Association between Intracranial Atherosclerotic Calcium Burden and Angiographic Luminal Stenosis Measurements
H Baradaran1,2, P Patel1, G Gialdini2
1From the Departments of Radiology (H.B., P.P., A. Gupta).
Insights
Intracranial atherosclerosis calcification shows a weak correlation with arterial narrowing. CT imaging detects more calcification than angiography, suggesting differences in sensitivity for assessing stroke risk factors.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Science
Background:
- Intracranial vascular calcification is a known stroke risk factor.
- The link between intracranial arterial stenosis and calcium burden is not fully understood.
- Atherosclerosis in the intracranial internal carotid arteries (ICAs) is a key area of investigation.
Purpose of the Study:
- To investigate the relationship between atherosclerotic calcification and luminal stenosis in the intracranial ICAs.
- To evaluate how calcium burden correlates with the degree of arterial narrowing.
Main Methods:
- Utilized a prospective stroke registry for patient selection.
- Employed non-contrast computed tomography (NCCT) for calcium assessment (qualitative and quantitative scores).
- Used computed tomography angiography (CTA) or magnetic resonance angiography (MRA) for stenosis measurement and correlation analysis.
Main Results:
- Atherosclerotic calcification was detected in 79.1% of ICAs by CT, while only 34% had measurable stenosis on CTA/MRA.
- A weak linear correlation was observed between calcium burden (qualitative R=0.48, quantitative R=0.42) and luminal stenosis.
- A significant proportion of ICAs without stenosis (69.7%) still exhibited measurable calcium scores.
Conclusions:
- The correlation between intracranial calcification and luminal narrowing is weak.
- CT's higher sensitivity in detecting calcification compared to angiography may explain this discrepancy.
- Further research is needed to clarify the role of stenosis and calcium burden in predicting stroke risk.
Background And Purpose:
Calcification of the intracranial vasculature is an independent risk factor for stroke. The relationship between luminal stenosis and calcium burden in the intracranial circulation is incompletely understood. We evaluated the relationship between atherosclerotic calcification and luminal stenosis in the intracranial ICAs.
Materials And Methods:
Using a prospective stroke registry, we identified patients who had both NCCT and CTA or MRA examinations as part of a diagnostic evaluation for ischemic stroke. We used NCCTs to qualitatively (modified Woodcock Visual Score) and quantitatively (Agatston-Janowitz Calcium Score) measure ICA calcium burden and used angiography to measure arterial stenosis. We calculated correlation coefficients between the degree of narrowing and calcium burden measures.
Results:
In 470 unique carotid arteries (235 patients), 372 (79.1%) had atherosclerotic calcification detectable on CT compared with 160 (34%) with measurable arterial stenosis on CTA or MRA (P < .001). We found a weak linear correlation between qualitative (R = 0.48) and quantitative (R = 0.42) measures of calcium burden and the degree of luminal stenosis (P < .001 for both). Of 310 ICAs with 0% luminal stenosis, 216 (69.7%) had measurable calcium scores.
Conclusions:
There is a weak correlation between intracranial atherosclerotic calcium scores and luminal narrowing, which may be explained by the greater sensitivity of CT than angiography in detecting the presence of measurable atherosclerotic disease. Future studies are warranted to evaluate the relationship between stenosis and calcium burden in predicting stroke risk.
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