Kathuveetil Arun, Kim Diana, Bhogal Mankirat, Babwani Ali, Ding Mao, Arabambi Babawale, Ray Sucharita, Alhabli Ibrahim, Ganesh Aravind
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
J Stroke Cerebrovasc Dis. 2025 Aug;34(8):108359. doi: 10.1016/j.jstrokecerebrovasdis.2025.108359. Epub 2025 May 26.
Coronary calcium is a well-recognized marker of atherosclerotic risk. While intracranial carotid artery calcification has received some attention, calcific disease in other intracranial arteries is not well studied. In this pilot study, we sought to examine the whether the total volume of calcium in the intracranial arteries is associated with established markers of atherosclerosis and stroke risk.
We examined a subset of 360 consecutive cases in a population-level cohort of 7,745 patients representing all patients diagnosed with ischemic stroke/TIA in an entire Canadian province (Alberta) from 1-April-2016 to 31-March-2017. Trained readers manually segmented visible calcifications in all intracranial arteries on non-contrast CT using ITKSnap. Volumetric data for all segmentations were combined to obtain the total Arterial Brain Calcium (ABC) volume. We related this volume to the total burden of vascular risk factors, number of vessels with intracranial atherosclerotic disease, atherosclerosis burden in different territories using ordinal logistic regressions adjusted for age and sex, and to the 5-year risk of recurrent events using Poisson regressions.
Among 360 cases (median age: 68 years, IQR:56-80), ABC volume (median:5.40 mL, 95 % CI:3.05-7.85 mL) increased with age (per-year increase: 66.5 mm, 95 % CI:37.5-95.5 mm) and was lower in females (4.22 mL, IQR:0.25-6.37 v/s 6.60 mL, IQR:0.35-8.33, p = 0.0004). ABC volume was independently associated with the burden of intracranial arterial (age/ sex-adjusted common odds-ratio [acOR] per mL increase:1.14, 95 %CI:1.04-1.26) and combined intracranial/carotid/ aortic/ coronary atherosclerosis (acOR:1.18, 95 %CI:1.10-1.27), and vascular risk factors (acOR:1.07, 95 %CI:1.01-1.13). Those with higher ABC volume had a higher risk of recurrent events (IRR:3.20, 95 % CI:1.24-8.25).
ABC volume derived from routine non contrast CT scan may be utilised as a novel imaging marker of atherosclerotic burden and merits further validation as a predictive tool in recurrent ischemic stroke/ TIA.
冠状动脉钙化是动脉粥样硬化风险的一个公认标志物。虽然颅内颈动脉钙化已受到一定关注，但其他颅内动脉的钙化疾病尚未得到充分研究。在这项初步研究中，我们试图探讨颅内动脉钙化的总体积是否与既定的动脉粥样硬化和中风风险标志物相关。
我们在一个包含7745名患者的人群队列中检查了连续360例患者的子集，这些患者代表了2016年4月1日至2017年3月31日在加拿大艾伯塔省被诊断为缺血性中风/短暂性脑缺血发作（TIA）的所有患者。经过培训的阅片者使用ITKSnap在非增强CT上手动分割所有颅内动脉中可见的钙化。将所有分割的体积数据合并以获得总脑动脉钙化（ABC）体积。我们使用经年龄和性别调整的有序逻辑回归，将该体积与血管危险因素的总负担、患有颅内动脉粥样硬化疾病的血管数量、不同区域的动脉粥样硬化负担相关联，并使用泊松回归将其与复发性事件的5年风险相关联。
在360例患者中（中位年龄：68岁，四分位间距：56 - 80岁），ABC体积（中位值：5.40 mL，95%CI：3.05 - 7.85 mL）随年龄增加（每年增加：66.5 mm，95%CI：37.5 - 95.5 mm），且女性较低（4.22 mL，四分位间距：[0.25 - 6.37] 对比 6.60 mL，四分位间距：[0.35 - 8.33]，p = 0.0004）。ABC体积与颅内动脉负担（每增加1 mL，年龄/性别调整后的共同优势比[acOR]：1.14，95%CI：1.04 - 1.26）、颅内/颈动脉/主动脉/冠状动脉粥样硬化综合负担（acOR：1.18，95%CI：1.10 - 1.27）以及血管危险因素（acOR：1.07，95%CI：1.01 - 1.13）独立相关。ABC体积较高的患者复发性事件风险较高（发病率比：3.20，95%CI：1.24 - 8.25）。
从常规非增强CT扫描得出的ABC体积可作为动脉粥样硬化负担的一种新型影像学标志物，作为复发性缺血性中风/TIA的预测工具值得进一步验证。
