Top

Published in:

01-04-2018 | Diagnostic Neuroradiology

Impact of intracranial artery calcification on cerebral hemodynamic changes

Authors: Xiaohong Wu, Li Wang, Jingxin Zhong, Jacky Ko, Lin Shi, Yannie Soo, Thomas Leung, Ka Sing Wong, Jill Abrigo, Xiangyan Chen

Published in: Neuroradiology | Issue 4/2018

Abstract

Purpose

Intracranial artery calcification (IAC) has been demonstrated to be correlated with ischemic stroke, cognitive decline, and other vascular events by accumulating evidences from both Western and Asian populations. The proposed study aimed to investigate its potential mechanisms by evaluating the blood flow velocity and pulsatility index (PI) of cerebral arteries.

Methods

Consecutive ischemic stroke patients admitted to the Prince of Wales Hospital were recruited after excluding those with atrial fibrillation or poor temporal window. Quantitative measurements of IAC severity were assessed on brain CT scans. Transcranial Doppler (TCD) ultrasonography was performed to evaluate the blood flow velocity of the middle cerebral artery (MCA) and vertebral-basilar artery (VBA).

Results

In total, 318 patients were analyzed. Spearman’s correlation analysis demonstrated both high MCA systolic flow velocity and high MCA PI were correlated with IAC Agatston score, p < 0.001 individually. Similar correlation was also found between IAC Agatston score and high VBA velocity/high VBA PI, p ≤ 0.001 individually. Multiple logistic regression analysis showed IAC Agatston score was an independent risk factor for high MCA velocity (OR 1.533; 95% CI 1.235–1.903), high VBA velocity (OR 1.964; 95% CI 1.381–2.794), and high VBA PI (OR 1.200; 95% CI 1.016–1.418), respectively.

Conclusion

Heavier IAC might cause generalized artery flow velocity changes and increased pulsatility index, which may indicate high resistance within cerebrovasculature.

Chen XY, Lam WW, Ng HK, Fan YH, Wong KS (2007) Intracranial artery calcification: a newly identified risk factor of ischemic stroke. J Neuroimaging 17(4):300–303. https://doi.org/10.1111/j.1552-6569.2007.00158.x CrossRefPubMed

Bos D, Portegies ML, van der Lugt A, Bos MJ, Koudstaal PJ, Hofman A, Krestin GP, Franco OH, Vernooij MW, Ikram MA (2014) Intracranial carotid artery atherosclerosis and the risk of stroke in whites: the Rotterdam Study. JAMA Neurol 71(4):405–411. https://doi.org/10.1001/jamaneurol.2013.6223 CrossRefPubMed

Hong NR, Seo HS, Lee YH, Kim JH, Seol HY, Lee NJ, Suh SI (2011) The correlation between carotid siphon calcification and lacunar infarction. Neuroradiology 53(9):643–649. https://doi.org/10.1007/s00234-010-0798-y CrossRefPubMed

Bos D, Vernooij MW, Elias-Smale SE, Verhaaren BF, Vrooman HA, Hofman A, Niessen WJ, Witteman JC, van der Lugt A, Ikram MA (2012) Atherosclerotic calcification relates to cognitive function and to brain changes on magnetic resonance imaging. Alzheimers Dement 8(5):S104–S111. https://doi.org/10.1016/j.jalz.2012.01.008 CrossRefPubMed

Nakamura S, Ishibashi-Ueda H, Niizuma S, Yoshihara F, Horio T, Kawano Y (2009) Coronary calcification in patients with chronic kidney disease and coronary artery disease. Clin J Am Soc Nephrol 4(12):1892–1900. https://doi.org/10.2215/CJN.04320709 CrossRefPubMedPubMedCentral

Lanzer P, Boehm M, Sorribas V, Thiriet M, Janzen J, Zeller T, St Hilaire C, Shanahan C (2014) Medial vascular calcification revisited: review and perspectives. Eur Heart J 35(23):1515–1525. https://doi.org/10.1093/eurheartj/ehu163 CrossRefPubMedPubMedCentral

Vos A, Van Hecke W, Spliet WG, Goldschmeding R, Isgum I, Kockelkoren R, Bleys RL, Mali WP, de Jong PA, Vink A (2016) Predominance of nonatherosclerotic internal elastic lamina calcification in the intracranial internal carotid artery. Stroke 47(1):221–223. https://doi.org/10.1161/STROKEAHA.115.011196 CrossRefPubMed

Micheletti RG, Fishbein GA, Currier JS, Singer EJ, Fishbein MC (2008) Calcification of the internal elastic lamina of coronary arteries. Mod Pathol 21(8):1019–1028. https://doi.org/10.1038/modpathol.2008.89 CrossRefPubMed

Kim JS, Caplan LR, Wong KSL (2008) Intracranial atherosclerosis. Blackwell Publishing Ltd UK, pp:57–68

10.

Sloan MA, Alexandrov AV, Tegeler CH, Spencer MP, Caplan LR, Feldmann E, Wechsler LR, Newell DW, Gomez CR, Babikian VL, Lefkowitz D, Goldman RS, Armon C, Hsu CY, Goodin DS (2004) Assessment: transcranial Doppler ultrasonography: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 62(9):1468–1481. https://doi.org/10.1212/WNL.62.9.1468 CrossRefPubMed

11.

Wong KS, Li H, Chan YL, Ahuja A, Lam WW, Wong A, Kay R (2000) Use of transcranial Doppler ultrasound to predict outcome in patients with intracranial large-artery occlusive disease. Stroke 31:2641–2647CrossRefPubMed

12.

Tsivgoulis G, Sharma VK, Hoover SL, Lao AY, Ardelt AA, Malkoff MD, Alexandrov AV (2008) Applications and advantages of power motion-mode Doppler in acute posterior circulation cerebral ischemia. Stroke 39(4):1197–1204. https://doi.org/10.1161/STROKEAHA.107.499392 CrossRefPubMed

13.

Wu XH, Chen XY, Fan YH, Leung TW, Wong KS (2017) High extent of intracranial carotid artery calcification is associated with downstream microemboli in stroke patients. J Stroke Cerebrovasc Dis 26(2):442–447. https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.10.007 CrossRefPubMed

14.

Yushkevich PA, Piven J, Hazlett HC, Smith RG, Ho S, Gee JC, Gerig G (2006) User-guided 3d active contour segmentation of anatomical structures: significantly improved efficiency and reliability. NeuroImage 31(3):1116–1128. https://doi.org/10.1016/j.neuroimage.2006.01.015 CrossRefPubMed

15.

Woodcock RJ Jr, Goldstein JH, Kallmes DF, Cloft HJ, Phillips CD (1999) Angiographic correlation of ct calcification in the carotid siphon. AJNR Am J Neuroradiol 20(3):495–499PubMed

16.

Kassab MY, Gupta R, Majid A, Farooq MU, Giles BP, Johnson MD, Graybeal DF, Rappard G (2009) Extent of intra-arterial calcification on head CT is predictive of the degree of intracranial atherosclerosis on digital subtraction angiography. Cerebrovasc Dis 28(1):45–48. https://doi.org/10.1159/000219296 CrossRefPubMed

17.

Sohn YH, Cheon HY, Jeon P, Kang SY (2004) Clinical implication of cerebral artery calcification on brain ct. Cerebrovasc Dis 18(4):332–337. https://doi.org/10.1159/000080772 CrossRefPubMed

18.

Park KY, Chung PW, Kim YB, Moon HS, Suh BC, Yoon WT (2013) Increased pulsatility index is associated with intracranial arterial calcification. Eur Neurol 69(2):83–88. https://doi.org/10.1159/000342889 CrossRefPubMed

19.

Powers WJ, Press GA, Grubb RL Jr, Gado M, Raichle ME (1987) The effect of hemodynamically significant carotid artery disease on the hemodynamic status of the cerebral circulation. Ann Intern Med 106(1):27–34. https://doi.org/10.7326/0003-4819-106-1-27 CrossRefPubMed

20.

Kamouchi M, Kishikawa K, Okada Y, Inoue T, Ibayashi S, Iida M (2005) Poststenotic flow and intracranial hemodynamics in patients with carotid stenosis: Transoral carotid ultrasonography study. AJNR Am J Neuroradiol 26(1):76–81PubMed

Title: Impact of intracranial artery calcification on cerebral hemodynamic changes
Authors: Xiaohong Wu
Li Wang
Jingxin Zhong
Jacky Ko
Lin Shi
Yannie Soo
Thomas Leung
Ka Sing Wong
Jill Abrigo
Xiangyan Chen
Publication date: 01-04-2018
Publisher: Springer Berlin Heidelberg
Published in: Neuroradiology / Issue 4/2018
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-018-1988-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Impact of intracranial artery calcification on cerebral hemodynamic changes

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2018

Volumetric assessment of tumor size changes in pediatric low-grade gliomas: feasibility and comparison with linear measurements

MR findings of the orbit in patients with Vogt–Koyanagi–Harada disease

Age-related early/late variations of functional connectivity across the human lifespan

Usefulness of perfusion- and diffusion-weighted imaging to differentiate between pilocytic astrocytomas and high-grade gliomas: a multicenter study in Japan

Letter in response to editorials Goyal et al. and von Kummer

Brain computed tomography using iterative reconstruction to diagnose acute middle cerebral artery stroke: usefulness in combination of narrow window setting and thin slice reconstruction