Intracranial Carotid Calcification on Cranial Computed Tomography

Subedi, Deepak; Zishan, Umme Sara; Chappell, Francesca M; Gregoriades, Marialena; Sudlow, Cathie; Sellar, Robin

doi:10.1161/strokeaha.115.009716

Cited by 43 publications

(16 citation statements)

References 27 publications

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“…Visual scores provide an overall good, quick and reproducible measure of iICA calcification burden[18] whereas quantitative or volumetric calcification measurement are time intensive but do provide a more accurate (volumetric) depiction of the calcium load/burden. [1] However, the previous qualitative scores were not designed to separate intimal and medial calcification.…”

Section: Discussionmentioning

confidence: 99%

Computed Tomographic Distinction of Intimal and Medial Calcification in the Intracranial Internal Carotid Artery

et al. 2017

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BackgroundIntracranial internal carotid artery (iICA) calcification is associated with stroke and is often seen as a proxy of atherosclerosis of the intima. However, it was recently shown that these calcifications are predominantly located in the tunica media and internal elastic lamina (medial calcification). Intimal and medial calcifications are thought to have a different pathogenesis and clinical consequences and can only be distinguished through ex vivo histological analysis. Therefore, our aim was to develop CT scoring method to distinguish intimal and medial iICA calcification in vivo.MethodsFirst, in both iICAs of 16 cerebral autopsy patients the intimal and/or medial calcification area was histologically assessed (142 slides). Brain CT images of these patients were matched to the corresponding histological slides to develop a CT score that determines intimal or medial calcification dominance. Second, performance of the CT score was assessed in these 16 patients. Third, reproducibility was tested in a separate cohort.ResultsFirst, CT features of the score were circularity (absent, dot(s), <90°, 90–270° or 270–360°), thickness (absent, ≥1.5mm, or <1.5mm), and morphology (indistinguishable, irregular/patchy or continuous). A high sum of features represented medial and a lower sum intimal calcifications. Second, in the 16 patients the concordance between the CT score and the dominant calcification type was reasonable. Third, the score showed good reproducibility (kappa: 0.72 proportion of agreement: 0.82) between the categories intimal, medial or absent/indistinguishable.ConclusionsThe developed CT score shows good reproducibility and can differentiate reasonably well between intimal and medial calcification dominance in the iICA, allowing for further (epidemiological) studies on iICA calcification.

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Section: Discussionmentioning

confidence: 99%

Computed Tomographic Distinction of Intimal and Medial Calcification in the Intracranial Internal Carotid Artery

et al. 2017

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“…Additionally, the calcium load was graded with a qualitative score and it was measured in a specific intracranial location. However, a recent study showed that visual scores correlate highly with quantitative calcification measures [18]. …”

Section: Discussionmentioning

confidence: 99%

Intracranial Internal Carotid Artery Wall Calcification in Ischemic Strokes Treated with Thrombolysis

et al. 2017

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Background: Calcifications are an important element of atherosclerotic plaques and have been used as a marker of atherosclerosis and clinical outcome predictor in different vascular territories. CT-scan, performed in the acute ischemic stroke setting, can reliably detect intracranial arterial calcifications. Objectives: To investigate the association between intracranial internal carotid artery calcification and functional outcome, symptomatic intracerebral hemorrhage (sICH), recanalization, and death. Methods: We included 396 consecutive ischemic stroke patients submitted to recombinant tissue plasminogen activator treatment between January 2011 and September 2014. Admission CT-scans were reviewed to calculate the Total Carotid Syphon Calcification score. Patients were followed for up to at least 6 months post-stroke or until death. Outcome measures included evaluation of recanalization on the first 24 h (transcranial color coded Doppler or angio-CT), sICH, and assessment of functional outcome at 3 months after stroke (using modified Rankin scale). Results: Carotid artery wall calcification did not predict sICH, recanalization or any good outcome. However, it was a statistically significant predictor of death (OR 1.102, 95% CI [1.004–1.211], p = 0.042). Discussion: Intracranial carotid artery calcification does not increase the risk of thrombolysis-induced sICH. Patients with higher grade of carotid artery wall calcification may have a higher mortality rate.

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“…(10,11) The MWVS scale assigns a score reflecting the severity of calcification on each axial slice in which the ICA is visible, starting just distal to the petrous temporal bone and ending at the level of the terminal bifurcation. A score of 0 reflects no calcification; 1 reflects thin, discontinuous calcification; 2 reflects thin and continuous or thick and discontinuous calcification; and 3 reflects thick, continuous calcification (Figure 1).…”

Section: Methodsmentioning

confidence: 99%

Cryptogenic Stroke and Nonstenosing Intracranial Calcified Atherosclerosis

Kamel

Gialdini

Baradaran

et al. 2017

Journal of Stroke and Cerebrovascular Diseases

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Objective Since some cryptogenic strokes may result from large-artery atherosclerosis that goes unrecognized because it causes <50% luminal stenosis, we compared the prevalence of nonstenosing intracranial atherosclerotic plaques ipsilateral to cryptogenic cerebral infarcts versus the unaffected side using imaging biomarkers of calcium burden. Methods In a prospective stroke registry, we identified patients with cerebral infarction limited to the territory of one internal carotid artery (ICA). We included patients with stroke of undetermined etiology and, as controls, patients with cardioembolic stroke. We used noncontrast computed tomography (CT) to measure calcification in both intracranial ICAs including qualitative calcium scoring and quantitative scoring utilizing Agatston-Janowitz (AJ) calcium scoring. Within subjects, the Wilcoxon signed rank sum test for non-parametric paired data was used to compare the calcium burden in the ICA upstream of the infarction versus the ICA on the unaffected side. Results We obtained 440 calcium measures from 110 ICAs in 55 patients. Among 34 patients with stroke of undetermined etiology, we found greater calcium in the ICA ipsilateral to the infarction (mean Modified Woodcock Visual Score, 6.7 ± 4.6) compared to the contralateral side (5.4 ± 4.1) (P = 0.005). Among 21 patients with cardioembolic stroke, we found no difference in calcium burden ipsilateral to the infarction (6.7 ± 5.9) versus the contralateral side (7.3 ± 6.3) (P = 0.13). Results were similar using quantitative calcium measurements including AJ calcium scores. Conclusion In patients with strokes of undetermined etiology, the burden of calcified intracranial large-artery plaque was associated with downstream cerebral infarction.

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Intracranial Carotid Calcification on Cranial Computed Tomography

Abstract: Supplemental Digital Content is available in the text.

Cited by 43 publications

References 27 publications

Computed Tomographic Distinction of Intimal and Medial Calcification in the Intracranial Internal Carotid Artery

Computed Tomographic Distinction of Intimal and Medial Calcification in the Intracranial Internal Carotid Artery

Intracranial Internal Carotid Artery Wall Calcification in Ischemic Strokes Treated with Thrombolysis

Cryptogenic Stroke and Nonstenosing Intracranial Calcified Atherosclerosis

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