COMPARISON OF SPOTTY CALCIFICATIONS ON CERVICO-CEREBRAL COMPUTED TOMOGRAPHY ANGIOGRAPHY IN PATIENTS WITH AND WITHOUT ISCHEMIC STROKE

Abstract

Background: Ischemic stroke is a major global cause of morbidity and mortality. Cervico-cerebral computed tomography angiography (CTA) allows early visualization of vascular changes, such as spotty calcifications and small, focal calcium deposits within arterial walls, considered indicators of plaque vulnerability and stroke risk. Objective: To compare the mean number and distribution of spotty calcifications on CTA among patients with ischemic stroke and those without stroke but with carotid atherosclerosis in the Pakistani population. Study Design: Case–control study. Setting: Department of Diagnostic Radiology, Chaudhry Pervaiz Elahi Institute of Cardiology (CPEIC), Multan, Pakistan. Duration of Study: January to December 2024. Methods: Sixty participants aged 40–65 years were enrolled, including 30 patients with confirmed ischemic stroke (cases) and 30 age- and sex-matched controls with carotid atherosclerosis but no prior stroke. Cervico-cerebral CTA was performed using a 256-slice multidetector scanner. Spotty calcifications were defined as calcified plaques <3 mm in length and <90° arc with attenuation ≥130 Hounsfield Units. The number and vascular distribution of calcifications were assessed and compared using an independent-samples t-test. Data analysis was conducted in SPSS version 25, with a p-value ≤ 0.05 considered statistically significant. Results: The mean age of participants was 56.8 ± 6.9 years, with males comprising 63.3%. The mean number of spotty calcifications was significantly higher in ischemic stroke patients (6.9 ± 4.2) than in controls (3.0 ± 2.8; p < 0.001). The carotid bifurcation was the most frequent site of calcification, followed by the carotid siphon and middle cerebral artery (MCA) segments. Stroke patients showed significantly higher calcification counts in LMCA1, RMCA1, and the basilar artery (p < 0.05). Subgroup analysis revealed a higher calcification burden in stroke patients with diabetes mellitus (p = 0.002), hypertension (p = 0.003), and smoking history (p = 0.004). Conclusion: Spotty calcifications are significantly more prevalent and widely distributed in patients with ischemic stroke compared to those without stroke, particularly at the carotid bifurcation and MCA segments. Their strong association with diabetes, hypertension, and smoking suggests that spotty calcifications on CTA may serve as early imaging biomarkers for stroke risk, aiding in timely prevention and intervention strategies in the Pakistani population.