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CT-derived density of intracranial arteriosclerosis: a population-based cohort study
Bernhard P Berghout1,2, Robin Y R Camarasa2, Maarten J G Leening1,2,3
1Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.
Insights
Intracranial artery calcification (IAC) density is higher in the anterior compared to the posterior circulation. Key drivers of IAC density include hypertension, lipid-lowering medication use, and smoking, similar to IAC volume.
Area of Science:
- Neuroradiology
- Vascular Biology
- Public Health
Background:
- Coronary artery calcification density is linked to ischemic heart disease risk.
- The relationship between intracranial artery calcifications (IAC) density and cerebrovascular disease risk is not well understood.
- Population-based data on IAC density and its determinants are lacking.
Purpose of the Study:
- To estimate the density distribution of intracranial artery calcifications (IAC) in a community-living cohort.
- To investigate the correlation between IAC density and IAC volume.
- To identify the key determinants of IAC density and compare them with those of IAC volume.
Main Methods:
- Non-contrast CT scans from 2464 individuals were analyzed to measure IAC density.
- Spearman's rank correlation was used to assess the relationship between IAC density and volume.
- Multivariable ordinal regression models were employed to determine associations between risk factors and IAC density.
Main Results:
- The prevalence of IAC was 82.8%, with a median density of 232 HU.
- IAC density showed a moderate correlation with IAC volume (ρ = 0.67).
- Anterior circulation calcifications (ICAC) were denser than posterior circulation calcifications (VBAC).
- Hypertension, lipid-lowering medication use, and smoking were significant determinants of IAC density.
Conclusions:
- IAC density varies significantly between anterior and posterior cerebral circulation arteries.
- While IAC density moderately correlates with volume, its key drivers are similar to those of IAC volume.
- IAC density may aid in differentiating intracranial calcification subtypes and their specific effects on cerebrovascular disease risk.
Background:
The CT-derived density of coronary artery calcification is increasingly associated with the risk of ischemic heart disease. Whether this principle also applies to intracranial artery calcifications (IAC) and cerebrovascular disease risk is unknown, primarily due to the lack of population-based estimates of IAC density and its determinants. We investigated these facets in this cohort study.
Materials And Methods:
In 2464 community-living individuals who underwent non-contrast CT, we measured IAC density and assessed its correlation with IAC volume using Spearman's ρ. We described its distribution in intracranial carotid artery calcification (ICAC), with specific estimates for its subtypes, and vertebrobasilar artery calcification (VBAC). We investigated associations between risk factors and IAC density using multivariable ordinal regression models.
Results:
The prevalence of IAC was 82.8%, with a median density of 232 (IQR 189-287) HU. IAC density correlated moderately with volume (ρ 0.67, 95% CI [0.65-0.70]). ICAC was predominantly composed of higher density, with 80.1% of affected participants having components of ICAC above 400 HU, whereas only 32.0% of participants with VBAC had components above 400 HU. Intimal subtype ICACs showed a predominance for lower densities when compared to medial subtype ICACs. The main determinants of IAC density were hypertension, use of lipid-lowering medication, and smoking, with adjusted odds ratios of 1.59 [1.28-1.90], 1.55 [1.26-1.91], and 1.33 [1.10-1.61], respectively.
Conclusion:
IAC density differs significantly between the anterior and posterior cerebropetal arteries. While IAC density correlated only moderately with its volume, the associations between cardiovascular risk factors and IAC density were mostly similar to those observed with IAC volume.
Key Points:
Question Drivers of the CT density of intracranial artery calcifications are unknown and may reveal novel risk targets for population-based prevention strategies. Findings Calcifications of the anterior cerebral circulation are denser than those of the posterior circulation. Hypertension, diabetes, and smoking are key drivers of calcification density, resembling most drivers of its volume. Clinical relevance Calcification density may serve in distinguishing subtypes of intracranial calcifications, improving detection of subtype-specific effects. Further research is warranted to determine the role of intracranial arteriosclerosis density in prevention strategies for cerebrovascular diseases.
