Combination of Agatston Calcium Score and CTA: quantification and characterization of carotid calcium

Objective: To quantify and characterize carotid calcification with combined Agatston Calcium Score and multidetector CT angiography (MDCTA) and to determine whether the combination could he applied as a useful decision- making tool for treatment. Methods: A total of 136 carotid arteries were examined with MDCTA (67.6±10.2 years; age range from 37-86 years; 11 women, 57 men). The calcium scores were determined using Agatston method from pre-contrast data. The stenosis was assessed based on North American Symptomatic Carotid Endarterectomy Trial criteria from post-contrast data. Results: Symptomatic patients had higher total calcium volume (TCV), total equiv mass (TEM) and total calcium score (TCS) than asymptomatic patients, but the differences did not reach statistical significance with or without taking the interactive effect of age and stenosis into account. TCV, TEM, and TCS differed significantly between high-grade and mild- grade stenotic vessels (P<0.001), and moderate-grade and mild-grade stenotic vessels (P<0.001); and they also differed statistically between age groups of 51-69 years and of ≥70 years (P<0.001). Pearson's correlation test showed a mild but significant correlation between stenotic grade of carotid bifurcation and ipsilateral ICA and total calcium volume (r_bifurcation=0.322 and r_ICA=0.418 respectively, P<0.01). Conclusion: Combination of Agatston Calcium Score and CTA is likely to emerge as a noninvasive choice to accurately assess calcification and quantification of the burden in the carotid arteries. It can provide valuable insights into plaque characterization and stability, which is especially important for clinical decision-making. (authors)