Calcium at the carotid siphon as an indicator of internal carotid artery stenosis
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Carotid siphon calcification is often visible on unenhanced head CT (UCT), but the relation to proximal carotid artery stenosis (CAS) is unclear. We investigated the association of carotid siphon calcification with the presence of CAS.
This IRB-waived retrospective study included 160 consecutive patients suspected of stroke (age 64 ± 14 years, 63 female) who underwent head UCT and CTA of the head and neck. CAS was rated on CTA as not present or present with non-significant (<50 %), moderate (50–69 %) or significant (≥70 %) stenosis. Presence, shape (on UCT) and volume (on CTA) of carotid siphon calcifications were related to CAS.
Carotid siphon calcification was absent in 41 % of patients and bilateral in 94 % of those with calcifications. Presence, shape and volume of calcification resulted in odds ratios for having significant CAS of 10.1, 3.9 and 8.4, with 95 % CIs of 1.3–79.6, 1.1–14.1 and 2.6–26.8, respectively. Corresponding NPVs were 0.98, 0.98 and 0.96, while PPVs were 0.14, 0.07 and 0.29, respectively.
Absence of calcification in the carotid artery siphon on UCT has high negative predictive value for carotid artery stenosis in patients with suspected stroke. However, siphon calcification is not a reliable indicator of significant carotid artery stenosis.
• Many stroke patients do not have calcification in the carotid artery siphon.
• Carotid stenosis ≥50 % is unlikely in stroke patients without siphon calcification.
• Carotid siphon calcium is a poor indicator of significant carotid artery stenosis.
- Rothwell PM, Eliasziw M, Gutnikov SA et al (2003) for the Carotid Endarterectomy Trialists’ Collaboration. Analysis of pooled data from the randomized controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet 361:107–16 CrossRef
- Furie KL, Kasner SE, Adams RJ et al (2011) American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Clinical Cardiology, and Interdisciplinary Council on Quality of Care and Outcomes Research. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke 42:227–276 CrossRef
- Vliegenthart R, Hollander M, Breteler MM et al (2002) Stroke is associated with coronary calcification as detected by electron-beam CT: the Rotterdam Coronary Calcification Study. Stroke 33:462–465 CrossRef
- Wong ND, Hsu JC, Detrano RC, Diamond G, Eisenberg H, Gardin JM (2000) Coronary artery calcium evaluation by electron beam computed tomography and its relation to new cardiovascular events. Am J Cardiol 86:495–498 CrossRef
- Stolzmann P, Donati OF, Scheffel H et al (2000) Low-dose CT angiography for the prediction of myocardial ischemia. Eur Radiol 20:56–64 CrossRef
- Jacobs PC, Prokop M, van der Graaf Y et al (2010) Comparing coronary artery calcium and thoracic aorta calcium for prediction of all-cause mortality and cardiovascular events on low-dose non-gated computed tomography in a high-risk population of heavy smokers. Atherosclerosis 209:455–462 CrossRef
- Babiarz LS, Yousem DM, Wasserman BA, Wu C, Bilker W, Beauchamp NJ Jr (2003) Cavernous carotid artery calcification and white matter ischemia. Am J Neuroradiol 24:872–877
- Mak HK, Wong CW, Yau KK, Wong WM, Gu J, Khong PL, Chan BP (2009) Computed tomography evaluation of intracranial atherosclerosis in Chinese patients with transient ischemic attack or minor ischemic stroke—its distribution and association with vascular risk factors. J Stroke Cerebrovasc Dis 18:158–63 CrossRef
- Fanning NF, Walters TD, Fox AJ, Symons SP (2006) Association between calcification of the cervical carotid artery bifurcation and white metter ischemia. Am J Neuroradiol 27:378–383
- Erbay S, Han R, Baccei S et al (2007) 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. Neuroradiology 49:27–33 CrossRef
- Saba L, Sanfilippo R, Pascalis L, Montisci R, Mallarini G (2009) Cartoid artery abnormalities and leukariosis in eldery patients: evaluation with MDCT. AJR 192:W63–W70 CrossRef
- Nandalur KR, Baskurt E, Hagspiel KD et al (2006) Carotid artery calcification on CT may independently predict stroke risk. AJR 186:547–552 CrossRef
- Kwee RM (2010) Systematic review on the association between calcification in carotid plaques and clinical ischemic symptoms. J Vasc Surg 51:1015–25 CrossRef
- McKinney A, Casey SO, Teksam M et al (2005) Carotid bifurcation and correlation with percent stenosis of the internal carotid artery on CT angiography. Neuroradiology 47:1–9 CrossRef
- Marquering HA, Majoie CBLM, Smagge L et al (2011) The relation of carotid calcium volume with carotid artery stenosis in symptomatic patients. Am J Neuroradiol 32:1182–87 CrossRef
- de Weert TT, Cakir H, Rozie S et al (2009) Intracranial internal carotid artery calcifications: association with vascular risk factors and ischemic cerebrovascular disease. Am J Neuroradiol 30:177–184 CrossRef
- Rutten A, Isgum I, Prokop M (2005) Coronary calcification: effect of small variation of scan starting position on Agatston, volume, and mass scores. Radiology 246:90–98 CrossRef
- North American Symptomatic Carotid Endarterectomy Trial (1991) Methods, patient characteristics, and progress. Stroke 22:711–720 CrossRef
- Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174 CrossRef
- Woodcock RJ Jr, Goldstein JH, Kallmes DF et al (1999) Angiographic correlation of CT calcification in the carotid siphon. AJNR Am J Neuroradiol 20:495–99
- Waaijer A, Weber M, van Leeuwen MS et al (2009) Grading of carotid artery stenosis with multidetector-row CT angiography: visual estimation or caliper measurements? Eur Radiol 19:2809–2818 CrossRef
- Ahn SS, Nam HS, Heo JH et al (2013) Quantification of intracranial internal carotid artery calcification on brain unenhanced CT: evaluation of its feasibility and assessment of the reliability of visual grading scales. Eur Radiol 23:20–27 CrossRef
- Kassab MY, Gupta R, Majid A et al (2009) Extent of intra-arterial calcification on head CT is predictive of the degree of intracranial atherosclerosis on digital subtraction angiography. Cerebrovasc Dis 28:45–48 CrossRef
- Hong NR, Seo HS, Lee YH et al (2011) The correlation between carotid siphon calcification and lacunar infarction. Neuroradiology 53:643–649 CrossRef
- Taoka T, Iwasaki S, Nakagawa H et al (2006) Evaluation of arteriosclerotic changes in the intracranial carotid artery using the calcium score obtained on plain cranial computed tomography scan: correlation with angiographic changes and clinical outcome. J Comput Assist Tomogr 30:624–628 CrossRef
- Detrano RC, Anderson M, Nelson J et al (2005) Coronary calcium measurements: effect of CT scanner type and calcium measure on rescan reproducibility—MESA study. Radiology 236:477–484 CrossRef
- Calcium at the carotid siphon as an indicator of internal carotid artery stenosis
Volume 23, Issue 6 , pp 1478-1486
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- Intracranial atherosclerosis
- Internal carotid artery
- Vascular calcification
- Carotid stenosis
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- Author Affiliations
- 1. Department of Radiology, County hospital Požega, Osječka 107, 34000, Požega, Croatia
- 2. Image Sciences Institute, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- 3. Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
- 4. Department of Surgery, County hospital Požega, Osječka 107, 34000, Požega, Croatia
- 5. Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- 6. Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands