title: Prevalence and distribution of calcified nodules in carotid arteries in correlation with clinical symptoms.
abstract: OBJECTIVE
  Calcified nodules ("CN") are responsible for up to 5% of coronary-infarcts and, therefore, classified as minor criteria of "vulnerable" atherosclerotic plaque. We sought to evaluate prevalence and distribution of CN in carotid arteries in correlation with clinical symptoms.
  
  
  METHODS
  178 consecutive patients with unilateral ischemic stroke and carotid plaques ≥2 mm by duplex ultrasound underwent a carotid-black-blood-3T-MRI with fat-saturated pre- and post-contrast T1w-, PDw-, T2w- and TOF images using dedicated surface-coils. CN were defined as distinct calcification with an irregular, protruding, and convex luminal surface. Prevalence of CN was determined in common carotid artery ("CCA") and internal carotid artery ("ICA") in consensus by two reviewers blinded to clinical information.
  
  
  RESULTS
  Thirty seven CN in 28 arteries of 26 patients were identified. Prevalence of CN in CCA compared to ICA was slightly higher (59 vs. 41%), but nearly similar in 66 arteries with ≥30% compared to 290 arteries with <30% stenosis (9.1 vs. 7.6%) and in the artery ipsilateral versus contralateral to stroke (7.9 vs. 7.9%; P values n.s.). Prevalence of CN was significantly higher in 40 symptomatic arteries with ≥30% stenosis compared to asymptomatic 26 arteries (15.6 vs. 0%; P = 0.04). There was a significantly higher prevalence of hypercholesterolemia and hypertension in patients with CN (57.7 vs. 36.0 and 88.5 vs. 66.7%; P values <0.05).
  
  
  CONCLUSIONS
  CN were found in 7.9% of arteries with carotid-plaques ≥2 mm by duplex-ultrasound; prevalence was significantly higher in symptomatic arteries with ≥30% stenosis compared to asymptomatic with <30% stenosis, suggesting that CN play a role in pathogenesis of ischemic stroke in a small subset of patients.
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Nussbaumstr. 20, 80336, Munich, Germany. karolin.paprottka@med.lmu.de.
authors.forename: Karolin Johanna
authors.initials: KJ
authors.lastname: Paprottka
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Nussbaumstr. 20, 80336, Munich, Germany.
authors.forename: Damiana
authors.initials: D
authors.lastname: Saam
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Nussbaumstr. 20, 80336, Munich, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Rübenthaler
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Nussbaumstr. 20, 80336, Munich, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schindler
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Nussbaumstr. 20, 80336, Munich, Germany.
authors.forename: Nora Navina
authors.initials: NN
authors.lastname: Sommer
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Nussbaumstr. 20, 80336, Munich, Germany.
authors.forename: Philipp Marius
authors.initials: PM
authors.lastname: Paprottka
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Nussbaumstr. 20, 80336, Munich, Germany.
authors.forename: Dirk André
authors.initials: DA
authors.lastname: Clevert
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Nussbaumstr. 20, 80336, Munich, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Reiser
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Nussbaumstr. 20, 80336, Munich, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Saam
authors.affiliation: Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Nussbaumstr. 20, 80336, Munich, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Helck
mesh_terms: D000368:Aged; D002339:Carotid Arteries; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D018616:Ultrasonography, Doppler, Duplex; D061205:Vascular Calcification / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*
keywords: Calcified nodules; Carotid arteries; Prevalence; Stroke