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Objective:Carotid intraplaque hemorrhage(IPH)has a close relationship with cardiovascular events and may stimulate plaque progression.However,the pathogenesis of IPH is still inconclusive.Although studies have explored some determinants of IPH,the relationship between IPH and other plaque compositions are still rarely discussed.In this study we aimed to investigate the association between calcification and IPH in carotid plaque using high-resolution magnetic resonance imaging(HRMRI).Methods: Cerebrovascular symptomatic subjects with carotid atherosclerotic plaque determined by ultrasound underwent multicontrast carotid plaque magnetic resonance imaging(MRI)to assess plaque composition.Plaques with composition were included to analysis.Based on calcification location,calcification were divided into the following categories: surface calcification,mixed calcification,and deep calcification.The calcification was also classified into single and multiple calcification based on calcification quantity.Clinical risk factors and plaque characteristics were compared between plaque with and without IPH group.Generalized estimating equation analysis,adjusted for some potential confounding factors,was used to examine the association between different types of calcification and IPH.Results:Among 117 subjects,142 carotid plaques(from 85 subjects)with composition were analyzed,of which 40(28.2%)contained IPH.Compared with carotid plaques without IPH,plaques with IPH were more frequently seen in men,older subjects,smoker,subjects with lower levels of TC and LDL and subjects with greater maximum wall thickness.In addition,the incidence of calcification,multiple calcification,surface calcification and mixed calcification are higher in plaque with IPH group than without IPH group.In multivariable analysis,adjusted for age,gender,smoke,LDL,TC and max plaque thickness,the presence of calcification yielded a strong association with the presence of IPH,with an odds ratio(OR)of 4.32(95%CI,1.37-13.63).In particular,the OR for multiple calcification,surface calcification and mixed calcification were 6.28(2.02-19.54),12.18(2.6-57.11)and 9.63(2.67-34.68),respectively.Conclusions: Calcification,particularly multiple calcification,surface calcification and mixed calcification,was associated with the presence of IPH.Biomechanics changes resulting from different types of calcification may be the underlying pathophysiological link.These findings may offer novel insights about the pathogenesis of IPH.