High-resolution MR study of the relationship between superficial calcification and the stability of carotid atherosclerotic plaque

In this study, we have aimed to evaluate the relationship between the shape and location of superficial calcification and the presence of fibrous cap rupture and intraplaque hemorrhage in atherosclerotic carotid plaque. Sixty-three patients with carotid stenosis underwent contrast-enhanced high resolution MR examinations with a 3-T MR scanner and 226 slices with superficial calcification were evaluated in the study. The shape of superficial calcification was categorized as the irregular type (dotted/arcuated) and patchy type and the location of superficial calcification was categorized as the marginal type and central type. Intraplaque hemorrhage and fibrous cap rupture depicted on the same slice as superficial calcification were identified. The chi-squared test was used for statistical analysis. A total of 149 slices (65.9%) with intraplaque hemorrhage and 107 slices(47.3%)with fibrous cap rupture were detected. There were 191 slices with irregular type (dotted/arcuated) calcification and 166 slices with marginal type calcification. Irregular superficial calcification was found more frequently accompanied with intraplaque hemorrhage as compared to the patchy type (73.8 vs. 22.9%, P < 0.0001); there was a significant difference between the marginal type and the central type for the accompaniment of intraplaque hemorrhage (72.9 vs. 46.7%, P < 0.05). However, there was no significant difference between different shapes and locations of superficial calcification that accompanied with fibrous cap rupture (P > 0.05). This study showed that superficial calcification is an important factor for determination of instability of atherosclerotic carotid plaque. The shape and location of superficial calcification are important features associated with the occurrence of intraplaque hemorrhage.