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Zhang F, Yang L, Gan L, Fan Z, Zhou B, Deng Z, Dey D, Berman DS, Li D, Xie Y. Spotty Calcium on Cervicocerebral Computed Tomography Angiography Associates With Increased Risk of Ischemic Stroke. Stroke 2020; 50:859-866. [PMID: 30879439 DOI: 10.1161/strokeaha.118.023273] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Cervicocerebral vascular calcification on computed tomography angiography is a known sign of advanced atherosclerosis. However, the clinical significance of calcification pattern remains unclear. In this study, we aimed to investigate the potential association between spotty calcium and acute ischemic stroke. Methods- This study included patients with first-time nonlacunar ischemic stroke (N=50) confirmed by brain magnetic resonance imaging or nonenhanced head computed tomography, as well as control subjects with asymptomatic carotid atherosclerosis (N=50) confirmed by carotid ultrasonography. Subjects in both groups underwent contrast-enhanced cervicocerebral computed tomography angiography within a week after the initial imaging examination. Spotty calcification was evaluated at 11 arterial segments commonly affected by atherosclerosis along the carotid and vertebrobasilar circulation. Statistical analysis was performed comparing the frequency and spatial pattern of spotty calcification between the 2 groups. Results- Spotty calcification in the Stroke group was markedly more prevalent than that in the Control group (total SC count: 8.74±4.96 versus 1.84±1.82, P<0.001). The odds ratio (95% CI) for stroke was 2.49 (1.55-4.00) for spotty calcification at bilateral carotid bifurcation, 1.52 (1.13-2.04) at carotid siphon, and 1.98 (1.45-2.69) at all evaluated locations. A total number of 3 spotty calcifications were determined as the optimal cutoff threshold for increased risk of stroke. Spotty calcium showed significantly greater area under the receiver operating characteristics curve than total calcium volume irrespective of size (0.88 versus 0.77). Within the Stroke group, ipsilateral lateral side showed significantly more spotty calcium than the contralateral side (5.18±3.05 versus 3.56±2.67, P<0.001). Conclusions- Nonlacunar ischemia stroke was associated with markedly increased incidence of spotty calcification with a distinct spatial pattern on cervicocerebral computed tomography compared with subclinical atherosclerosis, suggesting the potential role of spotty calcification for improving the risk stratification for ischemic stroke.
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Affiliation(s)
- Fan Zhang
- From the Department of Radiology, Hainan Branch of Chinese People's Liberation Army General Hospital, Sanya, Hainan, China (F.Z.).,Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (F.Z., Z.F., B.Z., Z.D., D.D., D.S.B., D.L., Y.X.)
| | - Li Yang
- Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing, China (L.Y.)
| | - Lu Gan
- Department of Radiology, Tiantan Hospital, Capital Medical University, Beijing, China (L.G.)
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (F.Z., Z.F., B.Z., Z.D., D.D., D.S.B., D.L., Y.X.).,Department of Bioengineering (Z.F., Z.D., D.L.), University of California, Los Angeles.,Department of Medicine (Z.F., B.Z., D.L.), University of California, Los Angeles
| | - Bill Zhou
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (F.Z., Z.F., B.Z., Z.D., D.D., D.S.B., D.L., Y.X.).,Department of Medicine (Z.F., B.Z., D.L.), University of California, Los Angeles
| | - Zixin Deng
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (F.Z., Z.F., B.Z., Z.D., D.D., D.S.B., D.L., Y.X.).,Department of Bioengineering (Z.F., Z.D., D.L.), University of California, Los Angeles
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (F.Z., Z.F., B.Z., Z.D., D.D., D.S.B., D.L., Y.X.)
| | - Daniel S Berman
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (F.Z., Z.F., B.Z., Z.D., D.D., D.S.B., D.L., Y.X.)
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (F.Z., Z.F., B.Z., Z.D., D.D., D.S.B., D.L., Y.X.).,Department of Bioengineering (Z.F., Z.D., D.L.), University of California, Los Angeles.,Department of Medicine (Z.F., B.Z., D.L.), University of California, Los Angeles
| | - Yibin Xie
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (F.Z., Z.F., B.Z., Z.D., D.D., D.S.B., D.L., Y.X.)
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