability; however, an acceptable in vivo method to define plaques based on this component remains to be developed. The purpose of our study was to compare calcified and noncalcified volumes of carotid artery culprit symptomatic plaques with asymptomatic plaques using multidetector computed tomography.