Relationship between intracranial internal carotid artery calcification and enlarged cerebral perivascular space

Xiao-Xiao Tao,Yi-Sheng Liu,Ying Shen,Xue-Mei Tang,Wei Chen,Xue-Mei Wang,Jian-Ren Liu,Tian-Yu Hou,Yan-Hui Shi,Mei-Ting Zhuang,Feng-Di Liu,Ge-Fei Li,Yi-Lan Wu,Ji Sun,Jing-Jing Su,Guo-Hong Cui,Rong Zhao,Ying Zhao

doi:10.1007/s00234-017-1838-7

Abstract

PurposeThe association between intracranial internal carotid artery (IICA) calcification and lacunes, white matter hyperintensity (WMH), and cerebral microbleeds (CMBs) has been well researched. However, enlarged cerebral perivascular space (PVS) has not yet been reported to correlate with intracranial internal carotid artery calcification. Therefore, the primary aim of this study was to investigate the relationship between IICA calcification and enlarged PVS.MethodsA total of 189 patients with ischemic stroke in the middle cerebral artery territory who presented within 7 days of ictus from 2012 to 2015 were enrolled respectively. All patients were required to have undergone head computed tomography, magnetic resonance imaging, susceptibility-weighted magnetic resonance imaging, magnetic resonance angiography, or computed tomography angiography. Clinical characteristics were recorded. IICA calcification and enlarged PVS were semi-quantitatively evaluated, and the presence of lacunes, WMH, and CMBs was recorded.ResultsOf the 189 patients, 63.5% were male. Mean age of the patients was 68.6 ± 12.2 years. There were 104 patients with IICA calcification. Age, diabetes mellitus, lacunes, and white matter hyperintensity were significantly associated with IICA calcification (P < 0.05). Multivariate logistic regression analysis showed that age, diabetes mellitus, and lacunes were independent predictors of IICA calcification (P < 0.05). A lower risk of IICA calcification was found in patients with a higher enlarged PVS score (P = 0.004).ConclusionHigher enlarged PVS scores were associated with a lesser degree of IICA calcification. There appears to be a relationship between reduced risk of IICA calcification and enlarged PVS.

Highlights

Intracranial internal carotid artery (IICA) calcification is the most common type of intracranial arterial calcification [1, 2]
A lower risk of IICA calcification was found in patients with a higher enlarged Perivascular spaces (PVS) score (P = 0.004)
There were some similarities between the two groups such as gender, smoking, hypertension, cardiovascular disease, TOAST classification, and cerebral microbleeds, but patients with IICA calcification tended to be older (72.9 vs. 63.4 years, P < 0.001), more prone to diabetes (39.4 vs. 17.6%, P = 0.001), and having 0-point enlarged PVS score (31.7 vs. 16.5%, P = 0.047), lacunes (68.3 vs. 36.5%, P < 0.001), and white matter hyperintensity (36.5 vs. 16.5%, P = 0.002)

Summary

Introduction

Intracranial internal carotid artery (IICA) calcification is the most common type of intracranial arterial calcification [1, 2]. Neuroimaging studies have revealed that enlarged PVS, together with status lacunaris, white matter signal hyperintensity, and cerebral microbleeds, have been found to be markers related to cerebral SVD [9, 12, 13]. These four markers have been integrated as a system that is used to evaluate SVD (overall SVD scoring system) [14], which have been widely applied in clinical practice for the systemic evaluation of cerebral SVD

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