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TY - JOUR

T1 - Aortic calcification

T2 - A postmortem CT validation study in a middle-aged population

AU - Vos, Annelotte

AU - Houben, Ignas B.

AU - Celeng, Csilla

AU - Takx, Richard A. P.

AU - Isgum, Ivana

AU - Mali, Willem P. T. M.

AU - Vink, Aryan

AU - de Jong, Pim A.

N1 - Funding Information: Csilla Celeng is supported by a grant from the European Association of Cardiovascular Imaging (EACVI). The funding agencies had no role in design and conduct of the study, data collection, analysis and interpretation, or preparation, review or approval of the manuscript. Funding Information: This research is supported by a grant of the Netherlands Organization for Scientific Research/Foundation for Technological Sciences (NWO/STW, Project 12726) with industrial contribution (Pie Medical Imaging BV and 3mensio medical imaging). Publisher Copyright: © 2023 The Author(s)

PY - 2023/2/1

Y1 - 2023/2/1

N2 - Background: Computed tomography (CT)-detected aortic calcification is strongly associated with aortic stiffness and is an accurate predictor of cardiovascular and all-cause mortality and cognitive decline. Some previous pathologic studies have shown calcium accumulation in the medial layer of the vessel wall, while others have suggested localisation in the atherosclerotic intimal layer. Objectives: The aim of this study was to histologically validate CT findings of aortic calcification for detectability and location in the aortic wall. Methods: We acquired postmortem CT images and collected 170 aortic tissue samples from five different locations in the thoracic and abdominal aorta of 40 individuals who underwent autopsy. Microscopic slides were stained with haematoxylin and eosin and elastic van Gieson stain. Calcified lesions were characterised and calcifications were manually annotated in the intima and media. The presence and morphology of calcifications were scored on CT images. Results: The mean age of the autopsied individuals was 63 years, and 28 % died of cardiovascular disease. Calcifications were present in 74/170 (44 %) samples. Calcification was more common in the abdominal aorta than in the thoracic aorta. In all samples with calcifications, 99 % were located in the intimal layer. Only 16/170 samples had a small amount of medial arterial calcification. The histological results showed an 85 % concordance for the presence or absence of CT calcifications. There was complete inter-method agreement for annularity of calcifications in 68 % of the samples (linear weighted kappa 0.68 (95 %CI 0.60–0.77). Conclusions: Aortic calcifications visible on CT are located in the intimal layer of the abdominal aorta wall, at least in aortas that are not aneurysmatic or dissected. The presence and annularity of these calcifications can be reliably determined by CT.

AB - Background: Computed tomography (CT)-detected aortic calcification is strongly associated with aortic stiffness and is an accurate predictor of cardiovascular and all-cause mortality and cognitive decline. Some previous pathologic studies have shown calcium accumulation in the medial layer of the vessel wall, while others have suggested localisation in the atherosclerotic intimal layer. Objectives: The aim of this study was to histologically validate CT findings of aortic calcification for detectability and location in the aortic wall. Methods: We acquired postmortem CT images and collected 170 aortic tissue samples from five different locations in the thoracic and abdominal aorta of 40 individuals who underwent autopsy. Microscopic slides were stained with haematoxylin and eosin and elastic van Gieson stain. Calcified lesions were characterised and calcifications were manually annotated in the intima and media. The presence and morphology of calcifications were scored on CT images. Results: The mean age of the autopsied individuals was 63 years, and 28 % died of cardiovascular disease. Calcifications were present in 74/170 (44 %) samples. Calcification was more common in the abdominal aorta than in the thoracic aorta. In all samples with calcifications, 99 % were located in the intimal layer. Only 16/170 samples had a small amount of medial arterial calcification. The histological results showed an 85 % concordance for the presence or absence of CT calcifications. There was complete inter-method agreement for annularity of calcifications in 68 % of the samples (linear weighted kappa 0.68 (95 %CI 0.60–0.77). Conclusions: Aortic calcifications visible on CT are located in the intimal layer of the abdominal aorta wall, at least in aortas that are not aneurysmatic or dissected. The presence and annularity of these calcifications can be reliably determined by CT.

KW - Abdominal aorta

KW - Atherosclerosis

KW - Calcifications

KW - Intimal lesions

UR - http://www.scopus.com/inward/record.url?scp=85145848233&partnerID=8YFLogxK

U2 - 10.1016/j.ejrad.2023.110687

DO - 10.1016/j.ejrad.2023.110687

M3 - Article

C2 - 36610325

VL - 159

JO - European journal of radiology

JF - European journal of radiology

SN - 0720-048X

M1 - 110687

ER -