Miralles M, Merino J, Busto M, Perich X, Barranco C, Vidal-Barraquer F
Department of Vascular Surgery, Universidad Autonoma de Barcelona, Hospital Universitario de Mar, Passeig Marítim 27-29, 0803 Barcelona, Spain.
Eur J Vasc Endovasc Surg. 2006 Nov;32(5):561-7. doi: 10.1016/j.ejvs.2006.02.019. Epub 2006 Sep 18.
The aim of this study was to assess the accuracy of CT-angiography for identification and measurement of calcification of carotid atherosclerotic plaques and to characterise the content and distribution pattern of mineral calcium (hydroxyapatite, Ca) in carotid bifurcations and investigate its relationship with neurological symptoms.
Twenty-six patients with ICA stenosis > 60% (13 symptomatic, 13 asymptomatic) were selected for study. Ca was estimated from the weight of the ashed remnants of carotid endarterectomy (CEA) specimens in 11 patients. Calcium content (calcification volume (mm3),CV), and average calcium density (Hounsfield units (HU),CD), were determined by CT-angiography. The distribution pattern of calcium within the lesion (base (posterior), shoulder or luminal surface) was assessed in all cases.
CT-derived estimation of CV and Ca mass (modified Agatston Score, (mAS) = CV x CD) showed a good correlation with its direct measurement in CEA specimens (r = 0.911 and 0.993 respectively, p < 0,005). Asymptomatic patients with ICA stenosis > 60% showed statistically significant higher content of Ca than those who were symptomatic (mAS: 122.6 +/- 138.0 HU mm3 vs 42.8 +/- 59.1 HU mm3, p = 0.04). Calcification on the surface of the plaque was observed more commonly in asymptomatic patients (9/12 vs 3/15, p = 0.006). Non-calcified or plaques with posterior calcification were 12 times more likely to be symptomatic (OR: 12, 95%CI 1.5-91.1, p = 0.021).
CT-angiography permits the reliable quantification of calcification of carotid plaques. A lower content of calcium in carotid plaques, as well as its distribution in the base of the lesion, was associated with a greater prevalence of neurological symptoms. These parameters may be useful to identify those patients at higher risk of stroke.
本研究旨在评估CT血管造影在识别和测量颈动脉粥样硬化斑块钙化方面的准确性，以及颈动脉分叉处矿物质钙（羟基磷灰石，Ca）的含量和分布模式，并研究其与神经症状的关系。
选取26例颈内动脉狭窄>60%的患者（13例有症状，13例无症状）进行研究。对11例患者通过颈动脉内膜切除术（CEA）标本的灰分残余重量估算Ca。通过CT血管造影确定钙含量（钙化体积（mm3），CV）和平均钙密度（亨氏单位（HU），CD）。评估所有病例中病变内钙的分布模式（底部（后部）、肩部或管腔表面）。
CT衍生的CV和Ca质量估计值（改良阿加斯顿评分，（mAS）=CV×CD）与其在CEA标本中的直接测量值具有良好的相关性（分别为r = 0.911和0.993，p < 0.005）。颈内动脉狭窄>60%的无症状患者的Ca含量在统计学上显著高于有症状患者（mAS：122.6±138.0 HU mm3对42.8±59.1 HU mm3，p = 0.04）。无症状患者中斑块表面钙化更为常见（9/12对3/15，p = 0.006）。非钙化或后部钙化的斑块出现症状的可能性高12倍（OR：12，95%CI 1.5 - 91.1，p = 0.021）。
CT血管造影能够可靠地量化颈动脉斑块的钙化情况。颈动脉斑块中较低的钙含量及其在病变底部的分布与更高的神经症状患病率相关。这些参数可能有助于识别中风风险较高的患者。
