gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Carotid plaques with calcification: Quantitative assessment of hardness with calcium score and Volume score-Hounsfield unit matrix

Meeting Abstract

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  • H. Katano - Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Department of Medical Informatics and Integrative Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
  • M. Mase - Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
  • K. Yamada - Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP 058

DOI: 10.3205/12dgnc445, URN: urn:nbn:de:0183-12dgnc4458

Published: June 4, 2012

© 2012 Katano et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: We previously reported calcification depicted by multidetector (MD) CT to include relatively soft lesions of pathologically granular type. The aim of the study was to analyze individual calcified carotid plaques for quality (hardness) and quantity (volume) and determined whether the Agatston calcium score might be applied as a useful tool for evaluation, especially regarding selection of options for surgical treatment of carotid stenosis, either by carotid endarterectomy (CEA) or carotid angioplasty and stenting/carotid artery stenting (CAS).

Methods: A total of 124 carotid bifurcations in 62 consecutive patients (mean age 70.6±6.4 years, male : female=53 : 9) were examined with 16-row MDCT before and after surgical intervention. Operations were performed on 65 carotid arteries, 44 by CEA and 21 by CAS, including three restenoses. Calcium scores were determined according to the method described by Agatston et al. and the total volume score was obtained by summing the volume of each single lesion for all sections.

Results: In 124 carotid arteries, 83 plaques were found to have calcification greater than 0.67 mm3 with Agatston calcium scores ranging from 3.7–4274.2 (mean 486.5/379.2= operative/contralateral side). Volume scores ranged from 2.5–3205.7mm3 (mean 365.2/281.3), while averaged Hounsfield Units (HU) ranged from 255.9–871.7 (mean 600.8/665.9) and peaked HU 389–2075 (mean 1026.3/1137.4). Agatston scores generally appear appropriate for evaluation of calcified plaques, but some examples with similar scores demonstrated great variety in their mean and peak HU values. Calcification with higher volume scores tended to have bigger differences between mean and peak HU in single cases. Calcified lesions with this feature accounted for only 34.3 % of those with volume scores under 500 mm3, but the percentage rose 81.3 (p<0.001), 90.0 (p<0.001) and 100% (p<0.001), respectively, for those sized greater than 500, 600 and 700,

Conclusions: The Agatston calcium score is useful in evaluating carotid plaques with calcium. We recommend, however, individual analyses for quantity (volume) and quality (hardness) of each large calcified focus (>500 mm3) by MDCT lesions using Volume score-Hounsfield unit matrix in order to provide indications for surgical treatment of carotid stenosis, CEA or CAS.