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dc.contributor.authorYang, Jia
dc.contributor.authorPan, Xiangjun
dc.contributor.authorZhang, Bai
dc.contributor.authorYan, Yanhong
dc.contributor.authorHuang, Yabo
dc.contributor.authorWoolf, Adam K
dc.contributor.authorGillard, Jonathan H
dc.contributor.authorTeng, Zhongzhao
dc.contributor.authorHui, Pinjing
dc.date.accessioned2018-09-05T12:40:59Z
dc.date.available2018-09-05T12:40:59Z
dc.date.issued2018-12
dc.identifier.issn0938-7994
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/279364
dc.description.abstractOBJECTIVE: Intraplaque hemorrhage (IPH) and ulceration of carotid atherosclerotic plaques have been associated with vulnerability while calcification has been conventionally thought protective. However, studies suggested calcification size and location may increase plaque vulnerability. This study explored the association between calcium configurations and ulceration with IPH. METHODS: One hundred thirty-seven consecutive symptomatic patients scheduled for carotid endarterectomy were recruited. CTA and CTP were performed prior to surgery. Plaque samples were collected for histology. According to the location, calcifications were categorized into superficial, deep and mixed types; according to the size and number, calcifications were classified as thick and thin, multiple and single. RESULTS: Seventy-one plaques had IPH (51.8%) and 83 had ulceration (60.6%). The appearance of IPH and ulceration was correlated (r = 0.49; p < 0.001). The incidence of multiple, superficial and thin calcifications was significantly higher in lesions with IPH and ulceration compared with those without. After adjusting factors including age, stenosis and ulceration, the presence of calcification [OR (95% CI), 3.0 (1.1-8.2), p = 0.035], multiple calcification [3.9 (1.4-10.9), p = 0.009] and superficial calcification [3.4 (1.1-10.8), p = 0.001] were all associated with IPH. ROC analysis showed that the AUC of superficial and multiple calcifications in detecting IPH was 0.63 and 0.66, respectively (p < 0.05). When the ulceration was combined, AUC increased significantly to 0.82 and 0.83, respectively. Results also showed that patients with lesions of both ulceration and IPH have significantly reduced brain perfusion in the area ipsilateral to the infarction. CONCLUSIONS: Superficial and multiple calcifications and ulceration were associated with carotid IPH, and they may be a surrogate for higher risk lesions. KEY POINTS: • CTA-defined superficial and multiple calcifications in carotid atherosclerotic plaques are independently associated with the presence of intraplaque hemorrhage. • The combination of superficial and multiple calcifications and ulceration is highly predictive of carotid intraplaque hemorrhage. • Patients with lesions of both ulceration and intraplaque hemorrhage have significantly reduced brain perfusion in the area ipsilateral to the infarction.
dc.description.sponsorshipNIHR Cambridge Biomedical Research Centre
dc.format.mediumPrint-Electronic
dc.languageeng
dc.publisherSpringer Science and Business Media LLC
dc.rightsAttribution 4.0 International (CC BY 4.0)
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectCarotid Arteries
dc.subjectHumans
dc.subjectCarotid Stenosis
dc.subjectCalcinosis
dc.subjectHemorrhage
dc.subjectEndarterectomy, Carotid
dc.subjectROC Curve
dc.subjectAged
dc.subjectFemale
dc.subjectMale
dc.subjectPlaque, Atherosclerotic
dc.subjectComputed Tomography Angiography
dc.titleSuperficial and multiple calcifications and ulceration associate with intraplaque hemorrhage in the carotid atherosclerotic plaque.
dc.typeArticle
prism.endingPage4977
prism.issueIdentifier12
prism.publicationDate2018
prism.publicationNameEur Radiol
prism.startingPage4968
prism.volume28
dc.identifier.doi10.17863/CAM.26741
dcterms.dateAccepted2018-05-11
rioxxterms.versionofrecord10.1007/s00330-018-5535-7
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2018-12
dc.contributor.orcidTeng, Zhongzhao [0000-0003-3973-6157]
dc.identifier.eissn1432-1084
rioxxterms.typeJournal Article/Review
cam.issuedOnline2018-06-06


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Attribution 4.0 International (CC BY 4.0)
Except where otherwise noted, this item's licence is described as Attribution 4.0 International (CC BY 4.0)