Abstract
Introduction: Cervicocerebral vascular calcification on cervicocerebral computed tomography angiography is a known sign of advanced atherosclerosis. However, the clinical significance of calcification pattern remains unclear. This study aimed to investigate the potential association between spotty calcium (SC) and acute ischemic stroke. Methods: This study included patients with first-time nonlacunar ischemic stroke (N=50) confirmed by brain MRI or non-enhanced head CT, as well as age and sex-matched control subjects with asymptomatic carotid atherosclerosis (N=43) confirmed by carotid ultrasonography. Subjects in both groups underwent contrast-enhanced cervicocerebral CTA within a week after the initial imaging exam. Spotty calcification was evaluated at eleven 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 two 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 vs 1.84±1.77, p<0.001). The relative risk for stroke of spotty calcification at bilateral carotid bifurcation, carotid siphon, and all evaluated locations were (95% confidence interval): 2.521 (1.530~4.155), 1.441 (1.073~1.937), and 1.971 (1.434~2.709), respectively. A total number of 3 spotty calcifications was determined as the optimal cutoff threshold for increased risk of stroke. Spotty calcium showed significantly greater area under the receiver-operating characteristics curve (ROC) than that of total calcium 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 vs. 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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