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Association between vascular calcification in intracranial vertebrobasilar circulation and luminal stenosis

  • Diagnostic Neuroradiology
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Abstract

Introduction

The study aims to assess the correlation and association between calcium burden and luminal stenosis in the vertebrobasilar circulation.

Methods

We evaluated 166 patients [mean age, 79.8 ± 8.8 (SD) with 93 males] with stroke symptoms. The calcification patterns were assessed on non-contrast CT (NCCT); quantitative calcium burden [Agatston-Janowitz (AJ) calcium score, volume, and mass] on the initial non-contrast phase of CT perfusion (CTP); and the qualitative and quantitative luminal stenosis on CT angiography (CTA) studies. We calculated the correlation coefficient and association between measures of calcium burden and luminal stenosis.

Results

Two hundred twenty-eight of 498 arteries (45.8%) had detectable calcification on NCCT and measurable stenosis in 169 of 498 arteries (33.9%) on CTA. We found a moderate correlation between qualitative calcium burden and qualitative (0.51 for R1 and 0.62 for R2, p < 0.01) as well as quantitative luminal stenosis (0.67 for R1 and 0.69 for R2, p < 0.01). There was a moderate correlation of AJ score (0.66), volume (0.68), and mass of calcification (0.60, p < 0.01) with luminal stenosis measurements. The quantitative calcium burden and luminal stenosis showed statistically significant differences between different qualitative categories of calcium burden (p < 0.001 in both readers). However, severe stenosis was not seen even with the advanced circumferential wall calcification (mean stenosis of 35.3–40.7%).

Conclusion

Our study showed a moderate correlation between higher burden of vascular calcification and the degree of luminal stenosis. However, higher calcium burden and circumferential wall calcification were not associated with severe luminal stenosis.

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Data availability

The data will be available and shared on making personal requests to the corresponding author.

Code availability

The calcium scoring of the vertebrobasilar arteries was performed using VitreaTM advanced visualization application (Canon Medical Systems — Version 7.9.0.723).

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Authors and Affiliations

  1. Department of Radiology, Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada

    Shivaprakash B. Hiremath, Undrakh-Erdene Erdenebold, Mario Kontolemos, William Miller & Nader Zakhari

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  1. Shivaprakash B. Hiremath
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  2. Undrakh-Erdene Erdenebold
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  3. Mario Kontolemos
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  4. William Miller
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  5. Nader Zakhari
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Contributions

Dr Nader Zakhari and Dr Undrakh-Erdene Erdenebold contributed to the study conception and design. Material preparation, and data collection were performed by Dr. Undrakh-Erdene Erdenebold, Dr. Mario Kontolemos, and Dr. William Miller. The first draft of the manuscript was written and data analysis was performed by Dr. Shivaprakash B. Hiremath and supervised by Dr. Nader Zakhari. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Nader Zakhari.

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Hiremath, S.B., Erdenebold, UE., Kontolemos, M. et al. Association between vascular calcification in intracranial vertebrobasilar circulation and luminal stenosis. Neuroradiology 64, 2285–2293 (2022). https://doi.org/10.1007/s00234-022-02974-1

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