Skip to main content
Advertisement

Main menu

  • Home
  • Content
    • Current Issue
    • Accepted Manuscripts
    • Article Preview
    • Past Issue Archive
    • Video Articles
    • AJNR Case Collection
    • Case of the Week Archive
    • Case of the Month Archive
    • Classic Case Archive
  • Special Collections
    • AJNR Awards
    • Low-Field MRI
    • Alzheimer Disease
    • ASNR Foundation Special Collection
    • Photon-Counting CT
    • View All
  • Multimedia
    • AJNR Podcasts
    • AJNR SCANtastic
    • Trainee Corner
    • MRI Safety Corner
    • Imaging Protocols
  • For Authors
    • Submit a Manuscript
    • Submit a Video Article
    • Submit an eLetter to the Editor/Response
    • Manuscript Submission Guidelines
    • Statistical Tips
    • Fast Publishing of Accepted Manuscripts
    • Graphical Abstract Preparation
    • Imaging Protocol Submission
    • Author Policies
  • About Us
    • About AJNR
    • Editorial Board
    • Editorial Board Alumni
  • More
    • Become a Reviewer/Academy of Reviewers
    • Subscribers
    • Permissions
    • Alerts
    • Feedback
    • Advertisers
    • ASNR Home

User menu

  • Alerts
  • Log in

Search

  • Advanced search
American Journal of Neuroradiology
American Journal of Neuroradiology

American Journal of Neuroradiology

ASHNR American Society of Functional Neuroradiology ASHNR American Society of Pediatric Neuroradiology ASSR
  • Alerts
  • Log in

Advanced Search

  • Home
  • Content
    • Current Issue
    • Accepted Manuscripts
    • Article Preview
    • Past Issue Archive
    • Video Articles
    • AJNR Case Collection
    • Case of the Week Archive
    • Case of the Month Archive
    • Classic Case Archive
  • Special Collections
    • AJNR Awards
    • Low-Field MRI
    • Alzheimer Disease
    • ASNR Foundation Special Collection
    • Photon-Counting CT
    • View All
  • Multimedia
    • AJNR Podcasts
    • AJNR SCANtastic
    • Trainee Corner
    • MRI Safety Corner
    • Imaging Protocols
  • For Authors
    • Submit a Manuscript
    • Submit a Video Article
    • Submit an eLetter to the Editor/Response
    • Manuscript Submission Guidelines
    • Statistical Tips
    • Fast Publishing of Accepted Manuscripts
    • Graphical Abstract Preparation
    • Imaging Protocol Submission
    • Author Policies
  • About Us
    • About AJNR
    • Editorial Board
    • Editorial Board Alumni
  • More
    • Become a Reviewer/Academy of Reviewers
    • Subscribers
    • Permissions
    • Alerts
    • Feedback
    • Advertisers
    • ASNR Home
  • Follow AJNR on Twitter
  • Visit AJNR on Facebook
  • Follow AJNR on Instagram
  • Join AJNR on LinkedIn
  • RSS Feeds

AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleExtracranial Vascular

Carotid Plaque Composition Assessed by CT Predicts Subsequent Cardiovascular Events among Subjects with Carotid Stenosis

E. Choi, E. Byun, S.U. Kwon, N. Kim, C.H. Suh, H. Kwon, Y. Han, T.-W. Kwon and Y.-P. Cho
American Journal of Neuroradiology October 2021, DOI: https://doi.org/10.3174/ajnr.A7338
E. Choi
aFrom the Department of Surgery (E.C., E.B., H.K., Y.H., T.-W.K., Y.-P.C.)
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for E. Choi
E. Byun
aFrom the Department of Surgery (E.C., E.B., H.K., Y.H., T.-W.K., Y.-P.C.)
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for E. Byun
S.U. Kwon
bNeurology (S.U.K.)
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for S.U. Kwon
N. Kim
cClinical Epidemiology and Biostatistics (N.K.)
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for N. Kim
C.H. Suh
dRadiology and Research Institute of Radiology (C.H.S.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for C.H. Suh
H. Kwon
aFrom the Department of Surgery (E.C., E.B., H.K., Y.H., T.-W.K., Y.-P.C.)
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for H. Kwon
Y. Han
aFrom the Department of Surgery (E.C., E.B., H.K., Y.H., T.-W.K., Y.-P.C.)
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Y. Han
T.-W. Kwon
aFrom the Department of Surgery (E.C., E.B., H.K., Y.H., T.-W.K., Y.-P.C.)
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for T.-W. Kwon
Y.-P. Cho
aFrom the Department of Surgery (E.C., E.B., H.K., Y.H., T.-W.K., Y.-P.C.)
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Y.-P. Cho
  • Article
  • Figures & Data
  • Supplemental
  • Info & Metrics
  • Responses
  • References
  • PDF
Loading

Article Figures & Data

Figures

  • Tables
  • FIG 1.
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIG 1.

    Representative figure of plaque Hounsfield unit value measurement. The plaque Hounsfield unit values were measured from noncontrast axial CTA images. An ROI of 2 mm2 was preselected on the visually least attenuated area of the plaque at the most stenotic level of contrast-enhanced axial images. Measurements were performed 5 times from the noncontrast axial images using prepositioned ROIs on the plaque. The lowest Hounsfield unit value in each plaque was recorded. ECA indicates external carotid artery.

  • FIG 2.
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIG 2.

    Representative figures of high-risk features of carotid plaque (arrowheads) on CTA. Napkin-ring sign (A), carotid plaque ulceration (B), and spotty calcium (C).

  • FIG 3.
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIG 3.

    Kaplan-Meier survival analyses of the cumulative event-free rates based on the dichotomization of Hounsfield units at the median value of the cohort (36 HU). Cumulative event-free rates of MACE (A), stroke (B), ACS (C), and CV mortality (D), according to the carotid plaque density. CV indicates cardiovascular.

Tables

  • Figures
    • View popup
    Table 1:

    Baseline and clinical characteristics of the study sample, stratified by the occurrence of MACEsa

    SubjectsTotal (n = 176)Non-MACE Group (n = 142)MACE Group (n = 34)P Value
    Age (yr)69.3 (SD, 7.6)69.3 (SD, 7.7)69.2 (SD, 6.8).49
     Median (IQR) (yr)70 (64–75)69 (64–75)71 (66–75)
    Male sex156 (88.6)126 (88.7)30 (88.2).998
    Body mass index (kg/m2)24.5 (SD, 3.1)24.5 (SD, 3.0)24.4 (SD, 3.4).96
    Risk factors
     Diabetes mellitus76 (43.2)66 (46.5)10 (29.4).096
     Hypertension126 (71.6)101 (71.1)25 (73.5).80
     Dyslipidemia96 (54.6)77 (54.2)19 (55.9).60
     Current smoking43 (24.4)32 (22.5)11 (32.4).42
     Past smoking68 (38.6)56 (39.4)12 (35.3).91
     Atrial fibrillation9 (5.1)5 (3.5)4 (11.8).001
    Medical history
     History of strokeb56 (31.8)44 (31.0)12 (35.3).66
     History of ACSb30 (17.1)21 (14.8)9 (26.5).30
     Antiplatelet154 (87.5)124 (87.3)30 (88.2).72
     Statins142 (80.7)115 (81.0)27 (79.4).47
    • ↵a Any stroke, ACS, or cardiovascular mortality. Continuous data are presented as means (SD) or median (IQR); categoric data are given as (No.) (%).

    • ↵b Subjects with any stroke or ACS who had been diagnosed >6 months previously and successfully treated.

    • View popup
    Table 2:

    Plaque characteristics, stratified by the occurrence of MACEsa

    PlaquesTotal (n = 194)Non-MACE Group (n = 156)MACE Group (n = 38)P Value
    Stenosis (%)68.6 (SD, 10.8)67.9 (SD, 10.0)71.3 (SD, 13.4).49
     Median (IQR)68 (60–75)68 (60–75)71 (62–80)
    Mixed plaque129 (66.5)102 (65.4)27 (71.1).18
     Plaque ulceration15 (7.7)13 (8.3)2 (5.3).53
     Hounsfield unit36.9 (SD, 15.4)39.2 (SD, 15.2)27.6 (SD, 12.7)<.001
      Median (IQR)36 (28–45)40 (30–47)28 (19–36)
     Spotty calcium40 (20.6)23 (14.7)17 (44.7)<.001
     Napkin-ring sign56 (28.9)40 (25.6)16 (42.1).09
     Calcium score443.5 (SD, 443.8)416.3 (SD, 428.0)551.2 (SD, 493.0).06
      Median (IQR)306 (101–639)294 (74–564)367 (165–1018)
    Follow-up (mo) (median) (IQR)41 (29–60)41 (30–59)47 (22–71).76
    • ↵a Any stroke, ACS, or cardiovascular mortality. Continuous data are presented as means (SD) or median (IQR); categoric data are given as (No.) (%).

    • View popup
    Table 3:

    Cox proportional hazards model for variables associated with MACEa occurrence

    Model 1bModel 2c
    HR (95% CI)P ValueHR (95% CI)P Value
    Diabetes mellitus0.60 (0.28–1.24).17NANA
    Atrial fibrillation1.07 (0.33–3.48).91NANA
    Hounsfield unit0.96 (0.94–0.98)<.0010.96 (0.94–0.98)<.001
    Spotty calcium4.00 (2.00–8.00)<.0013.97 (2.08–7.60)<.001
    Napkin-ring sign0.75 (0.36–1.55).45NANA
    Calcium score1.00 (1.00–1.001).25NANA
    • Note:—NA indicates not applicable.

    • ↵a Any stroke, ACS, or cardiovascular mortality.

    • ↵b Model 1 is multivariable analysis including all variables with P < . 1 in univariable analysis.

    • ↵c Model 2 is multivariable analysis with backward elimination of variables with P < . 1 in univariable analysis.

    • View popup
    Table 4:

    Cox proportional hazards model for the association of the plaque Hounsfield unit values with the occurrence of the MACE composite outcome and the individual MACE components (n = 194)a

    MACE (–)MACE (+)HR (95% CI)P Value
    MACEb (n = 38)39.2 (SD, 15.2)27.6 (SD, 12.7)0.96 (0.95–0.98)<.001
    Any stroke (n = 19)37.9 (SD, 15.4)27.8 (SD, 12.0)0.97 (0.94–0.99).01
     Ipsilateral stroke (n = 14)37.6 (SD, 15.4)27.4 (SD, 12.4)0.96 (0.93–0.99).02
    ACS (n = 16)37.8 (SD, 15.2)26.6 (SD, 14.0)0.96 (0.93–0.99).01
    Cardiovascular mortality (n = 12)37.7 (SD, 15.4)24.9 (SD, 8.8)0.95 (0.92–0.99).01
    All-cause mortality (n = 32)37.7 (SD, 15.6)32.8 (SD, 13.9)0.98 (0.96–1.01).14
    • ↵a Data are presented as mean (SD) and 95% CI of plaque Hounsfield values.

    • ↵b Any stroke, ACS, or cardiovascular mortality.

    • View popup
    Table 5:

    Cox proportional hazards model for the association of the presence of spotty calcium on CTA with the occurrence of the MACE composite outcome and the individual MACE components (n = 194)a

    MACE (–)MACE (+)HR (95% CI)P Value
    MACEb (n = 38)23 (14.7)17 (44.7)4.08 (2.13–7.83)<.001
    Any stroke (n = 19)32 (18.3)8 (42.1)3.25 (1.30–8.11).01
     Ipsilateral stroke (n = 14)35 (19.4)5 (35.7)2.61 (0.87–7.82).09
    ACS (n = 16)31 (17.4)9 (56.3)6.39 (2.34–17.45)<.001
    Cardiovascular mortality (n = 12)35 (19.2)5 (41.7)3.01 (0.95–9.48).06
    All-cause mortality (n = 32)28 (17.3)12 (37.5)2.57 (1.25–5.26).01
    • ↵a Data are presented as (No.) (%) and 95% CI of carotid plaques with spotty calcium detected on CTA.

    • ↵b Any stroke, ACS, or cardiovascular mortality.

PreviousNext
Back to top
Advertisement
Print
Download PDF
Email Article

Thank you for your interest in spreading the word on American Journal of Neuroradiology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Carotid Plaque Composition Assessed by CT Predicts Subsequent Cardiovascular Events among Subjects with Carotid Stenosis
(Your Name) has sent you a message from American Journal of Neuroradiology
(Your Name) thought you would like to see the American Journal of Neuroradiology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Cite this article
E. Choi, E. Byun, S.U. Kwon, N. Kim, C.H. Suh, H. Kwon, Y. Han, T.-W. Kwon, Y.-P. Cho
Carotid Plaque Composition Assessed by CT Predicts Subsequent Cardiovascular Events among Subjects with Carotid Stenosis
American Journal of Neuroradiology Oct 2021, DOI: 10.3174/ajnr.A7338

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
0 Responses
Respond to this article
Share
Bookmark this article
Carotid Plaque Composition Assessed by CT Predicts Subsequent Cardiovascular Events among Subjects with Carotid Stenosis
E. Choi, E. Byun, S.U. Kwon, N. Kim, C.H. Suh, H. Kwon, Y. Han, T.-W. Kwon, Y.-P. Cho
American Journal of Neuroradiology Oct 2021, DOI: 10.3174/ajnr.A7338
del.icio.us logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
Purchase

Jump to section

  • Article
    • Abstract
    • ABBREVIATIONS:
    • MATERIALS AND METHODS
    • RESULTS
    • DISCUSSION
    • CONCLUSIONS
    • References
  • Figures & Data
  • Supplemental
  • Info & Metrics
  • Responses
  • References
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Crossref
  • Google Scholar

This article has not yet been cited by articles in journals that are participating in Crossref Cited-by Linking.

More in this TOC Section

  • Proximal Vertebral Artery Variants and Embryology
  • High-Risk Plaque Features in Carotid MRI
  • Nonstenotic Carotid Plaques and Stroke Review
Show more Extracranial Vascular

Similar Articles

Advertisement

Indexed Content

  • Current Issue
  • Accepted Manuscripts
  • Article Preview
  • Past Issues
  • Editorials
  • Editor's Choice
  • Fellows' Journal Club
  • Letters to the Editor
  • Video Articles

Cases

  • Case Collection
  • Archive - Case of the Week
  • Archive - Case of the Month
  • Archive - Classic Case

More from AJNR

  • Trainee Corner
  • Imaging Protocols
  • MRI Safety Corner
  • Book Reviews

Multimedia

  • AJNR Podcasts
  • AJNR Scantastics

Resources

  • Turnaround Time
  • Submit a Manuscript
  • Submit a Video Article
  • Submit an eLetter to the Editor/Response
  • Manuscript Submission Guidelines
  • Statistical Tips
  • Fast Publishing of Accepted Manuscripts
  • Graphical Abstract Preparation
  • Imaging Protocol Submission
  • Evidence-Based Medicine Level Guide
  • Publishing Checklists
  • Author Policies
  • Become a Reviewer/Academy of Reviewers
  • News and Updates

About Us

  • About AJNR
  • Editorial Board
  • Editorial Board Alumni
  • Alerts
  • Permissions
  • Not an AJNR Subscriber? Join Now
  • Advertise with Us
  • Librarian Resources
  • Feedback
  • Terms and Conditions
  • AJNR Editorial Board Alumni

American Society of Neuroradiology

  • Not an ASNR Member? Join Now

© 2025 by the American Society of Neuroradiology All rights, including for text and data mining, AI training, and similar technologies, are reserved.
Print ISSN: 0195-6108 Online ISSN: 1936-959X

Powered by HighWire