Background The CT-derived density of coronary artery calcification is increasingly associated with the risk of ischemic heart disease. Whether this principle also applies to intracranial artery calcifications (IAC) and cerebrovascular disease risk is unknown, primarily due to the lack of population-based estimates of IAC density and its determinants. We investigated these facets in this cohort study. Materials and methods In 2464 community-living individuals who underwent non-contrast CT, we measured IAC density and assessed its correlation with IAC volume using Spearman’s ρ. We described its distribution in intracranial carotid artery calcification (ICAC), with specific estimates for its subtypes, and vertebrobasilar artery calcification (VBAC). We investigated associations between risk factors and IAC density using multivariable ordinal regression models. Results The prevalence of IAC was 82.8%, with a median density of 232 (IQR 189–287) HU. IAC density correlated moderately with volume (ρ 0.67, 95% CI [0.65–0.70]). ICAC was predominantly composed of higher density, with 80.1% of affected participants having components of ICAC above 400 HU, whereas only 32.0% of participants with VBAC had components above 400 HU. Intimal subtype ICACs showed a predominance for lower densities when compared to medial subtype ICACs. The main determinants of IAC density were hypertension, use of lipid-lowering medication, and smoking, with adjusted odds ratios of 1.59 [1.28–1.90], 1.55 [1.26–1.91], and 1.33 [1.10–1.61], respectively. Conclusion IAC density differs significantly between the anterior and posterior cerebropetal arteries. While IAC density correlated only moderately with its volume, the associations between cardiovascular risk factors and IAC density were mostly similar to those observed with IAC volume. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> Drivers of the CT density of intracranial artery calcifications are unknown and may reveal novel risk targets for population-based prevention strategies. <Emphasis Type="BoldItalic">Findings</Emphasis> Calcifications of the anterior cerebral circulation are denser than those of the posterior circulation. Hypertension, diabetes, and smoking are key drivers of calcification density, resembling most drivers of its volume. <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> Calcification density may serve in distinguishing subtypes of intracranial calcifications, improving detection of subtype-specific effects. Further research is warranted to determine the role of intracranial arteriosclerosis density in prevention strategies for cerebrovascular diseases. Graphical Abstract

CT-derived density of intracranial arteriosclerosis: a population-based cohort study

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2026年1月15日

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Bernhard P. Berghout,
Robin Y. R. Camarasa,
Maarten J. G. Leening,
Marleen de Bruijne,
M. Kamran Ikram,
Daniel Bos

摘要

Background

The CT-derived density of coronary artery calcification is increasingly associated with the risk of ischemic heart disease. Whether this principle also applies to intracranial artery calcifications (IAC) and cerebrovascular disease risk is unknown, primarily due to the lack of population-based estimates of IAC density and its determinants. We investigated these facets in this cohort study.

Materials and methods

In 2464 community-living individuals who underwent non-contrast CT, we measured IAC density and assessed its correlation with IAC volume using Spearman’s ρ. We described its distribution in intracranial carotid artery calcification (ICAC), with specific estimates for its subtypes, and vertebrobasilar artery calcification (VBAC). We investigated associations between risk factors and IAC density using multivariable ordinal regression models.

Results

The prevalence of IAC was 82.8%, with a median density of 232 (IQR 189–287) HU. IAC density correlated moderately with volume (ρ 0.67, 95% CI [0.65–0.70]). ICAC was predominantly composed of higher density, with 80.1% of affected participants having components of ICAC above 400 HU, whereas only 32.0% of participants with VBAC had components above 400 HU. Intimal subtype ICACs showed a predominance for lower densities when compared to medial subtype ICACs. The main determinants of IAC density were hypertension, use of lipid-lowering medication, and smoking, with adjusted odds ratios of 1.59 [1.28–1.90], 1.55 [1.26–1.91], and 1.33 [1.10–1.61], respectively.

Conclusion

IAC density differs significantly between the anterior and posterior cerebropetal arteries. While IAC density correlated only moderately with its volume, the associations between cardiovascular risk factors and IAC density were mostly similar to those observed with IAC volume.

Key Points

Question Drivers of the CT density of intracranial artery calcifications are unknown and may reveal novel risk targets for population-based prevention strategies.

Findings Calcifications of the anterior cerebral circulation are denser than those of the posterior circulation. Hypertension, diabetes, and smoking are key drivers of calcification density, resembling most drivers of its volume.

Clinical relevance Calcification density may serve in distinguishing subtypes of intracranial calcifications, improving detection of subtype-specific effects. Further research is warranted to determine the role of intracranial arteriosclerosis density in prevention strategies for cerebrovascular diseases.

Graphical Abstract