title: Intracranial Carotid Calcification on Cranial Computed Tomography: Visual Scoring Methods, Semiautomated Scores, and Volume Measurements in Patients With Stroke.
abstract: OBJECTIVE
  Intracranial internal carotid artery calcification is associated with cerebrovascular risk factors and stroke, but few quantification methods are available. We tested the reliability of visual scoring, semiautomated Agatston score, and calcium volume measurement in patients with recent stroke.
  
  
  METHODS
  We used scans from a prospective hospital stroke registry and included patients with anterior circulation ischemic stroke or transient ischemic stroke whose noncontrast cranial computed tomographic scans were available electronically. Two raters measured semiautomatic quantitative Agatston score, and calcium volume, and performed qualitative visual scoring using the original 4-point Woodcock score and a modified Woodcock score, where each image on which the internal carotid arteries appeared was scored and the slice scores summed.
  
  
  RESULTS
  Intra- and interobserver coefficient of variations were 8.8% and 16.5% for Agatston, 8.8% and 15.5% for calcium volume, and 5.7% and 5.4% for the modified Woodcock visual score, respectively. The modified Woodcock visual score correlated strongly with both Agatston and calcium volume quantitative measures (both R(2)=0.84; P<0.0001); calcium volume increased by 0.47-mm/point increase in modified Woodcock visual score. Intracranial internal carotid artery calcification increased with age by all measures (eg, visual score, Spearman ρ=0.4; P=0.005).
  
  
  CONCLUSIONS
  Visual scores correlate highly with quantitative intracranial internal carotid artery calcification measures, with excellent observer agreements. Visual intracranial internal carotid artery scores could be a rapid and practical method for epidemiological studies.
authors.affiliation: From the Department of Clinical Radiology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (D.S., U.S.Z., M.-L.G.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (F.C., C.S., R.S., J.W.); and Brain Research Imaging Centre, Scottish Imaging Network-A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, United Kingdom (R.S., J.W.).
authors.forename: Deepak
authors.initials: D
authors.lastname: Subedi
authors.affiliation: From the Department of Clinical Radiology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (D.S., U.S.Z., M.-L.G.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (F.C., C.S., R.S., J.W.); and Brain Research Imaging Centre, Scottish Imaging Network-A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, United Kingdom (R.S., J.W.).
authors.forename: Umme Sara
authors.initials: US
authors.lastname: Zishan
authors.affiliation: From the Department of Clinical Radiology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (D.S., U.S.Z., M.-L.G.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (F.C., C.S., R.S., J.W.); and Brain Research Imaging Centre, Scottish Imaging Network-A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, United Kingdom (R.S., J.W.).
authors.forename: Francesca
authors.initials: F
authors.lastname: Chappell
authors.affiliation: From the Department of Clinical Radiology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (D.S., U.S.Z., M.-L.G.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (F.C., C.S., R.S., J.W.); and Brain Research Imaging Centre, Scottish Imaging Network-A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, United Kingdom (R.S., J.W.).
authors.forename: Maria-Lena
authors.initials: ML
authors.lastname: Gregoriades
authors.affiliation: From the Department of Clinical Radiology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (D.S., U.S.Z., M.-L.G.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (F.C., C.S., R.S., J.W.); and Brain Research Imaging Centre, Scottish Imaging Network-A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, United Kingdom (R.S., J.W.).
authors.forename: Cathie
authors.initials: C
authors.lastname: Sudlow
authors.affiliation: From the Department of Clinical Radiology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (D.S., U.S.Z., M.-L.G.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (F.C., C.S., R.S., J.W.); and Brain Research Imaging Centre, Scottish Imaging Network-A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, United Kingdom (R.S., J.W.).
authors.forename: Robin
authors.initials: R
authors.lastname: Sellar
authors.affiliation: From the Department of Clinical Radiology, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (D.S., U.S.Z., M.-L.G.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (F.C., C.S., R.S., J.W.); and Brain Research Imaging Centre, Scottish Imaging Network-A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, United Kingdom (R.S., J.W.). Joanna.Wardlaw@ed.ac.uk.
authors.forename: Joanna
authors.initials: J
authors.lastname: Wardlaw
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002114:Calcinosis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002340:Carotid Artery Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012042:Registries; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000000981:diagnostic imaging
keywords: calcification, physiologic; carotid artery, internal; epidemiological studies; risk factors; stroke