The Frequency and Determinants of Calcification in Intracranial Arteries in Chinese Patients Who Underwent Computed Tomography Examinations

Abstract

Background: Intracranial artery calcification is common but the prevalence and determinants are not well established. We aim to describe the prevalence and location of calcification in intracranial arteries according to brain multi-detector-row computed tomography (MDCT) images, and to investigate its correlation with potential risk factors. Methods: We studied consecutive men and women referred for brain CT in December 2004. All patients received a questionnaire regarding their medical history related to atherosclerosis, including traditional risk factors of atherosclerosis, serum chemistry values and inflammatory markers. All CT examinations were done with a 16-slice MDCT and the severity of intracranial artery calcification was categorized. Results: Four hundred and ninety patients aged 1.4–101 years (62.92 ± 19.04; mean ± SD) were included in our study. There were 340 patients (69.4%) who had intracranial artery calcification. The highest prevalence of intracranial artery calcification was seen in the internal carotid artery (60%), followed by vertebral artery (20%), middle cerebral artery (5%) and basilar artery (5%). Patients with calcification were significantly older than those without calcification (p < 0.001). A significantly higher prevalence of calcification was present among patients with hypertension (p < 0.001), diabetes (p < 0.001), renal failure (p < 0.05), atrial fibrillation (p < 0.05), smoking (p < 0.05), hyperlipidemia (p < 0.001), ischemic heart disease (p < 0.05) and ischemic stroke (p < 0.001). Mean values of serum phosphate, serum urea and CRP level were also significantly higher in patients with intracranial artery calcification (p < 0.05, respectively), and there was a trend that patients with intracranial calcification had a higher white blood cell count (p = 0.070). Stepwise multiple logistic regression showed age (RR = 2.795 per 10 years), a history of ischemic stroke (RR = 3.915), and white blood cell count (RR = 1.107) to be independently associated with intracranial artery calcification. Conclusions: Calcification of the intracranial arteries is associated with age, history of ischemic stroke and white blood cell count. Further prospective studies to investigate the clinical significance of intracranial artery calcification are needed.

Intracranial Internal Carotid Artery Calcifications: Association with Vascular Risk Factors and Ischemic Cerebrovascular Disease

“…17 One study found an independent association between sex and intracranial internal carotid artery calcifications, 11 whereas another study did not find this association. 10 In the present study, we found that smoking and hypercho- lesterolemia are independently associated with the presence of intracranial calcifications. Other studies showed independent associations of smoking with coronary, aortic arch, carotid bifurcation calcifications 4,5,18,19 and intracranial internal carotid artery calcifications.…”

“…Consequently, previous studies made use of a qualitative grading system. [8][9][10][11][12] Although Taoka et al 13 used commercially available software to assess the Agatston score of intracranial calcifications, they had to eliminate the contamination of bone attenuation on wide-windowed CT images. We developed custom-made software for quantification of intracranial calcifications.…”

“…Age, sex, smoking, hypercholesterolemia, a history of cardiac disease, and a history of ischemic cerebrovascular disease were independently related to the presence or volume of intracranial internal carotid artery calcifications. Associations between cardiovascular risk factors and intracranial calcifications have been studied in patients referred for brain CT. [10][11][12] One study had a prevalence of 36% in a group of patients with a mean age of 51 years, 11 whereas the second study found a prevalence of 67% in a group of patients with a mean age of 63 years. 10 Both studies confirmed the association between age and calcifications, an association that was also found in coronary artery studies.…”

“…Associations between cardiovascular risk factors and intracranial calcifications have been studied in patients referred for brain CT. [10][11][12] One study had a prevalence of 36% in a group of patients with a mean age of 51 years, 11 whereas the second study found a prevalence of 67% in a group of patients with a mean age of 63 years. 10 Both studies confirmed the association between age and calcifications, an association that was also found in coronary artery studies. 2 The present study found a higher prevalence and volume of calcifications in men, a finding that is in agreement with studies on coronary arteries 16,17 and carotid bifurcations.…”

“…Previous studies [8][9][10][11][12] had a binary or a qualitative (5-point scale) grading system for classification of intracranial calcifications, probably because quantification difficulties arose due to the close relationship between calcifications and the bony structures of the skull. Taoka et al 13 were able to use commercially available software for quantification of intracranial calcifications, but they had to eliminate the contamination of bone attenuation on wide-windowed CT images.…”