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Whether this principle also applies to intracranial artery calcifications (IAC) and cerebrovascular disease risk is unknown, primarily due to the lack of population-based estimates of IAC density and its determinants. We investigated these facets in this cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>In 2464 community-living individuals who underwent non-contrast CT, we measured IAC density and assessed its correlation with IAC volume using Spearman\u2019s \u03c1. We described its distribution in intracranial carotid artery calcification (ICAC), with specific estimates for its subtypes, and vertebrobasilar artery calcification (VBAC). We investigated associations between risk factors and IAC density using multivariable ordinal regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The prevalence of IAC was 82.8%, with a median density of 232 (IQR 189\u2013287) HU. IAC density correlated moderately with volume (\u03c1 0.67, 95% CI [0.65\u20130.70]). ICAC was predominantly composed of higher density, with 80.1% of affected participants having components of ICAC above 400 HU, whereas only 32.0% of participants with VBAC had components above 400 HU. Intimal subtype ICACs showed a predominance for lower densities when compared to medial subtype ICACs. The main determinants of IAC density were hypertension, use of lipid-lowering medication, and smoking, with adjusted odds ratios of 1.59 [1.28\u20131.90], 1.55 [1.26\u20131.91], and 1.33 [1.10\u20131.61], respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>IAC density differs significantly between the anterior and posterior cerebropetal arteries. While IAC density correlated only moderately with its volume, the associations between cardiovascular risk factors and IAC density were mostly similar to those observed with IAC volume.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Drivers of the CT density of intracranial artery calcifications are unknown and may reveal novel risk targets for population-based prevention strategies.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Calcifications of the anterior cerebral circulation are denser than those of the posterior circulation. Hypertension, diabetes, and smoking are key drivers of calcification density, resembling most drivers of its volume.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Calcification density may serve in distinguishing subtypes of intracranial calcifications, improving detection of subtype-specific effects. Further research is warranted to determine the role of intracranial arteriosclerosis density in prevention strategies for cerebrovascular diseases.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-025-12180-1","type":"journal-article","created":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T12:17:20Z","timestamp":1768479440000},"page":"4862-4872","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["CT-derived density of intracranial arteriosclerosis: a population-based cohort study"],"prefix":"10.1007","volume":"36","author":[{"given":"Bernhard P.","family":"Berghout","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin Y. R.","family":"Camarasa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten J. 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No other disclosures were reported. The authors of this manuscript declare no relationships with any other companies, whose products or services may be related to the subject matter of the article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Several of the authors have significant statistical expertise.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"All participants provided written informed consent to participate in the study and to have their medical information retrieved from treating physicians.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"The Rotterdam Study has been approved by the Medical Ethics Committee of the Erasmus MC (registration number MEC 02.1015) and by the Dutch Ministry of Health, Welfare and Sport (Population Screening Act WBO, license number 1071272-159521-PG). The Rotterdam Study Personal Registration Data collection is filed with the Erasmus MC Data Protection Officer under registration number EMC1712001. The Rotterdam Study has been entered into the Dutch Trial Register (NTR;\n                      \n                      ) and into the WHO International Clinical Trials Registry Platform (ICTRP\n                      \n                      , search portal\n                      \n                      ) under shared catalog number NL6645\/NTR6831. The Rotterdam Study project persistent identifier is\n                      \n                      .","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"No study subjects or cohorts have been previously reported.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}