Intracranial Carotid Artery Atherosclerosis and the Risk of Stroke in Whites

Bos, Daniel; Portegies, Marileen L.P.; Lugt, Aad van der; Bos, Michiel J.; Koudstaal, Peter J.; Hofman, Albert; Krestin, Gabriël P.; Franco, Oscar H.; Vernooij, Meike W.; Ikram, M. Arfan

doi:10.1001/jamaneurol.2013.6223

Cited by 165 publications

(152 citation statements)

References 42 publications

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“…8,11 As marker of intracranial atherosclerosis, we measured ICAC in both internal carotid arteries from the horizontal petrous bone segment up to its top. 3,4 To quantify ICAC, we used a semiautomated scoring method, which is described in detail elsewhere. 4,12 In short, all calcifications in the trajectory of the intracranial internal carotid artery were manually delineated in consecutive multidetector CT-slices while making sure that bony structures were not included.…”

Section: Assessment Of Icacmentioning

confidence: 99%

“…4,12 In short, all calcifications in the trajectory of the intracranial internal carotid artery were manually delineated in consecutive multidetector CT-slices while making sure that bony structures were not included. Next, the number of pixels >130 Hounsfield units was determined and the calcification volume (mm 3 ) was calculated by multiplying the number of pixels, pixel-size, and the increment.…”

Section: Assessment Of Icacmentioning

confidence: 99%

“…[1][2][3] Various established environmental and lifestyle factors such as smoking and diabetes mellitus are known to contribute substantially to the formation of ICAC. 1,2,4 Yet, it remains unknown to what extent genetics play a role in the development of ICAC.…”

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confidence: 99%

“…Therefore, in this study, we quantified ICAC, 3 determined its heritable component, and performed a genome-wide association study (GWAS) including independent replication of top hits. …”

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confidence: 99%

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Heritability and Genome-Wide Association Analyses of Intracranial Carotid Artery Calcification

Adams

Ikram

Vernooij

et al. 2016

Stroke

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) that were significantly associated with ICAC volume. Rs1537372 replicated in an independent sample of 716 stroke patients (P combined =1.38×10 −10 ). Conclusions-ICAC volume is a heritable trait, which is partly explained by common genetic variation. We identified specific genetic variants associated with ICAC, which given the importance of ICAC in stroke risk, needs replication in larger-scale studies to further elucidate its genetic basis.

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Section: Assessment Of Icacmentioning

confidence: 99%

Section: Assessment Of Icacmentioning

confidence: 99%

mentioning

confidence: 99%

“…Therefore, in this study, we quantified ICAC, 3 determined its heritable component, and performed a genome-wide association study (GWAS) including independent replication of top hits. …”

mentioning

confidence: 99%

See 2 more Smart Citations

Heritability and Genome-Wide Association Analyses of Intracranial Carotid Artery Calcification

Adams

Ikram

Vernooij

et al. 2016

Stroke

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“…Against this background, we would like to highlight that we quantified ICAC semiautomatedly 3 in a large, prospective population-based sample of >2500 middle-aged and elderly people and found that larger calcification volumes considerably increased the risk of stroke. 4 This quantification strategy was relatively time consuming (≤8 minutes for a 1-mm thin slice protocol) but definitely not insuperable.…”

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confidence: 99%

Letter by Bos et al Regarding Article, “Intracranial Carotid Calcification on Cranial Computed Tomography: Visual Scoring Methods, Semiautomated Scores, and Volume Measurements in Patients With Stroke”

Bos

Bruijne

Lugt

2015

Stroke

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1in which the performance of 2 visual scoring methods for intracranial carotid artery calcification (ICAC; ie, the original Woodcock score 2 and a modified Woodcock score) is compared with volumetric ICAC measurements. The original Woodcock score characterizes calcification in the intracranial carotid artery as absent, mild, moderate, or severe. The modified Woodcock score as proposed by the authors involves the same 4-point classification, but it was applied to each slice of the computerized tomographic examination and then summed into a total calcification score.The authors found a high correlation between the original Woodcock score and volumetric calcification measurements. Not surprisingly, this correlation improved for the modified score, which may be explained by the fact that more inspections reflect a more accurate approximation of the actual calcification volume. This directly underlines that, in contrast to the original score, the modified Woodcock score still involves slice-to-slice investigation of the total trajectory of the intracranial internal carotid artery. Although we expect that this could be less time consuming than slice-to-slice annotation of calcification, which is necessary for quantification, one should carefully balance the amount of information lost because of visual rating against time invested in the quantitative measurements.At this moment, the semiautomated methods for ICAC quantification may be too complicated and time consuming for clinical use. However, the authors also argue that these methods, especially the method described by de Weert et al, 3 are too time consuming and impractical for larger epidemiological studies. From our experience, there is typically less time pressure in epidemiological studies than in clinical practice, and there is more emphasis on the precision of measurements. Against this background, we would like to highlight that we quantified ICAC semiautomatedly 3 in a large, prospective population-based sample of >2500 middle-aged and elderly people and found that larger calcification volumes considerably increased the risk of stroke.4 This quantification strategy was relatively time consuming (≤8 minutes for a 1-mm thin slice protocol) but definitely not insuperable.We think that future research on ICAC could benefit from the development of fully automated quantification tools, given several advantages of quantitative image analysis over qualitative ratings.5 Quantitative analyses are more objective and reproducible and provide continuous measures that are more sensitive to small changes. With respect to interscan reproducibility, an important consideration on the modified Woodcock score is the high dependency on the slice thickness (ie, the sum score is directly depending on the number of slices), whereas for quantitative/volumetric analyses, the slice thickness is taken into account in the calculations. There are numerous biomarkers for which qualitative scales have been replaced by automated quantification algorithms. Examples include the quantificatio...

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Racial Differences in Prevalence and Risk for Intracranial Atherosclerosis in a US Community-Based Population

et al. 2017

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Intracranial Carotid Artery Atherosclerosis and the Risk of Stroke in Whites

Cited by 165 publications

References 42 publications

Heritability and Genome-Wide Association Analyses of Intracranial Carotid Artery Calcification

Heritability and Genome-Wide Association Analyses of Intracranial Carotid Artery Calcification

Letter by Bos et al Regarding Article, “Intracranial Carotid Calcification on Cranial Computed Tomography: Visual Scoring Methods, Semiautomated Scores, and Volume Measurements in Patients With Stroke”

Racial Differences in Prevalence and Risk for Intracranial Atherosclerosis in a US Community-Based Population

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