Comparative evaluation of intracranial vertebral artery calcification detection: CT vs. susceptibility-weighted imaging

Abstract

Background and aims

Traditionally, computed tomography (CT) has been more sensitive in detecting calcification compared to conventional magnetic resonance (MR) imaging. This study aims to compare the efficacy of susceptibility-weighted imaging (SWI), an advanced MR technique, with CT in detecting calcification in the intracranial vertebral artery.

Methods

This retrospective study reviewed brain SWI imaging of patients from January 2021 to March 2022. Inclusion criteria encompassed patients who underwent both SWI and brain CT within a 3-month interval. Exclusion criteria included poor imaging quality, insufficient or incomplete studies, and lack of MRA data. Vessel wall calcification was defined as hypointensity on SWI and hyper-attenuation (≥130 HU) on CT. We compared the incidence of calcification detected by CT with hypointensity on SWI at corresponding anatomical locations.

Results

A total of 817 patients (age range: 25–90 years, mean age: 62.1 ± 15.1 years) were included in the study. Of these, 393 (48.1 %) were females, 329 (40.3 %) had hypertension, and 242 (29.6 %) had diabetes. CT detected calcification in 613 intracranial vertebral arteries. SWI depicted hypointensity in 604 (98.5 %) of the CT positive cases. 21 subjects showed calcification on CT but no hypointensity on SWI, while 12 subjects had SWI hypointensity but no evidence of calcification on CT.

Conclusion

This study demonstrates that SWI is not inferior to CT in detecting intracranial vertebral artery wall calcification. SWI is possibly better than CT in detecting non-stenotic atherosclerosis, mural hematoma or dissection. The high concordance between SWI and CT, coupled with SWI’s ability to potentially detect additional vascular pathologies, shows promise as a radiation-free, comprehensive imaging modality.