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Calcium at the carotid siphon as an indicator of internal carotid artery stenosis

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Abstract

Objectives

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.

Methods

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.

Results

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.

Conclusion

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.

Key Points

• 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.

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Abbreviations

CAS:

Proximal internal carotid artery stenosis

CI:

95 % confidence interval

CT:

Computed tomography

CTA:

Computed tomography angiography

UCT:

Unenhanced computed tomography

HU:

Hounsfield units

PPV:

Positive predictive value

NPV:

Negative predictive value

TIA:

Transitory ischaemic attack

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Acknowledgments

Some of the patients were presented as EPOS on ECR 2011.

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Authors and Affiliations

  1. Department of Radiology, County hospital Požega, Osječka 107, 34000, Požega, Croatia

    Nikola Gotovac

  2. Image Sciences Institute, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    Nikola Gotovac, Ivana Išgum & Max A. Viergever

  3. Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands

    Geert J. Biessels

  4. Department of Surgery, County hospital Požega, Osječka 107, 34000, Požega, Croatia

    Josip Fajdić

  5. Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    Birgitta K. Velthuis & Mathias Prokop

  6. Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands

    Mathias Prokop

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  1. Nikola Gotovac
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  2. Ivana Išgum
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Correspondence to Nikola Gotovac.

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Gotovac, N., Išgum, I., Viergever, M.A. et al. Calcium at the carotid siphon as an indicator of internal carotid artery stenosis. Eur Radiol 23, 1478–1486 (2013). https://doi.org/10.1007/s00330-012-2766-x

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  • DOI: https://doi.org/10.1007/s00330-012-2766-x

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