J Korean Soc Radiol.  2019 Nov;80(6):1214-1228. 10.3348/jksr.2019.80.6.1214.

Correlation between Carotid Arterial Calcium Score and Silent Cerebrovascular Lesions in Obstructive Sleep Apnea Patients: by Using Upper Airway CT and Brain MRI

• Kim MS
• Kang EJ
• Bae WY
• Kim JK
• Kim CH
• Choi JH
• Kim SH
• Kim DY
• Lee KN

• KMID: 2464918
• DOI: http://doi.org/10.3348/jksr.2019.80.6.1214

Abstract

PURPOSE
To investigate the relationship between carotid arterial calcium score (CarACS) and silent cerebrovascular lesions in patients with obstructive sleep apnea (OSA).
MATERIALS AND METHODS
This study involved retrospective evaluation of 60 OSA patients who underwent both upper airway CT and brain MRI. Using polysomnography, several indicators, including apnea index (AI), were used to evaluate the relationship between OSA and silent cerebrovascular lesions. The CarACS was quantified on CT imaging using the modified Agatston method. Silent cerebrovascular lesions were evaluated on brain MRI by grading periventricular hyperintensity (PVH). Various clinical characteristics, including age, were analyzed in each patient.
RESULTS
The number of patients per PVH grade 0, 1, 2, 3, and 4 was 26 (43.3%), 14 (23.3%), 14 (23.3%), 4 (6.7%), and 2 (3.3%), respectively. The mean age, hypertension, smoking status, AI, and CarACS were significantly different among PVH groups (Ps < 0.05). In univariate analysis, the presence of carotid arterial calcification (β = 0.483, p < 0.01), CarACS (β = 0.482, p < 0.01), and age (β = 0.360, p < 0.01) showed a significant association with PVH grade. The mean AI and lowest O₂ saturation had statistically weak associations with PVH grade (β = 0.267, p < 0.01; β = −0.219, p < 0.14, respectively). In multivariate analysis, CarACS was the only factor affecting PVH grade (p < 0.04).
CONCLUSION
CarACS is associated with the severity of silent cerebrovascular lesions. Therefore, additional analysis of CarACS in OSA patients may provide more information on their cerebrovascular status.

MeSH Terms

Apnea
Brain Ischemia
Brain*
Calcium*
Carotid Arteries
Cerebrovascular Disorders
Fluorouracil
Humans
Hypertension
Magnetic Resonance Imaging*
Methods
Multivariate Analysis
Polysomnography
Retrospective Studies
Sleep Apnea, Obstructive*
Smoke
Smoking
Calcium
Fluorouracil
Smoke

Figure

• 

  Fig. 1 Representative images of measurement of carotid arterial calcification with upper airway CT scan. A. The arrow indicates calcification in the left common carotid artery on upper airway CT scan. B. Reconstructed image of upper airway CT to measure carotid arterial calcicum score. Calcification is shown as the red-colered area (arrow) and is semi-automatically calculated by the modified Agatston method.

• 

  Fig. 2 Representative images of PVH. PVH grade was evaluated on T2-weighted fluid-attenuated inversion recovery sequence of the brain MRI. PVH = periventricular hyperintensity

• 

  Fig. 3 Representative patient with a PVH grade 4 and high CarACS. A 60-year-old man with a PVH grade 4 as determined by brain MRI was included in the highest CarACS group with a score of 435 on upper airway CT (arrows indicate CarAC). The results of polysomnography were as follows: RDI) 38.7 events/h, AI 31.6 events/h, lowest O2 saturation 78.2%. He was a smoker and had hypertension. AI = apnea index, CarAC = carotid artery calcification, CarACS = carotid arterial calcium score, PVH = periventricular hyperintensity, RDI = respiratory disturbance index

• 

  Fig. 4 Representative patient with a PVH grade 1 and no CarAC. A 59-year-old man showed PVH only in the apex of the frontal horn of the lateral ventricle on brain MRI (PVH grade 1). On upper airway CT, he showed no CarAC (CarACS = 0) (arrows indicate the common carotid artery). The results of polysomnography were as follows: RDI 35.1 events/h; AI 10.6 event/h; lowest O2 saturation 83%. He was also a smoker. AI = apnea index, CarAC = carotid artery calcification, CarACS = carotid arterial calcium score, PVH = periventricular hyperintensity, RDI = respiratory disturbance index

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