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Möst T, Winter L, Ballheimer YE, Kappler C, Schmid M, Adler W, Weber M, Kesting MR, Lutz R. Prevalence of carotid artery calcification detected by different dental imaging techniques and their relationship with cardiovascular risk factors, age and gender. BMC Oral Health 2023; 23:949. [PMID: 38037004 PMCID: PMC10691106 DOI: 10.1186/s12903-023-03564-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/22/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Atherosclerosis and its secondary diseases display a major threat to patient's health. Sequelae, like carotid artery calcification (CAC), usually develop over decades and remain asymptomatic for a long time, making preventive measures to reduce mortality and morbidity extremely important. Through panoramic radiography (PR) and cone beam computed tomography (CBCT), dentists may have helpful tools in aiding the holistic care of patients. In this context, the correlation of atherosclerotic risk factors and CAC development have not yet been sufficiently investigated. Thus, the aim of this observational radiological study was to evaluate the diagnostic value of PR compared with CBCT for the detection of CAC in patients older than 60 years. The radiological findings were correlated with gender, age, and cardiac risk factors. METHODS PRs and CBCTs of N = 607 patients were used for the qualitative analysis and compared. Basic patient information such as age, gender, body mass index (BMI), smoking history as well as patient's detailed medical history, including heart disease and cardiovascular risk factors such as hypercholesterolemia, arterial hypertension and diabetes mellitus type II were documented and their relation to CAC provided by radiological data was estimated in the form of odds ratios (OR), which were calculated using logistic regression models. Proportions of CAC in different risk groups were compared using Fisher's exact test, the significance level was set to α ≤ 0.05. The interrater reliability of two physicians was estimated using Cohen's kappa. RESULTS With an accuracy of 90.6%, a sensitivity of 67.5% and a specificity of 99.5% compared to CBCT, PR was a reliable method for the diagnosis of CAC. The overall detection rate for CAC was 27.8% across all age groups. Age (OR: 1.351; p = 0.021), the male sex (OR: 1.645; p = 0.006), arterial hypertension (OR: 2.217; p = < 0.001), heart disease (OR: 1.675; p = 0.006), hypercholesterolemia (OR: 1.904; p = 0.003) and chronic obstructive pulmonary disease (OR: 2.016; p = 0.036) were statistically significant risk factors. When correlated, neither history of stroke nor nicotine abuse showed any statistical significance. CONCLUSIONS Due to the capabilities of PR in the diagnosis of CAC, dentists can play a vital role in the early diagnosis of vascular disease. Awareness should therefore be raised among dentists regarding the detection of CAC in patients over 60 years of age, with a particular focus on those with arterial hypertension and hypercholesterolaemia.
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Affiliation(s)
- Tobias Möst
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany.
| | - Linus Winter
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
| | - Yili Elisabeth Ballheimer
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
| | - Christian Kappler
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
| | - Magdalena Schmid
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology (IMBE), University of Erlangen- Nuremberg, Erlangen, Germany
| | - Manuel Weber
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
| | - Marco Rainer Kesting
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
| | - Rainer Lutz
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany
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Zaghden O, Jaziri R, Kammoun R, Chaabani I, Alaya TB. Benefit of Panoramic Radiography in the Detection of Carotid Calcifications: Clinical Case Reports and Review of the Literature. Case Rep Dent 2023; 2023:3989502. [PMID: 37305808 PMCID: PMC10257549 DOI: 10.1155/2023/3989502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/04/2023] [Accepted: 05/06/2023] [Indexed: 06/13/2023] Open
Abstract
Atherosclerotic lesions in the common carotid artery are one of the most frequent causes of ischemic stroke. They are usually diagnosed by cardiologists and are managed following complementary examinations. In dental practice, panoramic radiograph is a basic examination frequently performed in first line. On this radiography, possible unilateral or bilateral opacities projecting to the latero-cervical regions can be visualized, raising suspicion of carotid calcifications. The aim of this study was to present, through three cases and a review of the literature, the benefit of PR in the diagnosis of carotid calcifications and the approaches to be followed in case of such suspicious images. This would contribute, in some cases, to an early diagnosis and management, thus avoiding the evolution towards cerebral vascular accidents.
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Affiliation(s)
- Olfa Zaghden
- Department of Radiology, University Dental Clinic, University of Monastir, Monastir, Tunisia
| | - Rawia Jaziri
- Department of Radiology, University Dental Clinic, University of Monastir, Monastir, Tunisia
| | - Rym Kammoun
- Department of Radiology, University Dental Clinic, University of Monastir, Monastir, Tunisia
- Laboratory of Histology and Embryology, Faculty of Dental Medicine of Monastir, University of Monastir, Monastir, Tunisia
- ABCDF Laboratory for Biological Clinical and Dento-Facial Approach, University of Monastir, Monastir, Tunisia
| | - Imen Chaabani
- Department of Radiology, University Dental Clinic, University of Monastir, Monastir, Tunisia
- Unity of Bioactive Natural Substances and Biotechnology, Faculty of Dental Medicine, University of Monastir, Monastir, Tunisia
| | - Touhami Ben Alaya
- Department of Radiology, University Dental Clinic, University of Monastir, Monastir, Tunisia
- Unity of Bioactive Natural Substances and Biotechnology, Faculty of Dental Medicine, University of Monastir, Monastir, Tunisia
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Wang X, Chen X, Chen Z, Zhang M. Arterial Calcification and Its Association With Stroke: Implication of Risk, Prognosis, Treatment Response, and Prevention. Front Cell Neurosci 2022; 16:845215. [PMID: 35634461 PMCID: PMC9130460 DOI: 10.3389/fncel.2022.845215] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/28/2022] [Indexed: 01/07/2023] Open
Abstract
Stroke is a leading cause of death worldwide. Vascular calcification (VC), defined as deposition of calcium-phosphate complexes in the vessels, is considered as the characteristic of vascular aging. Calcifications at different vessel layers have different implications. Intimal calcification is closely related to atherosclerosis and affects plaque stability, while medial calcification can cause arterial stiffening and reduce compliance. Accumulating evidence suggested that arterial calcifications, including calcifications in the intracranial artery, coronary artery, and carotid artery, are associated with the risk, prognosis, and treatment response of stroke. VC can not only serve as a marker of atherosclerosis, but cause cerebral hemodynamic impairment. In addition, calcifications in large arteries are associated with cerebral small vessel disease. In this review, we summarize the findings of recently published studies focusing on the relationship between large artery calcification and the risk, prognosis, treatment response, and prevention of stroke and also discuss possible mechanisms behind those associations.
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Affiliation(s)
- Xiang Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xinghang Chen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zhuohui Chen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Mengqi Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Mengqi Zhang,
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Gustafsson N, Ahlqvist J, Norhammar A, Näslund U, Rydén L, Wester P, Levring Jäghagen E. Association of high cardiovascular risk and diabetes with calcified carotid artery atheromas depicted on panoramic radiographs. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:88-99. [PMID: 34305040 DOI: 10.1016/j.oooo.2021.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/01/2021] [Accepted: 06/11/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate whether estimates of risk of future cardiovascular events and death and established or unknown diabetes are significantly associated with calcified carotid artery atheromas (CCAAs) on panoramic radiographs (PRs). The main focus was on men and women without previous myocardial infarction (MI). METHODS The PAROKRANK (Periodontitis and its Relation to Coronary Artery Disease) study included patients with a first MI and matched control subjects. In this substudy, 738 patients (138 women) and 744 control subjects (144 women) with available PRs were assessed for CCAA. Cardiovascular risk estimates were determined according to the Framingham Risk Score (FRS) and Systematic COronary Risk Evaluation (SCORE). Established and previously unknown diabetes was also determined. RESULTS CCAA was detected on PRs in 206 control subjects (28%) and 251 patients (34%). FRS was significantly associated with CCAA among control subjects (P = .04) and patients (P = .001). SCORE was associated with CCAA among control subjects (P < .01) but not patients (P = .07). Among men, FRS and SCORE were associated with CCAA in both control subjects and patients. Diabetes was not significantly associated with CCAA after adjustments. CONCLUSIONS Elevated cardiovascular risk scores were associated with CCAA on PRs among control subjects. Diabetes was not independently associated with CCAA, possibly owing to selection bias.
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Affiliation(s)
- Nils Gustafsson
- Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Umeå, Sweden.
| | - Jan Ahlqvist
- Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Umeå, Sweden
| | - Anna Norhammar
- Department of Medicine K2, Karolinska Institutet, Solna, Sweden; Capio S:t Göran's Hospital, Stockholm, Sweden
| | - Ulf Näslund
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institutet, Solna, Sweden
| | - Per Wester
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Eva Levring Jäghagen
- Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Umeå, Sweden
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Sinjab A, Soman C, Sahab L. Prevalence of carotid artery calcifications in Riyadh from digital panoramic radiographs and its relationship with cardiovascular disorders: A retrospective cross-sectional study. SAUDI JOURNAL OF ORAL SCIENCES 2021. [DOI: 10.4103/sjos.sjoralsci_78_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Can carotid artery calcifications on dental radiographs predict adverse vascular events? A systematic review. Clin Oral Investig 2020; 25:37-53. [PMID: 33245449 DOI: 10.1007/s00784-020-03696-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To investigate the predictive value of carotid artery calcifications (CACs) seen on dental imaging for future adverse events related to cerebrovascular and cardiovascular diseases. METHODS Electronic databases (PubMed, Embase, SCOPUS and Cochrane) and selected grey literature were searched. Outcomes included stroke, transient ischaemic attack (TIA), myocardial infarction (MI), angina, heart failure, future interventional revascularization procedures and death. Risk of bias was assessed using the Newcastle-Ottawa Scale. RESULTS 5 studies were selected from 1011 records. All were of moderate to low risk of bias. Results were heterogeneous but showed that patients with CACs on panoramic radiographs (PANs) were more likely to experience strokes, TIA, MI and future revascularization procedures compared to control groups. The differences between groups were not all found to be statistically significant. Bilateral vessel-outlining CACs were an independent risk marker for future vascular events. Patients who are not currently being managed for cardiovascular risk factors should be referred for further evaluation. Those already being treated for atherosclerosis may not benefit from additional investigations. CONCLUSION The evidence for the predictive value of CACs on PANs for adverse future vascular events is equivocal but can help to identify at-risk patients who require further evaluation. CLINICAL RELEVANCE Dentists must be able to recognize CACs on PANs and make appropriate referrals for patients to be evaluated for cardiovascular risk factors, especially those who have not previously been assessed.
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Gustafsson N, Ahlqvist J, Näslund U, Buhlin K, Gustafsson A, Kjellström B, Klinge B, Rydén L, Levring Jäghagen E. Associations among Periodontitis, Calcified Carotid Artery Atheromas, and Risk of Myocardial Infarction. J Dent Res 2019; 99:60-68. [DOI: 10.1177/0022034519885362] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Cardiovascular disease is a common cause of morbidity and premature mortality. Cardiovascular disease can be prevented when risk factors are identified early. Calcified carotid artery atheromas (CCAAs), detected in panoramic radiographs, and periodontitis have both been associated with increased risk of cardiovascular disease. This case-control study aimed to 1) investigate associations between periodontitis and CCAA detected in panoramic radiographs and 2) determine the risk of future myocardial infarctions due to CCAA combined with periodontitis. We evaluated 1,482 participants (738 cases and 744 controls) with periodontitis and CCAAs recruited from the PAROKRANK study (Periodontitis and Its Relation to Coronary Artery Disease). Participants were examined with panoramic radiographs, including the carotid regions. Associations between myocardial infarction and periodontitis combined with CCAA were evaluated in 696 cases and 696 age-, sex-, and residential area–matched controls. Periodontitis was evaluated radiographically (as degree of bone loss) and with a clinical periodontal disease index score (from clinical and radiographic assessments). We found associations between CCAA and clinical periodontal disease index score among cases (odds ratio [OR], 1.51; 95% CI, 1.09 to 2.10; P = 0.02) and controls (OR, 1.70; 95% CI, 1.22 to 2.38; P < 0.01), although not between CCAA and the degree of bone loss. In a multivariable model, myocardial infarction was associated with CCAA combined with periodontitis, as assessed by degree of bone loss (OR, 1.75; 95% CI, 1.11 to 2.74; P = 0.01). When the cohort was stratified by sex, only men showed a significant association between myocardial infarction and CCAA combined with periodontitis. Participants with clinically diagnosed periodontitis exhibited CCAA in panoramic radiographs more often than those without periodontitis, irrespective of the presence of a recent myocardial infarction. Participants with combined periodontitis and CCAA had a higher risk of having had myocardial infarction as compared with participants with either condition alone. These findings implied that patients in dental care might benefit from dentists assessing panoramic radiographs for CCAA—particularly, patients with periodontitis who have not received any preventive measures for cardiovascular disease.
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Affiliation(s)
- N. Gustafsson
- Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Umeå, Sweden
| | - J. Ahlqvist
- Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Umeå, Sweden
| | - U. Näslund
- Heart Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - K. Buhlin
- Periodontology, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - A. Gustafsson
- Periodontology, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - B. Kjellström
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - B. Klinge
- Periodontology, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Periodontology, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - L. Rydén
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - E. Levring Jäghagen
- Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Umeå, Sweden
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Garoff M, Ahlqvist J, Edin LT, Jensen S, Levring Jäghagen E, Petäjäniemi F, Wester P, Johansson E. Bilateral vessel-outlining carotid artery calcifications in panoramic radiographs: an independent risk marker for vascular events. BMC Cardiovasc Disord 2019; 19:225. [PMID: 31619183 PMCID: PMC6796463 DOI: 10.1186/s12872-019-1211-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 09/26/2019] [Indexed: 12/27/2022] Open
Abstract
Background In odontology, panoramic radiographs (PRs) are regularly performed. PRs depict the teeth and jaws as well as carotid artery calcifications (CACs). Patients with CACs on PRs have an increased risk of vascular events compared to healthy controls without CACs, but this association is often caused by more vascular events and risk factors at baseline. However, the risk of vascular events has only been analyzed based on the presence of CACs, and not their shape. Thus, this study determined if the shape of CACs in PRs affects the risk of future vascular events. Methods The study cohort included 117 consecutive patients with CACs in PRs and 121 age-matched controls without CACs. CAC shape in PRs was dichotomized into bilateral vessel-outlining CACs and other CAC shapes. Participants were followed prospectively for an endpoint of vascular events including myocardial infarction, stroke, and vascular death. Results Patients with bilateral vessel-outlining CACs had more previous vascular events than those with other CAC shapes and the healthy controls (p < 0.001, χ2). The mean follow-up duration was 9.5 years. The endpoint was reached in 83 people. Patients with bilateral vessel-outlining CACs had a higher annual risk of vascular events (7.0%) than those with other CAC shapes (4.4%) and the controls (2.6%) (p < 0.001). In multivariate analysis, bilateral vessel-outlining CACs (hazard ratio: 2.2, 95% confidence interval: 1.1–4.5) were independent risk markers for the endpoint. Conclusions Findings of bilateral vessel-outlining CACs in PRs are independent risk markers for future vascular events.
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Affiliation(s)
- Maria Garoff
- Department of Odontology/Oral and Maxillofacial Radiology, Umeå University, SE-901 87, Umeå, Sweden.
| | - Jan Ahlqvist
- Department of Odontology/Oral and Maxillofacial Radiology, Umeå University, SE-901 87, Umeå, Sweden
| | - Linda-Tereza Edin
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Sofia Jensen
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Eva Levring Jäghagen
- Department of Odontology/Oral and Maxillofacial Radiology, Umeå University, SE-901 87, Umeå, Sweden
| | - Fredrik Petäjäniemi
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Per Wester
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Department of Clinical Sciences, Danderyd hospital, Stockholm, Sweden
| | - Elias Johansson
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden.,Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
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Barut O, Ahlqvist J, Garoff M, Johansson E, Johansson M, Wester P, Levring Jäghagen E. Calcifications in the neck region of patients with carotid artery stenosis: a computed tomography angiography study of topographic anatomy. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 129:523-530. [PMID: 31932251 DOI: 10.1016/j.oooo.2019.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 09/15/2019] [Accepted: 09/28/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of this study was to map the vertical locations of calcified carotid plaques (CCPs), osseous anatomic structures, and calcified soft tissues in the area of the carotid artery, determine to what extent CCPs are superimposed on the cervical spine in coronal images, and analyze the differences between men and women. STUDY DESIGN Computed tomography angiography (CTA) scans of 79 patients were studied. CCPs were discovered in 152 of the total 158 neck sides. Evaluations were performed by using sagittal and coronal reformatted CTA images with maximum intensity projection. RESULTS Most of the calcified anatomic structures studied, including the carotid bifurcation, were found in close relationship to the level of the third and fourth cervical vertebrae. In the coronal view, all or most of the areas of the CCPs were superimposed on the cervical spine in 22 of 44 (50%) neck sides with CCP in women and in 37 of 108 (34.2%) in men (P = .070). CONCLUSIONS The carotid bifurcation is in close proximity to various calcified anatomic structures. This should be taken into account when diagnosing CCPs in panoramic radiographs. In the coronal view, CCPs and the cervical spine are often superimposed; thus, coronal images are not recommended for confirmation of putative carotid calcifications diagnosed on the basis of panoramic radiographs.
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Affiliation(s)
- Oya Barut
- Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Sweden.
| | - Jan Ahlqvist
- Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Sweden
| | - Maria Garoff
- Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Sweden
| | - Elias Johansson
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Sweden; Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Magnus Johansson
- Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Sweden
| | - Per Wester
- Department of Public Health and Clinical Medicine, Umeå University, Sweden; Department of Clinical Sciences, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden
| | - Eva Levring Jäghagen
- Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Sweden
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Schroder AGD, de Araujo CM, Guariza-Filho O, Flores-Mir C, de Luca Canto G, Porporatti AL. Diagnostic accuracy of panoramic radiography in the detection of calcified carotid artery atheroma: a meta-analysis. Clin Oral Investig 2019; 23:2021-2040. [PMID: 30923911 DOI: 10.1007/s00784-019-02880-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 02/07/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the diagnostic accuracy of panoramic radiography (PR) in detecting calcified carotid artery atheroma (CCAA) compared with Doppler ultrasonography or angiography (the reference standard). SOURCES Cochrane, LILACS, PubMed, Scopus, Web of Science, Google Scholar, Open Grey, and ProQuest were searched. The reference lists of the included studies were also screened. DATA Observational studies. METHODS Only studies comparing the diagnostic accuracy of PR in detecting CCAA to Doppler ultrasonography or angiography (the reference standard) were included. The primary outcome measures were sensitivity and specificity. The secondary outcomes were negative predictive values, positive predictive values, diagnostic odds ratios, likelihood ratios (positive and negative), receiver operating characteristic curves, accuracy, and Youden's index. Two reviewers independently participated in the study selection, data extraction, and risk of bias assessment without language restriction. Risk of bias was assessed thought QUADAS-2, and the level of evidence was assessed through GRADE. RESULTS A total of 773 citations were identified after duplicates were removed, and 12 studies including 1002 patients were included in the final study. The sensitivity and specificity of the different selected studies varied substantially, with sensitivity ranging from 0.31 to 0.95 and specificity from 0.19 to 0.99. CONCLUSIONS Most studies reported excellent sensitivity and good specificity. The diagnostic accuracy of PR was good or excellent in 50% of the studies. CLINICAL SIGNIFICANCE The identification of CCAA by PR can be a risk predictor for stroke when used as a secondary screening tool.
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Affiliation(s)
| | | | - Odilon Guariza-Filho
- Department of Orthodontics, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil. .,School of Health and Bioscience, Department of orthodontics, Pontifícia Universidade Católica do Paraná, Street Imaculada Conceição, 1155, Prado Velho, Curitiba, PR, 80215-901, Brazil.
| | | | - Graziela de Luca Canto
- Brazilian Centre for Evidence-based Research, Department of Dentistry, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - André Luís Porporatti
- Brazilian Centre for Evidence-based Research, Department of Dentistry, Federal University of Santa Catarina, Florianópolis, SC, Brazil
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Carotid calcifications in panoramic radiographs are associated with future stroke or ischemic heart diseases: a long-term follow-up study. Clin Oral Investig 2018; 23:1171-1179. [DOI: 10.1007/s00784-018-2533-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/19/2018] [Indexed: 10/28/2022]
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12
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Calcified carotid artery atheromas in panoramic radiographs are associated with a first myocardial infarction: a case-control study. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 125:199-204.e1. [PMID: 29242130 DOI: 10.1016/j.oooo.2017.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/10/2017] [Accepted: 10/23/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this case-control study was to investigate whether patients with a first myocardial infarction (MI) had a higher prevalence of calcified carotid artery atheromas (CCAAs) on panoramic radiographs (PRs) than age-, gender-, and residential area-matched controls without MI. STUDY DESIGN Six hundred ninety-six cases with a first MI and 696 controls were included in this substudy of the Swedish multicentre PAROKRANK study. All participants underwent panoramic radiography, and the PRs were evaluated for CCAAs. RESULTS The prevalence of CCAAs detected by PR was 33.8% (235 of 696) in cases and 27.6% (192 of 696) in controls (odds ratio [OR] 1.24; 95% confidence interval [CI] 1.04-1.44; P = .012). Among males, 32.7% of cases (184 of 562) and 26.5% of controls (149 of 562) displayed CCAAs on PRs (OR 1.24; 95% CI 1.03-1.48; P = .022). Among both genders, bilateral CCAAs were significantly more common among cases than among controls (P = .002). CONCLUSIONS Cases with recent MIs had a significantly higher prevalence of CCAAs on PRs compared with controls without MIs. This difference between groups was more pronounced for bilateral CCAAs. These findings supported the hypothesis that CCAA detection could serve as a risk indicator for future MIs.
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Markman RL, Conceição-Vasconcelos KG, Brandão TB, Prado-Ribeiro AC, Santos-Silva AR, Lopes MA. Calcified carotid artery atheromas on panoramic radiographs of head and neck cancer patients before and after radiotherapy. Med Oral Patol Oral Cir Bucal 2017; 22:e153-e158. [PMID: 28160583 PMCID: PMC5359713 DOI: 10.4317/medoral.21436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 10/24/2016] [Indexed: 11/23/2022] Open
Abstract
Background The aims of this study were to verify if head and neck radiotherapy (RT) is able to induce calcified carotid artery atheroma (CCAA) in a large head and neck cancer (HNC) population and also to compare the socio-demographic and clinical findings of patients with and without CCAA detected on panoramic radiographs. Material and Methods Panoramic radiographs taken before and after head and neck radiotherapy (RT) of 180 HNC patients were selected and analyzed in order to identify the presence of CCAA. In addition, CCAA presence or absence on panoramic radiographs were compared and correlated with clinicopathological findings. Results A high overall prevalence of CCAA was found on panoramic radiographs (63 out of 180 = 35%) of HNC patients. No significant difference of CCAA before and after RT was observed. There were also no differences between groups (with and without CCAA) regarding age, gender, tobacco and alcohol use, arterial hypertension, diabetes mellitus, acute myocardial infarction, hypercholesterolemia, tumor location, clinical stage of disease and RT dose. However, there was a greater prevalence of strokes in patients with CCAA (p<0.05). Conclusions Although CCAA were frequently found in panoramic radiographs of patients with HNC, RT seems not to alter the prevalence of these calcifications. Key words:Head and neck cancer, radiotherapy, carotid artery diseases, panoramic radiography.
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Affiliation(s)
- R-L Markman
- Av Limeira, 901, Bairro Areão, Piracicaba, CEP 13414-903, Department of Oral Diagnosis, Semiology Area, Piracicaba Dental School University of Campinas, São Paulo, Brazil,
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14
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Thanakun S, Pornprasertsuk-Damrongsri S, Izumi Y. C-reactive protein levels and the association of carotid artery calcification with tooth loss. Oral Dis 2016; 23:69-77. [DOI: 10.1111/odi.12575] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/20/2016] [Accepted: 08/22/2016] [Indexed: 12/13/2022]
Affiliation(s)
- S Thanakun
- Department of Oral Medicine and Periodontology; Faculty of Dentistry; Mahidol University; Bangkok Thailand
| | | | - Y Izumi
- Department of Periodontology; Graduate School of Medical and Dental Sciences; Tokyo Medical and Dental University; Tokyo Japan
- Global Center of Excellence Program for Tooth and Bone Research; Tokyo Medical and Dental University; Tokyo Japan
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15
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Garoff M, Ahlqvist J, Levring Jäghagen E, Johansson E, Wester P. Carotid calcification in panoramic radiographs: radiographic appearance and the degree of carotid stenosis. Dentomaxillofac Radiol 2016; 45:20160147. [PMID: 27124572 DOI: 10.1259/dmfr.20160147] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES: Approximately 7% of patients examined with panoramic radiographs (PRs) for odontological reasons, and with incidental findings of carotid artery calcification (CAC), have significant (≥50%) carotid stenosis (SCS). The aim of this study was to determine if the radiographic appearance of CACs in PRs could be categorized such that we could improve the positive-predictive value (PPV) for SCS detection. METHODS: This cross-sectional study included 278 patients with CACs identified by PRs, 127 with SCS and 151 without SCS. CACs were categorized based on the following appearances: (1) single, (2) scattered or (3) vessel-outlining. Correlates were derived for each category according to positivity or not for SCS in the corresponding neck sides. For a representative adult population (in dentistry) presenting with CACs in PRs, PPVs for SCS prediction were then calculated for three subgroups based on different combinations of appearances (2) and/or (3). RESULTS: Vessel-outlining CACs corresponded to 65% of neck sides with SCS vs 47% without SCS (p < 0.001). Single CACs corresponded to 15% of neck sides with SCS vs 27% without SCS (p = 0.006). Scattered CACs corresponded to 20% of neck sides with SCS vs 26% without SCS (p = 0.127). In the representative population, the PPVs for SCS detection were comparable (7.2-7.8%) for all three subgroups and when the presence of a CAC is the sole criterion (7.4%). CONCLUSIONS: Stratifying the radiographic appearance of CACs in PRs does not improve the PPV for SCS detection. Whether different radiographic appearances are associated with future risk of stroke, or other cardiovascular events, remains unknown.
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Affiliation(s)
- Maria Garoff
- 1 Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Sweden
| | - Jan Ahlqvist
- 1 Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Sweden
| | - Eva Levring Jäghagen
- 1 Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Sweden
| | - Elias Johansson
- 2 Department of Public Health and Clinical Medicine, Umeå University, Sweden.,3 Department of Pharmacology and Clinical Neuroscience, Umeå University, Sweden
| | - Per Wester
- 2 Department of Public Health and Clinical Medicine, Umeå University, Sweden.,4 Department of Clinical Sciences, Karolinska Insititutet, Danderyds Hospital, Stockholm, Sweden
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