ArticleEuropean radiology2018
Superficial and multiple calcifications and ulceration associate with intraplaque hemorrhage in the carotid atherosclerotic plaque.
Article in European radiology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers.
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Who cites it
32 citing papers in PubMed, 51 citations in OpenAlex.
- Incremental value of ultrasound-based carotid plaque-RADS beyond stenosis degree in discriminating symptomatic carotid atherosclerosis.Journal of ultrasound · 2026Article
- Hypointensity on Carotid Plaque MRI and Its Relationship to Calcification: Histopathologic Validation With Quantitative Susceptibility Mapping.Journal of magnetic resonance imaging : JMRI · 2026Article
- Carotid plaque inflammation and calcification on somatostatin receptor PET/CT imaging predict stroke and major adverse cardiovascular events.European heart journal. Cardiovascular Imaging · 2026Article
- Computed Tomography Angiography "Rim Sign" for Detecting Carotid Intraplaque Hemorrhage: A Computed Tomography Angiography-Magnetic Resonance Imaging-Histology Correlation Study.Journal of the American Heart Association · 2026Article
- Geometric and density relationships of calcification clusters in carotid atherosclerosis.The neuroradiology journal · 2026Article
- AI-based modality-agnostic classification system for vascular calcifications.Scientific reports · 2025Article
- Ultra-high-resolution and dual-energy computed tomography of carotid artery plaques differentiate symptomatic and asymptomatic patients by novel volumetric analysis.Interdisciplinary cardiovascular and thoracic surgery · 2025Article
- Risk prediction of recurrent ischemic stroke based on Carotid Plaque-RADS: construction and validation of a nomogram model.Frontiers in aging neuroscience · 2025Article
- Constructing a clinical prediction model for patients with coronary heart disease: a study based on carotid ultrasound and clinical related factors.Frontiers in cardiovascular medicine · 2025Article
- Association between carotid plaque calcification and clinical outcomes of symptomatic cerebral small vessel disease.Frontiers in neurology · 2025Article
- Carotid artery calcium score: Definition, classification, application, and limits.The neuroradiology journal · 2024Article
- Pathophysiology of carotid atherosclerosis: Calcification, intraplaque haemorrhage and pulse pressure as key players.European journal of radiology · 2024Article
- Prevalence and clinical implications of calcification in internal carotid artery stenosis: a retrospective study.BMC neurology · 2024Article
- Machine learning detects symptomatic patients with carotid plaques based on 6-type calcium configuration classification on CT angiography.European radiology · 2024Article
- Embolic strokes of undetermined source: a clinical consensus statement of the ESC Council on Stroke, the European Association of Cardiovascular Imaging and the European Heart Rhythm Association of the ESC.European heart journal · 2024Article
- CT texture analysis of vertebrobasilar artery calcification to identify culprit plaques.Frontiers in neurology · 2024Article
- Impact of alkaline phosphatase on clinical outcomes in patients with ischemic stroke: a nationwide registry analysis.Frontiers in neurology · 2024Article
- Explore the value of carotid ultrasound radiomics nomogram in predicting ischemic stroke risk in patients with type 2 diabetes mellitus.Frontiers in endocrinology · 2024Article
- Article
- Imaging the Vulnerable Carotid Plaque with CT: Caveats to Consider. Comment on Wang et al. Identification Markers of Carotid Vulnerable Plaques: An Update.Biomolecules · 2023Article
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Authors and funding
9 authors at 2 institutions in 2 countries.
Funding
Abstract
objectiveIntraplaque 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.
methodsOne 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.
resultsSeventy-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.
conclusionsSuperficial 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.
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