Intracranial carotid artery calcification on head CT and its association with ischemic changes on brain MRI in patients presenting with stroke-like symptoms : retrospective analysis

• Published in: Neuroradiology 2007-01, Vol.49 (1), p.27-33
• Main Authors: ERBAY, S, HAN, R, BACCEI, S, KRAKOV, W, ZOU, K. H, BHADELIA, R, POLAK, J
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bone marrow, stem cells transplantation. Graft versus host reaction; Brain; Brain Ischemia - etiology; Brain Ischemia - pathology; Calcinosis - complications; Calcinosis - diagnostic imaging; Carotid Artery Diseases - complications; Carotid Artery Diseases - diagnostic imaging; Ear, auditive nerve, cochleovestibular tract, facial nerve: diseases, semeiology; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Magnetic Resonance Imaging; Male; Medical diagnosis; Medical sciences; Middle Aged; Nervous system; Neurology; NMR; Non tumoral diseases; Nuclear magnetic resonance; Otorhinolaryngology. Stomatology; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Retrospective Studies; Risk Factors; Stroke; Stroke - diagnostic imaging; Stroke - etiology; Stroke - pathology; Tomography; Tomography, X-Ray Computed; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Veins & arteries; Vertebrobasilar Insufficiency - complications; Vertebrobasilar Insufficiency - diagnostic imaging
• ISSN: 0028-3940; 1432-1920
• DOI: 10.1007/s00234-006-0159-z

Our purpose was to study the association between the intracranial arterial calcifications observed on head CT and brain infarcts demonstrated by MRI in patients presenting with acute stroke symptoms. Institutional review board approval was obtained for this retrospective study which included 65 consecutive patients presenting acutely who had both head CT and MRI. Arterial calcifications of the vertebrobasilar system and the intracranial cavernous carotid arteries (intracranial carotid artery calcification, ICAC) were assigned a number (1 to 4) in the bone window images from CT scans. These four groups were then combined into high calcium (grades 3 and 4) and low calcium (grades 1 and 2) subgroups. Brain MRI was independently evaluated to identify acute and chronic large-vessel infarcts (LVI) and small-vessel infarcts (SVI). The relationship between ICAC and infarcts was evaluated before and after adjusting for demographics and cardiovascular risk factors. Statistical analysis could not be performed for the vertebrobasilar system due to an insufficient number of patients in the high calcium group. Of the 65 patients, 46 (71%) had a high ICAC grade on head CT. They were older and had a higher prevalence of cardiovascular risk factors. Acute SVI (P = 0.006), chronic SVI (P = 0.006) and acute LVI (P = 0.04) were associated with a high ICAC grade. After adjustment for age and other risk factors, only acute SVI was associated with a high ICAC grade (P = 0.002). Although age emerged as the most important determinant of ischemic cerebral changes, there were rather complex interactions among multiple risk factors with different infarct types. A high ICAC grade demonstrated a correlation with acute SVI in our patients independent of these risk factors.