Calcification in carotid atheromatous plaque: delineation by 3D-CT angiography, compared with pathological findings

The authors investigated calcification in the carotid plaque of patients with carotid stenosis, using three-dimensional CT angiography (3D-CTA) and comparing the images with findings from pathological inspection. Calcification was clearly visualized using volume rendering (VR) images constructed with a refined workstation as well as maximum intensity projection and multiplanar reconstruction images. Calcification in VR images was classified into bean- and island-like shaped groups, while calcification in microscopic examination was classified into granular, lump and laminar types. Granular type of calcification tended to be found at the intimal side of the plaque, while lump/laminar calcification was preferentially located at the side of the internal elastic fiber. Though carotid endarterectomy successfully removed calcification at both sides, the presence of a granular calcification assembly when massive calcification is observed with 3D-CTA might alert us to the importance of predicting the hardness of plaque in carotid angioplasty and stenting.