Calcification at orifices of aortic arch branches is a reliable and significant marker of stenosis at carotid bifurcation and intracranial arteries.
OBJECTIVE
Simple rating scale for calcification in the cervical arteries and the aortic arch on multi-detector computed tomography angiography (MDCTA) was evaluated its reliability and validity. Additionally, we investigated where is the most representative location for evaluating the calcification risk of carotid bifurcation stenosis and atherosclerotic infarction in the overall cervical arteries covering from the aortic arch to the carotid bifurcation.


METHODS
The aortic arch and cervical arteries among 518 patients (292 men, 226 women) were evaluated the extent of calcification using a 4-point grading scale for MDCTA. Reliability, validity and the concomitant risk with vascular stenosis and atherosclerotic infarction were assessed.


RESULTS
Calcification was most frequently observed in the aortic arch itself, the orifices from the aortic arch, and the carotid bifurcation. Compared with the bilateral carotid bifurcations, the aortic arch itself had a stronger inter-observer agreement for the calcification score (Fleiss' kappa coefficients; 0.77), but weaker associations with stenosis and atherosclerotic infarction. Calcification at the orifices of the aortic arch branches had a stronger inter-observer agreement (0.74) and enough associations with carotid bifurcation stenosis and intracranial stenosis. In addition, the extensive calcification at the orifices from the aortic arch was significantly associated with atherosclerotic infarction, similar to the calcification at the bilateral carotid bifurcations.


CONCLUSIONS
The orifices of the aortic arch branches were the novel representative location of the aortic arch and overall cervical arteries for evaluating the calcification extent. Thus, calcification at the aortic arch should be evaluated with focus on the orifices of 3 main branches.
Department of Neurosurgery & Stroke Center, Rakuwakai Otowa Hospital, Kyoto, Japan; Interfaculty Initiative in Information Studies/Institute of Industrial Science, The University of Tokyo, Tokyo, Japan; Department of Neurosurgery, Hamamatsu Rosai Hospital, Shizuoka, Japan. Electronic address: shigekiyamada3@gmail.com.
Shigeki
S
Yamada
Department of Neurosurgery, Kishiwada Municipal Hospital, Osaka, Japan. Electronic address: hashiken8022@yahoo.co.jp.
Kenji
K
Hashimoto
Department of Neurosurgery, Hamamatsu Rosai Hospital, Shizuoka, Japan. Electronic address: hidogata@gmail.com.
Hideki
H
Ogata
Department of Neurosurgery, Hamamatsu Rosai Hospital, Shizuoka, Japan. Electronic address: ynabe@magic.odn.ne.jp.
Yoshihiko
Y
Watanabe
Interfaculty Initiative in Information Studies/Institute of Industrial Science, The University of Tokyo, Tokyo, Japan. Electronic address: marie@iis.u-tokyo.ac.jp.
Marie
M
Oshima
Department of Neurosurgery, Hamamatsu Rosai Hospital, Shizuoka, Japan. Electronic address: hi-miyake@hamamatsuh.rofuku.go.jp.
Hidenori
H
Miyake
D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002539:Cerebral Arterial Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D061330:Multidetector Computed Tomography / Q000706:statistics & numerical data; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity
Aortic arch; Arterial calcification; Arteriosclerosis; Carotid bifurcation; Multi-detector row CT; Stenosis