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Understanding the Clinical Implications of Intracranial Arterial Calcification Using Brain CT and Vessel Wall Imaging

Wen-Jie Yang1, Bruce A Wasserman1, Lu Zheng2

  • 1The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD, United States.

Frontiers in Neurology
|August 2, 2021
PubMed

Insights

Intracranial arterial calcification (IAC) patterns on CT scans reveal associations with atherosclerotic plaques. Intimal calcification correlates with stable plaques, while medial calcification is less associated with plaque presence.

Area of Science:

  • Neurology
  • Radiology
  • Cardiovascular Science

Background:

  • Intracranial arterial calcification (IAC) is a marker for intracranial atherosclerosis.
  • The relationship between IAC patterns (intimal vs. medial) and atherosclerotic plaque characteristics remains debated.
  • Understanding these patterns is crucial for assessing plaque stability and stroke risk.

Purpose of the Study:

  • To investigate the association between intracranial arterial calcification patterns identified on CT.
  • To determine the correlation of these patterns with the presence of atherosclerotic plaques.
  • To evaluate the relationship between IAC patterns and atherosclerotic plaque stability.

Main Methods:

  • Retrospective analysis of patients with stroke or transient ischemic attack and intracranial artery stenosis.
  • Identification and localization of IAC patterns (intimal or medial) on non-contrast CT.
  • Detection of intracranial atherosclerotic plaques using vessel wall MRI, matched with CT images.
  • Multivariate regression analysis to assess associations between IAC patterns and plaque characteristics.

Main Results:

  • Seventy-five patients were included; 221 IAC segments were identified.
  • Intimal calcifications (38.9%) were more frequently associated with atherosclerotic plaques (72.0%) compared to medial calcifications (10.2%).
  • Intimal calcification was significantly associated with non-culprit plaques (OR, 2.971; P=0.043), suggesting a stable plaque form.

Conclusions:

  • Intimal calcification may indicate a stable form of intracranial atherosclerotic plaque.
  • Atherosclerotic plaques can exist without intimal calcification, particularly in the middle cerebral artery.
  • Distinguishing IAC patterns provides insights into plaque characteristics and stability.

Keywords:
atherosclerosiscalcificationcomputed tomographyintracranial diseasemagnetic resonance imaging

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