Clinical and radiological characteristics of calcified cerebral embolism: a large case series including 242 calcified cerebral embolism.

Introduction: Radiological calcified cerebral embolism (CCE) characteristics have been reported in small case series. Our aim was to describe clinical and radiological CCE characteristics in a large number of CCE and to compare characteristics between different patient groups.

Methods: Characteristics of 79 stroke patients with CCE were analyzed retrospectively. Clinical characteristics included demographics, cardiovascular risk factors, stroke history, history of surgical/endovascular cardiovascular intervention, NIHSS on admission, stroke etiology, and presumed CCE source. Radiological characteristics included CCE diameter, density, number, involved cerebral artery and segment, and CCE distribution.

Results: A total of 242 CCE were analyzed in 79 patients (median age 79, 56% men). Presumed CCE source was vascular in 54%, mixed vascular/cardiac in 32%, and undetermined in 14%. Median CCE diameter was 1.55 mm and median density 146HU. Multiple CCE were observed in 34% of patients. The middle cerebral artery was the most frequently (84%) involved artery. CCE predominantly involved distal segments. Single uniterritorial, multiple uniterritorial, and multiterritorial CCE were observed in 63%, 22%, and 15% of patients respectively. Patients with combined vascular/cardiac CCE source were older compared with patients with vascular CCE source (p = 0.0135). Correlation coefficient between CCE diameter and density was 0.69. Clinical characteristics were similar between the groups with single uniterritorial, multiple uniterritorial, and multiterritorial CCE, apart from diabetes (p = 0.0076). Concerning radiological characteristics, median diameter and density differed between these three groups (p = 0.0029 and p = 0.0035, respectively). CCE diameter was larger (p < 0.0001) and density higher (p < 0.0001) when CCE involved proximal arterial segments.

Conclusion: Clinical and radiological characteristics of CCE patients and CCE are variable. CCE diameter and density and presence of diabetes history differed between CCE patients with single uniterritorial, multiple uniterritorial, and multiterritorial CCE.