Presence and severity of carotid siphon calcification on computed tomography images in mild cognitive impairment Poster No.: C-2117 Congress: ECR 2013 Type: Scientific Exhibit Authors: S. Rutkauskas, S. Lukosevicius, A. BASEVICIUS, K. Lauckaite, Z. Stepanavicius; Kaunas/LT Keywords: DOI: Geriatrics, Dementia, Diagnostic procedure, CT, Neuroradiology brain 10.1594/ecr2013/C-2117 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 7
Purpose Mild cognitive impairment (MCI) is a condition between normal ageing and dementia [Petersen et al. 2008]. Recently, the term vascular cognitive impairment has been proposed, which re#ects an awareness of the vascular burden on cognition. The vascular risk factors (diabetes mellitus, hypertension, dyslipidemia, smoking and obesity) are important in the development of dementia [Tang et al. 2012], including significant synergistic effect on primary neurodegenerative type [Gorelick et al. 2013, Kovacic et al. 2012]. The data from clinical studies suggested, that the calcification of siphon internal carotid artery (SICAc) on brain computed tomography (CT) significantly correlated with the degree of stenosis on brain magnetic resonance angiography and with maximal intima-medial thickness on carotid ultrasonography [Matsumoto H 2008]. The aim of our study was to determine clinical significance of the presence and severity of SICAc in MCI. Methods and Materials The study was carried out at the Hospital of Lithuanian University of Health sciences, Clinics of Kaunas (Kaunas,Lithuania) during a period of one year in 2011 and 2012. The patients were recruited into the study, who were coming to the Out-patient Department of Neurology for the consultation of a doctor neurologist and psychiatrist with the complaints of memory decline or, rarely, experiencing other cognitive difficulties. A total of 75 patients, who met the criteria for MCI and were willing to participate, were included in the study. Every patient underwent a structured interview, an objective neurological examination for the focal signs, and the laboratory tests in order to exclude secondary causes of cognitive impairment. The Mini Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale - Cognitive subscale (ADAS-Cog) were employed for the cognitive assessment. The total score equal or higher than 25 points on the MMSE (range 0-30), and less than 18 points on the ADAS-Cog (range 0-70) was considered to be normal. The patients were assorted into the groups according to the collected score on each test: MMSE # 26 (A), MMSE # 25 (B), ADAS-cog # 16 (C) and ADAS-cog # 17 (D) points. The cranial CT imaging was performed (2 mm thick sections) through the cavernous region to all the patients. SICAc was evaluated bilaterally using bone window settings and scored by a five-grade scale [Babiarz et al. 2005, Hong et al. 2011] (Fig. 1-3). According to this scale, grade 0 is defined as SICA with an absent calcification, grade 1 - the dots, grade 2 - the arcs, grade 3- an incomplete circumferential and grade 4 - a complete circumferential calcification of the carotid artery. The total score of the scale ranges from 0 to 8 points. The statistical calculations were performed with statistical package MedCalc (v.11.4.2.0), using independent sample Student t test and Pearson's correlation for the parametric variables. All the values were given as a mean, standard deviation Page 2 of 7
and the 95% confidence intervals (95% CI). A P value less than 0.05 was considered as statistically significant. Images for this section: Fig. 1: The calcification scoring system of the carotid siphon (CS) according by Babiarz (2005). Small dot of calcification are found in both CS (Grade 1). Page 3 of 7
Fig. 2: Thick continuous calcification is in the left CS (Grade 3). Grade 2 is found in the right CS. Page 4 of 7
Fig. 3: The circumferential involvement with atherosclerotic plaque of both CS (Grade 4). Page 5 of 7
Results The mean age of patients was 67 ± 9 years, 17 (23%) were men. The mean MMSE scores were 25.3±2.6 points, and of ADAS-Cog - 16.9 ± 6.0 points. The mean SICAc scores were 3.9 ± 2.3 points: in the group A - 3.6 ± 2.5 points (n=38); B - 4.1 ± 2.1 points (n=37); C - 3.6 ± 2.4 points (n=38); and D - 4.1 ± 2.1 points (n=37), respectively. A strong positive correlation between the age and SICAc scale points (Pearson r=0.46, 95%CI 0.26-0.62, p<0.001) was found. However, according to the SICAc scale scores, we did not detec any significant differences either between the groups A and B (p=0.279), C and D (p=0.733), or any correlation with the MMSE (p=0.772) or ADAS-Cog points (p=0.108). Conclusion The siphon internal carotid artery calcification score was strongly associated with an age. However, the presence and severity of SICA calcification was not associated with a greater level of cognitive impairment. References 1. Babiarz LS, Yousem DM, Bilker W, Wasserman BA. Middle cerebral artery infarction: relationship of cavernous carotid artery calcification. AJNR Am J Neuroradiol. 2005 Jun- Jul;26(6):1505-11. 2. Hong NR, Seo HS, Lee YH, Kim JH, Seol HY, Lee NJ, Suh SI. The correlation between carotid siphon calcification and lacunar infarction. Neuroradiology. 2011 Sep;53(9):643-9. 3. Petersen RC, Negash S. Mild cognitive impairment: an overview. CNS Spectr. 2008 Jan;13(1):45-53. 4. Tang CY, Narula J, Friedman JI. Novel imaging strategies for assessment of cerebrovascular involvement. Mt Sinai J Med. 2012 Nov;79(6):674-82. 5. Gorelick PB, Pantoni L. Advances in vascular cognitive impairment. Stroke. 2013 Feb;44(2):307-8. 6. Kovacic JC, Fuster V. Atherosclerotic risk factors, vascular cognitive impairment, and Alzheimer disease. Mt Sinai J Med. 2012 Nov;79(6):664-73. Page 6 of 7
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