Skip to main content


Log in

Computed tomography detection of carotid calcium and subclinical carotid atherosclerosis

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript


Computed tomography (CT) detection of coronary calcium has become a popular technique for assessing coronary atherosclerosis. Whether CT detection of carotid calcium could similarly assess carotid atherosclerosis is unknown. We thus performed a study evaluating the feasibility of carotid calcium scoring by CT. We also looked for an association between carotid calcium and subclinical carotid atherosclerosis. Subjects (n = 876) underwent non-contrast CT scanning of their carotid arteries. Carotid calcium was quantified by the Agatston method. Stenoses were detected by subsequent CT angiography. Significant subclinical atherosclerosis was defined by the presence of a ≥30% carotid stenosis. The frequency of a ≥30% carotid stenosis was then analyzed as a function of carotid calcium scores and various cardiovascular risk factors. CT detection of carotid calcium was feasible, robust, and reliable. Significant univariate associations for a ≥30% carotid stenosis included age (P < 0.001), diabetes (P = 0.02), hypertension (P = 0.01), and the carotid calcium score (P < 0.001). Those with a ≥30% carotid stenosis exhibited a median (25th, 75th percentile) carotid calcium score of 153 (19, 489), while those without a ≥30% carotid stenosis had a median (25th, 75th percentile) carotid calcium score of 0 (0, 89). Conversely, when no carotid calcium was detected, there was a low (1%) frequency of significant carotid atherosclerosis. The frequency of a ≥30% carotid stenosis increased as the carotid calcium score increased (P < 0.001 for trend). This association remained significant after adjustment for age, hypertension, diabetes, hyperlipidemia, and tobacco use. CT detection of carotid calcium can assess the burden of carotid atherosclerosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others


  1. Stary H, Chandler A, Dinsmore R, Fuster V, Glagov S, Insull W Jr, Rosenfeld M, Schwartz C, Wagner W, Wissler R (1995) A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis: a report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. Circulation 92:1355–1374

    Article  PubMed  CAS  Google Scholar 

  2. LaMonte M, FitzGerald S, Church T, Barlow C, Radford N, Levine B, Pippin J, Gibbons L, Blair S, Nichaman M (2005) Coronary artery calcium score and coronary heart disease events in a large cohort of asymptomatic men and women. Am J Epidemiol 162:421–429

    Article  PubMed  Google Scholar 

  3. Budoff M, Shaw L, Liu S, Weinstein S, Mosler T, Tseng P, Flores F, Callister T, Raggi P, Berman D (2004) Long-term prognosis associated with coronary calcification. Observations from a registry of 25, 253 patients. J Am Coll Cardiol 44:923–930

    Article  Google Scholar 

  4. Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC (2004) Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA 291:210–215

    Article  PubMed  CAS  Google Scholar 

  5. Agatston A, Janowitz W, Hildner F, Zusmer N, Viamonte M Jr, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832

    Article  PubMed  CAS  Google Scholar 

  6. European Commission (2000) European guidelines on quality criteria for computed tomography. EUR 16262 EN. Office for Official Publications of the European Communities, Luxembourg

  7. Rumberger J, Brundage B, Rader D, Kondos G (1999) Electron beam computed tomographic coronary calcium scanning: a review and guidelines for use in asymptomatic persons. Mayo Clin Proc 74:243–252

    Article  PubMed  CAS  Google Scholar 

  8. Hollander M, Bots M, del Sol A, Koudstaal P, Witteman J, Grobbee D, Hofman A, Breteler M (2002) Carotid plaques increase the risk of stroke and subtypes of cerebral infarction in asymptomatic elderly. The Rotterdam Study. Circulation 105:2872–2877

    Article  PubMed  CAS  Google Scholar 

  9. Biller J, Feinberg W, Castaldo J, Whittemore A, Harbaugh R, Dempsey R, Caplan L, Kresowik T, Matchar D, Toole J, Easton J, Adams H Jr, Brass L, Hobson R II, Brott T, Sternau L (1998) Guidelines for carotid endarterectomy: a statement for healthcare professionals from a Special Writing Group of the Stroke Council, American Heart Association. Circulation 97:501–509

    Article  PubMed  CAS  Google Scholar 

  10. D’Agostino R, Wolf P, Belanger A, Kannel W (1994) Stroke risk profile: adjustment for antihypertensive medication. The Framingham Study. Stroke 25:40–43

    Article  PubMed  Google Scholar 

  11. Bineau S, Dufouil C, Helmer C, Ritchie K, Empana JP, Ducimetiere P, Alperovitch A, Bousser M, Tzourio C (2009) Framingham stroke risk function in a large population-based cohort of elderly people: the 3C study. Stroke 40:1564–1570

    Article  PubMed  Google Scholar 

  12. McKinney A, Casey S, Teksam M, Lucato L, Smith M, Truwit C, Kieffer S (2005) Carotid bifurcation calcium and correlation with percent stenosis on the internal carotid artery on CT angiography. Neuroradiology 47:1–9

    Article  PubMed  Google Scholar 

  13. Fanning H, Walters T, Fox A, Symons S (2006) Association between calcification of the cervical carotid artery bifurcation and white matter ischemia. Am J Neurorad 27:378–383

    CAS  Google Scholar 

  14. Nandalur K, Baskurt E, Hagspiel K, Finch M, Phillips C, Bollampally S, Kramer C (2006) Carotid artery calcification on CT may independently predict stroke risk. Am J Roentgenol 186:547–552

    Article  Google Scholar 

  15. Berman D, Wong N, Gransar H, Miranda-Peats R, Dahlbeck J, Hayes S, Friedman J, Kang X, Polk D, Hachamovitch R, Shaw L, Rozanski A (2004) Relationship between stress-induced myocardial ischemia and atherosclerosis measured by coronary calcium tomography. J Am Coll Cardiol 44:923–930

    Article  PubMed  CAS  Google Scholar 

  16. Ho J, FitzGerald S, Stolfus L, Cannaday J, Radford N (2007) Severe coronary artery calcifications are associated with ischemia in patients with well controlled risk factors. J Nucl Cardiol 14:341–346

    Article  PubMed  Google Scholar 

  17. Ho J, FitzGerald S, Stolfus L, Wade W, Reinhardt D, Barlow C, Cannaday J (2008) Relation of a coronary artery calcium score >400 to coronary stenoses detected by multidetector computed tomography and to traditional cardiovascular risk factors. Am J Cardiol 101:1444–1447

    Article  PubMed  CAS  Google Scholar 

  18. Kennedy J, Shavelle R, Wang S, Budoff M, Detrano R (1998) Coronary calcium and standard risk factors in symptomatic patients referred for coronary angiography. Am Heart J 135:696–702

    Article  PubMed  CAS  Google Scholar 

  19. Greenland P, Bonow R, Brundage B, Budoff M, Eisenberg M, Grundy S, Lauer M, Post W, Raggi P, Redberg R, Rodgers G, Shaw L, Taylor A, Weintraub W (2007) ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography). J Am Coll Cardiol 49:378–402

    Article  PubMed  Google Scholar 

Download references

Conflict of interest


Author information

Authors and Affiliations


Corresponding author

Correspondence to John S. Ho.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ho, J.S., Cannaday, J.J., Barlow, C.E. et al. Computed tomography detection of carotid calcium and subclinical carotid atherosclerosis. Int J Cardiovasc Imaging 28, 1601–1607 (2012).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: