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Published in: Journal of Cardiovascular Magnetic Resonance 1/2017

Open Access 01-12-2017 | Research

Comparison of CT and CMR for detection and quantification of carotid artery calcification: the Rotterdam Study

Authors: Blerim Mujaj, Andrés M. Arias Lorza, Arna van Engelen, Marleen de Bruijne, Oscar H. Franco, Aad van der Lugt, Meike W. Vernooij, Daniel Bos

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2017

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Abstract

Background

Carotid artery atherosclerosis is an important risk factor for stroke. As such, quantitative imaging of carotid artery calcification, as a proxy of atherosclerosis, has become a cornerstone of current stroke research. Yet, population-based data comparing the computed tomography (CT) and cardiovascular magnetic resonance (CMR) for the detection and quantification of calcification remain scarce.

Methods

A total of 684 participants from the population-based Rotterdam Study underwent both a CT and CMR of the carotid artery bifurcation to quantify the amount of carotid artery calcification (mean interscan interval: 4.9 ± 1.2 years). We investigated the correlation between the amount of calcification measured on CT and CMR using Spearman’s correlation coefficient, Bland-Altman plots, and linear regression. In addition, using logistic regression modeling, we assessed the association of CT and CMR based calcification volumes with a history of stroke.

Results

We found a strong correlation between CT and CMR based calcification volumes (Spearman’s correlation coefficient:0.86, p-value ≤0.01). Bland-Altman analyses showed a good agreement, though CT based calcification volumes were systematically larger. Finally, calcification volume assessed with either imaging modality was associated with a history of stroke with similar effect estimates (odds ratio (OR) per 1-SD increase in calcification volume: 1.52 (95% CI:1.00;2.30) for CT, and 1.47 (95% CI:1.01;2.14) for CMR.

Conclusion

CT based and CMR based volumes of carotid artery calcification are highly correlated, but CMR based calcification is systematically smaller than those obtained with CT. Despite this difference, both provide comparable information with regard to a history of stroke.
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Literature
1.
go back to reference Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Despres JP, Fullerton HJ, et al. Executive Summary: Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation. 2016;133:447–54.CrossRefPubMed Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Despres JP, Fullerton HJ, et al. Executive Summary: Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation. 2016;133:447–54.CrossRefPubMed
2.
go back to reference Kwee RM. Systematic review on the association between calcification in carotid plaques and clinical ischemic symptoms. J Vasc Surg. 2010;51:1015–25.CrossRefPubMed Kwee RM. Systematic review on the association between calcification in carotid plaques and clinical ischemic symptoms. J Vasc Surg. 2010;51:1015–25.CrossRefPubMed
5.
go back to reference Libby P, Ridker PM, Hansson GK. Progress and challenges in translating the biology of atherosclerosis. Nature. 2011;473:317–25.CrossRefPubMed Libby P, Ridker PM, Hansson GK. Progress and challenges in translating the biology of atherosclerosis. Nature. 2011;473:317–25.CrossRefPubMed
7.
go back to reference Golledge J, Siew DA. Identifying the carotid 'high risk' plaque: is it still a riddle wrapped up in an enigma? Eur J Vasc Endovasc Surg. 2008;35:2–8.CrossRefPubMed Golledge J, Siew DA. Identifying the carotid 'high risk' plaque: is it still a riddle wrapped up in an enigma? Eur J Vasc Endovasc Surg. 2008;35:2–8.CrossRefPubMed
8.
go back to reference Nandalur KR, Baskurt E, Hagspiel KD, Finch M, Phillips CD, Bollampally SR, Kramer CM. Carotid artery calcification on CT may independently predict stroke risk. AJR Am J Roentgenol. 2006;186:547–52.CrossRefPubMedPubMedCentral Nandalur KR, Baskurt E, Hagspiel KD, Finch M, Phillips CD, Bollampally SR, Kramer CM. Carotid artery calcification on CT may independently predict stroke risk. AJR Am J Roentgenol. 2006;186:547–52.CrossRefPubMedPubMedCentral
9.
go back to reference Chalela JA. Evaluating the carotid plaque: going beyond stenosis. Cerebrovasc Dis. 2009;27 Suppl 1:19–24.CrossRefPubMed Chalela JA. Evaluating the carotid plaque: going beyond stenosis. Cerebrovasc Dis. 2009;27 Suppl 1:19–24.CrossRefPubMed
10.
go back to reference Truijman MT, Kooi ME, van Dijk AC, de Rotte AA, van der Kolk AG, Liem MI, Schreuder FH, Boersma E, Mess WH, van Oostenbrugge RJ, et al. Plaque At RISK (PARISK): prospective multicenter study to improve diagnosis of high-risk carotid plaques. Int J Stroke. 2014;9:747–54.CrossRefPubMed Truijman MT, Kooi ME, van Dijk AC, de Rotte AA, van der Kolk AG, Liem MI, Schreuder FH, Boersma E, Mess WH, van Oostenbrugge RJ, et al. Plaque At RISK (PARISK): prospective multicenter study to improve diagnosis of high-risk carotid plaques. Int J Stroke. 2014;9:747–54.CrossRefPubMed
11.
go back to reference Hofman A, Brusselle GG, Darwish Murad S, van Duijn CM, Franco OH, Goedegebure A, Ikram MA, Klaver CC, Nijsten TE, Peeters RP, et al. The Rotterdam Study: 2016 objectives and design update. Eur J Epidemiol. 2015;30:661–708.CrossRefPubMedPubMedCentral Hofman A, Brusselle GG, Darwish Murad S, van Duijn CM, Franco OH, Goedegebure A, Ikram MA, Klaver CC, Nijsten TE, Peeters RP, et al. The Rotterdam Study: 2016 objectives and design update. Eur J Epidemiol. 2015;30:661–708.CrossRefPubMedPubMedCentral
12.
go back to reference Odink AE, van der Lugt A, Hofman A, Hunink MG, Breteler MM, Krestin GP, Witteman JC. Association between calcification in the coronary arteries, aortic arch and carotid arteries: the Rotterdam study. Atherosclerosis. 2007;193:408–13.CrossRefPubMed Odink AE, van der Lugt A, Hofman A, Hunink MG, Breteler MM, Krestin GP, Witteman JC. Association between calcification in the coronary arteries, aortic arch and carotid arteries: the Rotterdam study. Atherosclerosis. 2007;193:408–13.CrossRefPubMed
13.
go back to reference van den Bouwhuijsen QJ, Bos D, Ikram MA, Hofman A, Krestin GP, Franco OH, van der Lugt A, Vernooij MW. Coexistence of Calcification, Intraplaque Hemorrhage and Lipid Core within the Asymptomatic Atherosclerotic Carotid Plaque: The Rotterdam Study. Cerebrovasc Dis. 2015;39:319–24.CrossRefPubMed van den Bouwhuijsen QJ, Bos D, Ikram MA, Hofman A, Krestin GP, Franco OH, van der Lugt A, Vernooij MW. Coexistence of Calcification, Intraplaque Hemorrhage and Lipid Core within the Asymptomatic Atherosclerotic Carotid Plaque: The Rotterdam Study. Cerebrovasc Dis. 2015;39:319–24.CrossRefPubMed
14.
go back to reference van den Bouwhuijsen QJ, Vernooij MW, Hofman A, Krestin GP, van der Lugt A, Witteman JC. Determinants of magnetic resonance imaging detected carotid plaque components: the Rotterdam Study. Eur Heart J. 2012;33:221–9.CrossRefPubMed van den Bouwhuijsen QJ, Vernooij MW, Hofman A, Krestin GP, van der Lugt A, Witteman JC. Determinants of magnetic resonance imaging detected carotid plaque components: the Rotterdam Study. Eur Heart J. 2012;33:221–9.CrossRefPubMed
15.
go back to reference Arias-Lorza AM, Petersen J, van Engelen A, Selwaness M, van der Lugt A, Niessen WJ, de Bruijne M. Carotid Artery Wall Segmentation in Multispectral MRI by Coupled Optimal Surface Graph Cuts. IEEE Trans Med Imaging. 2016;35:901–11.CrossRefPubMed Arias-Lorza AM, Petersen J, van Engelen A, Selwaness M, van der Lugt A, Niessen WJ, de Bruijne M. Carotid Artery Wall Segmentation in Multispectral MRI by Coupled Optimal Surface Graph Cuts. IEEE Trans Med Imaging. 2016;35:901–11.CrossRefPubMed
16.
go back to reference Bos D, Portegies ML, van der Lugt A, Bos MJ, Koudstaal PJ, Hofman A, Krestin GP, Franco OH, Vernooij MW, Ikram MA. Intracranial carotid artery atherosclerosis and the risk of stroke in whites: the Rotterdam Study. JAMA Neurol. 2014;71:405–11.CrossRefPubMed Bos D, Portegies ML, van der Lugt A, Bos MJ, Koudstaal PJ, Hofman A, Krestin GP, Franco OH, Vernooij MW, Ikram MA. Intracranial carotid artery atherosclerosis and the risk of stroke in whites: the Rotterdam Study. JAMA Neurol. 2014;71:405–11.CrossRefPubMed
17.
go back to reference Wieberdink RG, Poels MM, Vernooij MW, Koudstaal PJ, Hofman A, van der Lugt A, Breteler MM, Ikram MA. Serum lipid levels and the risk of intracerebral hemorrhage: the Rotterdam Study. Arterioscler Thromb Vasc Biol. 2011;31:2982–9.CrossRefPubMed Wieberdink RG, Poels MM, Vernooij MW, Koudstaal PJ, Hofman A, van der Lugt A, Breteler MM, Ikram MA. Serum lipid levels and the risk of intracerebral hemorrhage: the Rotterdam Study. Arterioscler Thromb Vasc Biol. 2011;31:2982–9.CrossRefPubMed
18.
go back to reference Kwee RM, Teule GJ, van Oostenbrugge RJ, Mess WH, Prins MH, van der Geest RJ, Ter Berg JW, Franke CL, Korten AG, Meems BJ, et al. Multimodality imaging of carotid artery plaques: 18 F-fluoro-2-deoxyglucose positron emission tomography, computed tomography, and magnetic resonance imaging. Stroke. 2009;40:3718–24.CrossRefPubMed Kwee RM, Teule GJ, van Oostenbrugge RJ, Mess WH, Prins MH, van der Geest RJ, Ter Berg JW, Franke CL, Korten AG, Meems BJ, et al. Multimodality imaging of carotid artery plaques: 18 F-fluoro-2-deoxyglucose positron emission tomography, computed tomography, and magnetic resonance imaging. Stroke. 2009;40:3718–24.CrossRefPubMed
19.
go back to reference de Weert TT, Ouhlous M, Meijering E, Zondervan PE, Hendriks JM, van Sambeek MR, Dippel DW, van der Lugt A. In vivo characterization and quantification of atherosclerotic carotid plaque components with multidetector computed tomography and histopathological correlation. Arterioscler Thromb Vasc Biol. 2006;26:2366–72.CrossRefPubMed de Weert TT, Ouhlous M, Meijering E, Zondervan PE, Hendriks JM, van Sambeek MR, Dippel DW, van der Lugt A. In vivo characterization and quantification of atherosclerotic carotid plaque components with multidetector computed tomography and histopathological correlation. Arterioscler Thromb Vasc Biol. 2006;26:2366–72.CrossRefPubMed
20.
go back to reference Baheza RA, Welch EB, Gochberg DF, Sanders M, Harvey S, Gore JC, Yankeelov TE. Detection of microcalcifications by characteristic magnetic susceptibility effects using MR phase image cross-correlation analysis. Med Phys. 2015;42:1436–52.CrossRefPubMedPubMedCentral Baheza RA, Welch EB, Gochberg DF, Sanders M, Harvey S, Gore JC, Yankeelov TE. Detection of microcalcifications by characteristic magnetic susceptibility effects using MR phase image cross-correlation analysis. Med Phys. 2015;42:1436–52.CrossRefPubMedPubMedCentral
21.
go back to reference Bos D, Ikram MA, Elias-Smale SE, Krestin GP, Hofman A, Witteman JC, van der Lugt A, Vernooij MW. Calcification in major vessel beds relates to vascular brain disease. Arterioscler Thromb Vasc Biol. 2011;31:2331–7.CrossRefPubMed Bos D, Ikram MA, Elias-Smale SE, Krestin GP, Hofman A, Witteman JC, van der Lugt A, Vernooij MW. Calcification in major vessel beds relates to vascular brain disease. Arterioscler Thromb Vasc Biol. 2011;31:2331–7.CrossRefPubMed
22.
go back to reference Rennenberg RJ, Kessels AG, Schurgers LJ, van Engelshoven JM, de Leeuw PW, Kroon AA. Vascular calcifications as a marker of increased cardiovascular risk: a meta-analysis. Vasc Health Risk Manag. 2009;5:185–97.CrossRefPubMedPubMedCentral Rennenberg RJ, Kessels AG, Schurgers LJ, van Engelshoven JM, de Leeuw PW, Kroon AA. Vascular calcifications as a marker of increased cardiovascular risk: a meta-analysis. Vasc Health Risk Manag. 2009;5:185–97.CrossRefPubMedPubMedCentral
23.
go back to reference van Gils MJ, Bodde MC, Cremers LG, Dippel DW, van der Lugt A. Determinants of calcification growth in atherosclerotic carotid arteries; a serial multi-detector CT angiography study. Atherosclerosis. 2013;227:95–9.CrossRefPubMed van Gils MJ, Bodde MC, Cremers LG, Dippel DW, van der Lugt A. Determinants of calcification growth in atherosclerotic carotid arteries; a serial multi-detector CT angiography study. Atherosclerosis. 2013;227:95–9.CrossRefPubMed
24.
go back to reference van Gils MJ, Vukadinovic D, van Dijk AC, Dippel DW, Niessen WJ, van der Lugt A. Carotid atherosclerotic plaque progression and change in plaque composition over time: a 5-year follow-up study using serial CT angiography. AJNR Am J Neuroradiol. 2012;33:1267–73.CrossRefPubMed van Gils MJ, Vukadinovic D, van Dijk AC, Dippel DW, Niessen WJ, van der Lugt A. Carotid atherosclerotic plaque progression and change in plaque composition over time: a 5-year follow-up study using serial CT angiography. AJNR Am J Neuroradiol. 2012;33:1267–73.CrossRefPubMed
Metadata
Title
Comparison of CT and CMR for detection and quantification of carotid artery calcification: the Rotterdam Study
Authors
Blerim Mujaj
Andrés M. Arias Lorza
Arna van Engelen
Marleen de Bruijne
Oscar H. Franco
Aad van der Lugt
Meike W. Vernooij
Daniel Bos
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Journal of Cardiovascular Magnetic Resonance / Issue 1/2017
Electronic ISSN: 1532-429X
DOI
https://doi.org/10.1186/s12968-017-0340-z

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