Carotid Artery Calcification on Multislice Detector-Row Computed Tomography

Abstract

Background: To determine the underlying conditions that affect the degree of calcification of carotid arterial plaques, measured quantitatively using multidetector row computed tomography (MDCT), and to study the association of carotid calcification with clinical symptomatology. Methods: We measured the calcification volume of stenotic lesions at the carotid bifurcation using MDCT in 84 consecutive patients who were scheduled to undergo carotid revascularization. These results were compared with the clinical and radiological characteristics of the patients. Results: On MDCT, calcification in the carotid plaques was present in 78 patients (93%). Compared to the other patients, patients in the highest quartile of calcification volume (quartile 4) had higher serum creatinine levels (p < 0.001) and tended to have fewer symptomatic ischemic events in the territory of the affected carotid artery in the preceding 6 months (29 vs. 49%, p = 0.099); in particular, there were fewer transient symptoms (5 vs. 27%, p = 0.032) and symptoms possibly occurring due to local embolism (14 vs. 37%, p = 0.045). On ultrasound, plaque ulceration was less prevalent in patients in quartile 4 than in the remaining patients (5 vs. 29%, p = 0.026), although the severity of carotid stenosis was similar among all the quartiles. Conclusions: Renal dysfunction was associated with enhanced carotid plaque calcification. Patients with severe carotid calcification were found to have a low risk of recent ischemic stroke, presumably due, in part, to a lower prevalence of emboligenic carotid ulceration. MDCT was valuable for the quantitative evaluation of carotid calcification.

Eccentric Stenosis of the Carotid Artery Associated with Ipsilateral Cerebrovascular Events

“…In our study population, such arteries might account for 10% of the arteries with maximum area stenosis at 70% or more. Although the contribution of carotid calcification to cerebrovascular events is uncertain, 27,28,31,32 the present results may have been affected by the exclusion of these calcified arteries from the analysis. Second, although the present retrospective analysis demonstrated an association between stenosis geometry and pre-existent cerebrovascular events, a prospective trial is required to assess the contribution of eccentric stenosis to future cerebrovascular events.…”

“…13,[26][27][28][29][30] In a recent study on MDCT, the relationship between stroke symptoms and plaque morphology was assessed. 30 In the study, expansive carotid remodeling was greater in patients with cerebral ischemic symptoms than in asymptomatic patients, though there was no significant difference in the plaque eccentricity between symptomatic and asymptomatic patients.…”

Association between Carotid Plaque Features on CTA and Cerebrovascular Ischemia: A Systematic Review and Meta-Analysis

“…13,19,22,23,[25][26][27] The time interval between the onset of ischemic symptoms and CTA ranged from 2 weeks to 6 months for those studies that provided these data (On-line Table 1). 14,20,22,23 We found no studies evaluating the association between CTA plaque features and future ischemic events. Seven studies were performed in the United States 6,10,11,18,20,24,28 while 2 studies focused only on patients with mild-to-moderate (30%-69%) stenosis, 22,27 and 1 study focused only on patients with moderate (50%-69%) stenosis.…”

“…6,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Of the 20 articles meeting the inclusion criteria for systematic review, 13 were retrospective, cross-sectional studies 6,10-12,14-18,20,21,24,28 and 7 were prospective, cross-sectional studies. 13,19,22,23,[25][26][27] The time interval between the onset of ischemic symptoms and CTA ranged from 2 weeks to 6 months for those studies that provided these data (On-line Table 1).…”

“…Twelve studies were performed on at least a 16 -detector row helical CT scanner, 11,14,[18][19][20][22][23][24][26][27][28][29] while only 7 studies included patients who may have been scanned on a 4 -or 8 -detector row CT scanner. 10,12,13,[15][16][17]21 One study did not provide the relevant number of rows (On-line Table 3).…”