Rubin Jeremy, Cao Quy, Sakai Yu, Arnett Nathan, Phi Huy Q, Hu Andrew C, Cucchiara Brett L, Bos Daniel, Saba Luca, Johannson Elias, Zee Jarcy, Song Jae W
Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Neuroimaging. 2025 Jul-Aug;35(4):e70071. doi: 10.1111/jon.70071.
Despite the high prevalence of plaque calcifications in carotid atherosclerosis, the association between morphologic and attenuation features of calcifications and intraplaque hemorrhage (IPH) remains unclear.
Calcific carotid plaques were identified on neck computed tomography angiographies (CTAs) from patients meeting criteria for embolic stroke of undetermined source. Plaque calcifications were manually segmented using 3D-Slicer to quantify features, including volume and attenuation (Hounsfield Units [HU]). IPH volume (IPHvol) was quantified using a semi-automated software. A linear mixed regression model evaluated associations between calcification features and IPHvol, adjusting for sex, age, and cardiovascular risk factors. An interaction term between calcification volume and attenuation was included after dichotomizing attenuation (>924HU) and volume (>30 millimeter [mm]) as high versus low on the basis of median values.
From 70 patients (median age 68 years, 50% female), 116 calcific plaques containing 269 plaque calcifications were analyzed. Adjusting for age, cardiovascular risk factors, and plaque calcification features, being female showed lower IPHvols compared to males (mean ratio 0.34, p = 0.002). A significant interaction between calcification volume and attenuation emerged (p = 0.042). Among plaques with low plaque calcification volumes, plaques with low-attenuation (<924HU) calcifications showed 5.53 times higher IPHvols than plaques with high-attenuation calcifications (p = 0.003). Among plaques with high-attenuation calcifications, plaques with high volumes of these calcifications showed 4.40 times higher IPHvols compared to low-volumes of high-attenuation calcifications (p = 0.011).
Plaque calcification attenuation characteristics are associated with IPHvols. Understanding calcification patterns that correlate with IPH could enable clinicians to infer plaque instability from readily visible calcifications on CTA.
尽管颈动脉粥样硬化斑块钙化的患病率很高，但钙化的形态学和衰减特征与斑块内出血（IPH）之间的关联仍不清楚。
在符合不明来源栓塞性卒中标准患者的颈部计算机断层扫描血管造影（CTA）上识别钙化性颈动脉斑块。使用3D-Slicer手动分割斑块钙化以量化特征，包括体积和衰减（亨氏单位[HU]）。使用半自动软件量化IPH体积（IPHvol）。线性混合回归模型评估钙化特征与IPHvol之间的关联，并对性别、年龄和心血管危险因素进行校正。在根据中位数将衰减（>924HU）和体积（>30毫米[mm]）分为高与低之后，纳入钙化体积与衰减之间的交互项。
对70例患者（中位年龄68岁，50%为女性）的116个钙化斑块（包含269个斑块钙化）进行了分析。校正年龄、心血管危险因素和斑块钙化特征后，女性的IPHvol低于男性（平均比值0.34，p = 0.002）。钙化体积与衰减之间出现显著交互作用（p = 0.042）。在斑块钙化体积低的斑块中，低衰减（<924HU）钙化的斑块的IPHvol比高衰减钙化的斑块高5.53倍（p = 0.003）。在高衰减钙化的斑块中，这些钙化体积大的斑块的IPHvol比高衰减钙化体积小的斑块高4.40倍（p = 0.011）。
斑块钙化衰减特征与IPHvol相关。了解与IPH相关的钙化模式可使临床医生能够从CTA上易于看到的钙化推断斑块不稳定性。
