Journal Article

Computed Tomographic Distinction of Intimal and Medial Calcification in the Intracranial Internal Carotid Artery

Mali, Willem P. Th. M., De Vis, Jill B., Koek, Huiberdina L., de Jong, Pim A., Bleys, Ronald L. A. W., Hendrikse, Jeroen, Vos, Annelotte, Van Hecke, Wim, Verdoorn, Daphne, Vink, Aryan, Kockelkoren, Remko

2017

Overview

Intracranial internal carotid artery (iICA) calcification is associated with stroke and is often seen as a proxy of atherosclerosis of the intima. However, it was recently shown that these calcifications are predominantly located in the tunica media and internal elastic lamina (medial calcification). Intimal and medial calcifications are thought to have a different pathogenesis and clinical consequences and can only be distinguished through ex vivo histological analysis. Therefore, our aim was to develop CT scoring method to distinguish intimal and medial iICA calcification in vivo. First, in both iICAs of 16 cerebral autopsy patients the intimal and/or medial calcification area was histologically assessed (142 slides). Brain CT images of these patients were matched to the corresponding histological slides to develop a CT score that determines intimal or medial calcification dominance. Second, performance of the CT score was assessed in these 16 patients. Third, reproducibility was tested in a separate cohort. First, CT features of the score were circularity (absent, dot(s), <90°, 90-270° or 270-360°), thickness (absent, ≥1.5mm, or <1.5mm), and morphology (indistinguishable, irregular/patchy or continuous). A high sum of features represented medial and a lower sum intimal calcifications. Second, in the 16 patients the concordance between the CT score and the dominant calcification type was reasonable. Third, the score showed good reproducibility (kappa: 0.72 proportion of agreement: 0.82) between the categories intimal, medial or absent/indistinguishable. The developed CT score shows good reproducibility and can differentiate reasonably well between intimal and medial calcification dominance in the iICA, allowing for further (epidemiological) studies on iICA calcification.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / Aged / Aged, 80 and over / Arteriosclerosis / Atherosclerosis / Autopsies / Autopsy / Biology and Life Sciences / Brain / Calcification / Calcification (ectopic) / Calcification (Physiology) / Carotid arteries / Carotid artery / Carotid Artery, Internal - diagnostic imaging / Carotid Artery, Internal - pathology / CAT scans / Cohort Studies / Computed tomography / Diagnosis / Diagnosis, Differential / Dominance / Epidemiology / Female / Health aspects / Histology / Humans / Hypertension / In vivo methods and tests / Male / Medical imaging / Medicine and Health Sciences / Middle Aged / Pathogenesis / Pathology / Patients / Reproducibility / Reproducibility of Results / Research and Analysis Methods / Stroke / Studies / Tomography, X-Ray Computed / Tunica Intima - diagnostic imaging / Tunica Media - diagnostic imaging / Tunica Media - pathology / Vascular Calcification - diagnostic imaging / Vascular Calcification - pathology / Veins & arteries