1
|
Yang Y, Lin N, Xu Y, Niu Z, Meng F, Zhang K, Wang Y, Ruan L, Zhang L. Calcification detection on upper extremity arteries: a comparison of ultrasonic and X-ray methods. PeerJ 2023; 11:e15855. [PMID: 37637162 PMCID: PMC10460149 DOI: 10.7717/peerj.15855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/16/2023] [Indexed: 08/29/2023] Open
Abstract
Background Vascular calcification (VC) has been observed in patients with hemodialysis, whereas few studies have investigated calcification in the upper extremity vasculature. Both ultrasound and X-ray are used to investigate the calcification of arteries in patients. However, there is a lack of data on the consistency between these two methods. The aim of this study was to investigate the occurrence of VC in the radial and ulnar arteries of hemodialysis patients and investigate the detection consistency in VC between ultrasound and X-ray. Methods Ultrasound and X-ray examinations were performed in the radial and ulnar arteries of both the left and right upper extremities of 40 patients on hemodialysis. The calcification status of arteries was evaluated by the calcification index from ultrasound and X-ray respectively. Clinical variables of patients were collected from all the involved patients. Results Of the 40 patients, VC was detected in 31 patients by ultrasound, while X-ray detected VC in 22 patients. Compared to ultrasound assessment, X-ray assessment was 73.21% sensitive but only 66.35% specific with a positive predictive value of 53.95% for detecting calcifications in the radial or ulnar artery. The level of agreement between ultrasound and X-ray results was fair. In addition, our data showed that more ulnar arteries had VCs than the corresponding radial arteries. Conclusion Ultrasound is more sensitive in detecting the presence of calcified atherosclerotic lesions. Ultrasound and X-ray exhibited fair consistency. Ultrasound screening for upper extremity radial and ulnar arteries in hemodialysis patients may deserve attention to explore its clinical significance.
Collapse
Affiliation(s)
- Yanli Yang
- Department of Nephrology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Na Lin
- Department of Nephrology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuankai Xu
- Department of Nephrology, Zhejiang Hospital, Hangzhou, China
| | - Zheli Niu
- Department of Nephrology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Fulei Meng
- Department of Nephrology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Kaidi Zhang
- Department of Nephrology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuhuan Wang
- Department of Nephrology, The First Hospital of Shijiazhuang City, Shijiazhuang, China
| | - Lin Ruan
- Department of Nephrology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lihong Zhang
- Department of Nephrology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Kwon YE, An CH, Choi KS, An SY. Comparison of carotid artery calcification between stroke and nonstroke patients using CT angiographic and panoramic images. Dentomaxillofac Radiol 2022; 51:20210500. [PMID: 35925038 PMCID: PMC9717401 DOI: 10.1259/dmfr.20210500] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This study aimed to analyze the characteristics of carotid artery calcification (CAC) in stroke and nonstroke patients using computed tomography angiographic (CTA) and panoramic images. METHODS This is a retrospective study on patients who acquired both CTA and panoramic images at the Neurology Department of Kyungpook National University Hospital, Daegu, South Korea, between 2011 and 2016. The patients were divided into stroke (n = 109) and nonstroke (n = 355) groups based on the final diagnosis. CAC was analyzed in each group based on its presence, shape, and severity using the [Formula: see text]2 test. The differences in age and sex between the two groups were examined using a two-sample t-test. A measure of intraobserver reliability was obtained using Cohen's κ index. RESULTS CAC was more frequently observed in the stroke group than in the nonstroke group using both CTA (stroke group, 100%; nonstroke group, 23.1%) and panoramic (stroke group, 83.5%; nonstroke group, 16.6%) images. Although scattered CAC shape and mild severity occupied the largest portion in both groups, vessel-outlined CAC was more common in nonstroke patients than in stroke patients. In age and sex analyses, only females patients in their 70 s showed significant differences in CAC shape between the stroke and nonstroke groups. CONCLUSIONS On both CTA and panoramic images, although CAC is found more frequently in the stroke group, vessel-outlined-shaped CAC in the nonstorke group shows significant differences compared to other shapes.
Collapse
Affiliation(s)
- Young-Eun Kwon
- Doctor of dental clinic, 7 Promise Dental Clinic, Daegu, Republic of Korea
| | - Chang-Hyeon An
- Department of Oral and Maxillofacial Radiology, School of Dentistry, IHBR, Kyungpook National University, Daegu, Republic of Korea
| | - Karp-Shik Choi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
| | - Seo-Young An
- Department of Oral and Maxillofacial Radiology, School of Dentistry, IHBR, Kyungpook National University, Daegu, Republic of Korea
| |
Collapse
|
4
|
Janiszewska-Olszowska J, Jakubowska A, Gieruszczak E, Jakubowski K, Wawrzyniak P, Grocholewicz K. Carotid Artery Calcifications on Panoramic Radiographs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14056. [PMID: 36360932 PMCID: PMC9654866 DOI: 10.3390/ijerph192114056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/23/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the prevalence of carotid artery calcifications (CACs) on panoramic radiographs of Polish dental patients. METHODS Panoramic radiographs made between 2005 and 2012 in 4000 patients born between 1922 and 1958 were accessed from the server of the Department of Radiology and analyzed for the presence or absence of CACs by a group of trained dentists. RESULTS The anatomical area covered by the analysis was visible in 2189 images (54.73%). Calcifications in the carotid arteries were found in 468 (21.68%) patients, including 327 (14.94%) unilaterally and 141 (6.44%) bilaterally. CACs were found in 284 (60.68%) women and 184 (39.32%) men. CONCLUSIONS The prevalence rate of CACs detected on panoramic radiographs in patients aged 54 and older was 21.68%, which makes it an important clinical problem.
Collapse
Affiliation(s)
| | | | | | | | | | - Katarzyna Grocholewicz
- Department of Interdisciplinary Dentistry, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland
| |
Collapse
|
5
|
Fitzgerald J, Ziegler ME, Green PT, Neville BW. Calcified facial and maxillary arteries: Incidental radiographic findings indicative of Mönckeberg arteriosclerosis. J Am Dent Assoc 2021; 152:943-946. [PMID: 34373081 DOI: 10.1016/j.adaj.2021.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/22/2020] [Accepted: 04/26/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OVERVIEW Mönckeberg arteriosclerosis is a disease of unknown etiology characterized by dystrophic calcifications within the tunica media of small- and medium-sized arteries, leading to reduced arterial compliance. The authors report a case discovered incidentally on dental radiographs. CASE DESCRIPTION A 78-year-old man with a complex medical history was seen for routine oral health care. Panoramic and bite-wing radiographs revealed a tortuous, linear calcification in the area of the left mandibular first molar anterior to the angle of the mandible and suggestive of a calcified facial artery. CONCLUSIONS AND PRACTICAL IMPLICATIONS Medical radiologists have used the presence of arterial calcifications to determine the severity and prognosis of such diseases as primary hyperparathyroidism, secondary hyperparathyroidism, coronary artery disease, and diabetes. The presence of Mönckeberg arteriosclerosis on dental radiographs can help oral health care professionals identify patients with undiagnosed systemic disease.
Collapse
|
6
|
Chang TI, Wu X, Boström KI, Tran HA, Couto-Souza PH, Friedlander AH. Panoramic imaged carotid atheromas are associated with increased neutrophil count: both validated, independent predictors of near-term myocardial infarction. Dentomaxillofac Radiol 2021; 50:20210045. [PMID: 34111366 DOI: 10.1259/dmfr.20210045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Panoramic images (PXs) demonstrating calcified carotid artery atheromas (CCAAs) are associated with heightened risk of near-term myocardial infarction (MI). Elevated neutrophil counts (NC) within normal range 2,500-6,000 per mm3 are likewise associated with future MI signaling the role neutrophils play in the chronic inflammation process underlying coronary artery atherogenesis. We determined if CCAAs on PXs are associated with increased NC. METHODS Investigators implemented a retrospective study of PXs and accompanying medical records of white males ≥ 65 years treated by a VA dental service. Two groups (N = 60 each) were constituted, one with atheromas (CCAA+) and one without (CCAA-). Predictor variable was CCAA + and outcome variable was NC. Bootstrapping analysis determined the difference in mean NCs between two groups, significance set at ≤0.05. RESULTS The study group of (CCAA+) (mean age 75.9; range 69-91 years) demonstrated a mean NC of 4,843 per mm3 and control group (CCAA-) (mean age 75.3; range; 66-94) a mean NC of 4,108 per mm3. The difference between the groups was significant (p = 0.0008) (95% CI of difference of mean: -432, 431; observed effect size 736). CONCLUSIONS CCAAs on PXs of elderly white males are associated with elevated NC; amplifying need for medical consultation prior to invasive dental procedures.
Collapse
Affiliation(s)
- Tina I Chang
- Inpatient Oral and Maxillofacial Surgery, Veterans Affairs Great Los Angeles Healthcare System, Los Angeles, CA, USA.,Oral and Maxillofacial Surgery, School of Dentistry, University of California, Los Angeles, CA, USA
| | - Xiuju Wu
- Division of Cardiology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Kristina I Boström
- Cardiology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Medicine/Cardiology, David Geffen School of Medicine at UCLA and at the Molecular Biology Institute, University of California, Los Angeles, CA, USA
| | - Hoang-Anh Tran
- Periodontology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Paulo Henrique Couto-Souza
- Maxillofacial Radiology, Dentistry/School of Life Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Arthur H Friedlander
- Maxillofacial Surgery & Medicine, Dental Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Quality Assurance Hospital Dental Service, Ronald Reagan UCLA Medical Center and Professor-in-Residence of Oral and Maxillofacial Surgery, School of Dentistry, University of California, Los Angeles, CA, USA
| |
Collapse
|
7
|
Carasso S, Porat Ben Amy D, Issawy M, Kusniec F, Ghanim D, Sudarsky D, Elbaz-Greener G, Kinany W, Shmuel C, Abu El-Naaj I, Kachel E, Amir O. The association between carotid calcium on dental panoramic radiographs and coronary calcium score on chest computerized tomography. Dentomaxillofac Radiol 2021; 50:20200174. [PMID: 32755409 DOI: 10.1259/dmfr.20200174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Coronary artery calcium measured by CT predicts future coronary events. Similarly, carotid artery calcium on dental panoramic radiographs has been associated with increased cardiovascular events. Pre-procedural assessment of candidates for valve replacement in our institution includes panoramic radiographs and chest tomography. We aimed to assess the association of carotid calcium on panoramic radiographs with coronary artery calcium on chest tomography. METHODS Paired pre-procedural panoramic radiographs and chest tomography scans were done in 177 consecutive patients between October 2016 and October 2017. Carotid calcium was quantified using NIH's ImageJ. Coronary artery calcium was quantified by the Agatston score using Philips Intellispace portal, v. 8.0.1.20640. RESULTS Carotid calcium maximal intensity, area and perimeter were higher among patients with high coronary artery calcium. Non-zero carotid calcium was found in half of patients with high coronary artery calcium, doubling prevalence of low coronary artery calcium. CONCLUSION Carotid calcium identified in panoramic radiographs was associated with high coronary artery calcium. Awareness of carotid calcium recognized by dental practitioners in low-cost, low radiation and commonly done panoramic radiographs may be useful to identify patients at risk of coronary disease with potential future cardiovascular events.
Collapse
Affiliation(s)
- Shemy Carasso
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee, Israel.,The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Dalit Porat Ben Amy
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.,Oral Medicine Unit, B Padeh Medical Center, Poriya, Lower Galilee, Israel
| | - Mariana Issawy
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Fabio Kusniec
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee, Israel.,The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Diab Ghanim
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee, Israel.,The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Doron Sudarsky
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee, Israel.,The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Gabby Elbaz-Greener
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee, Israel.,The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.,Heart Institute, Hadassah Medical Center, Jerusalem, Israel
| | - Wadi Kinany
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee, Israel.,The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Chen Shmuel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.,Oral Medicine Unit, B Padeh Medical Center, Poriya, Lower Galilee, Israel
| | - Imad Abu El-Naaj
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.,Department of Oral and Cranio-maxillofacial surgery, B Padeh Medical Center, Poriya, Lower Galilee, Israel
| | - Erez Kachel
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee, Israel.,The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Offer Amir
- Division of Cardiovascular Medicine, B Padeh Medical Center, Poriya, Lower Galilee, Israel.,The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.,Heart Institute, Hadassah Medical Center, Jerusalem, Israel
| |
Collapse
|
8
|
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
|
9
|
Akkemik O, Kazaz H, Tamsel S, Dündar N, Sahinalp S, Ellidokuz H. A 5 years follow-up for ischemic cardiac outcomes in patients with carotid artery calcification on panoramic radiographs confirmed by doppler ultrasonography in Turkish population. Dentomaxillofac Radiol 2020; 49:20190440. [PMID: 32058807 DOI: 10.1259/dmfr.20190440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of digital panoramic radiograph (DPR) for detection of carotid artery calcification (CAC) confirmed by Doppler Ultrasonography (DUSG) and to clarify the relationship between between CAC identified by DPR and cardiovascular events through a 5 year follow-up period. METHODS Of 3600 consecutive patients examined, 158 patients presented with CAC as detected by DPR. The final study group was composed of 96 patients who had CAC confirmed by DUSG or CT angiogram. The control group was composed of 62 patients who has normal DUSG. The end point of the study was the occurrence of any cardiovascular event. RESULTS 72 (75%) of the 96 patients with CAC confirmed by DUSG (16 patients had significant stenosis) had bilateral and 24 (25%) had unilateral CAS as detected by DUSG. There was a low agreement between the examination results with a κ value of 0.488 (p < 0.005) for calcification. Study data revealed that smoking, chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM) and diastolic hypertension were significantly more common in patients with CAC than the control group (p < 0.05). During the follow-up period, 13 subjects had myocardial infarction and 1 subject died; in the control group, 1 patient died after MI and 1 patient died of a non-cardiac event. CONCLUSION Patients with CAC detectable by DPR concomitant with COPD, DM, smoking or diastolic hypertension are more likely to suffer from vascular events. Therefore, patients with detectable carotid plaque in DPR require referral to a cardiovascular surgery clinic for further investigations.
Collapse
Affiliation(s)
- Ozlem Akkemik
- Dept. of Maxillofacial Radiology, Faculty of Dentistry, Yeni Yuzyil University, Istanbul, Turkey
| | - Hakkı Kazaz
- Dept. of Cardiovascular Surgery, Private Western Anatolia Central Hospital, Izmir, Turkey
| | - Sadik Tamsel
- Dept. of Radiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Nesrin Dündar
- Dept. of Maxillofacial Radiology, Faculty of Dentistry, Ege University, Izmir, Turkey
| | - Sahin Sahinalp
- Dept. of Cardiovascular Surgery, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
| | - Hulya Ellidokuz
- Dept. of Biostatistics and Medical Informatics, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| |
Collapse
|
10
|
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: 11] [Impact Index Per Article: 2.2] [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.
Collapse
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
| |
Collapse
|
11
|
Freire JL, França SR, Teixeira FW, Fonteles FA, Chaves FN, Sampieri MB. Prevalence of calcification of the head and neck soft tissue diagnosed with digital panoramic radiography in Northeast Brazilian population. ACTA ACUST UNITED AC 2019; 68:17-24. [DOI: 10.23736/s0026-4970.18.04187-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
12
|
Assessment of carotid calcifications on digital panoramic radiographs: Retrospective analysis and review of the literature. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2017; 119:102-106. [PMID: 29158070 DOI: 10.1016/j.jormas.2017.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 11/03/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To assess the validity of digital panoramic radiographs as an effective means of diagnosis for atherosclerosis and as a potential aid in the early detection of the disease. STUDY DESIGN We reviewed 2014 digital panoramic radiographs taken throughout 2012 and 2013 to identify the presence of calcified atherosclerotic plaques of both female and male patients all aged over 18 years. In addition the medical records of these patients were reviewed in order to establish if there were any predisposing risk factors for atherosclerosis. Statistical analysis was performed to identify any possible link between radiographic atherosclerotic plaques and predisposing risk factors for atherosclerosis using univariate and multivariate models. Statistical significance criteria was defined as P<0.05. RESULTS Out of 2014 patients (1149 female and 865 male), 191 (9.5%) were determined to have calcified atherosclerotic plaques on panoramic radiography. There was a statistically significant relationship between the presence of calcified atherosclerotic plaques and the established risk factors of atherosclerosis such as gender (OR=2.39, P<0.001), age (OR=1.5, P<0.001), stroke (OR=5.38, P<0.001) and hypertension (OR=2.11, P<0.001). CONCLUSION To our knowledge this is the largest study investigating atherosclerotic plaques on digital panoramic radiographs ever carried out in Portugal. Dental practitioners need to be aware of these incidental findings and to consider referring these patients for further investigations to confirm diagnosis.
Collapse
|
13
|
Soares ADS, Wanzeler AMV, Oliveria Renda MD, Marinho CG, Tuji FM. Cone-Beam Computed Tomography Findings in the Early Diagnosis of Calcified Atheromas. J Oral Maxillofac Surg 2016; 75:143-148. [PMID: 27444103 DOI: 10.1016/j.joms.2016.06.179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 06/17/2016] [Accepted: 06/18/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Computed tomograms of the mandibles of 285 patients with indications for dental implants were evaluated at a private clinic. MATERIALS AND METHODS This study involved the evaluation of 285 cone-beam computed tomograms of patients 50 to 75 years of age who were referred to the clinic for the evaluation for implant placement images with visible C3 and C5 vertebrae that were obtained using the same I-Cat tomographic device (Imaging Sciences-Kavo, Hatfield, PA). Atheromas in the carotid space were visualized using paraxial images. RESULTS Data were analyzed using Student t and χ2 tests, with a significance level of a P value less than or equal to .05. Atheromas in the carotid space were observed in 17.89% of patients; a significant difference in the incidence of atheromas was observed between men (24.27%) and women (14.29%; P = .034). However, no significant correlation was found between the frequency of occurrence of atheromas and the affected side of the carotid bifurcation (right or left) in women (P = .431) or men (P = .558). CONCLUSION Based on these results, cone-beam computed tomography could be a useful tool for the diagnosis of atheroma.
Collapse
Affiliation(s)
- Artur Dos Santos Soares
- Implantodontics Specialist, Department of Oral Radiology, Postgraduate Program in Dentistry, Federal University of Pará, Belém, PA, Brazil.
| | - Ana Márcia Viana Wanzeler
- Radiology Specialist, Department of Oral Radiology, Postgraduate Program in Dentistry, Federal University of Pará, Belém, PA, Brazil
| | | | - Cláudia Gemaque Marinho
- Radiology Specialist, Department of Oral Radiology, Postgraduate Program in Dentistry, Federal University of Pará, Belém, PA, Brazil
| | - Fabrício Mesquita Tuji
- Radiology Specialist, Department of Oral Radiology, Postgraduate Program in Dentistry, Federal University of Pará, Belém, PA, Brazil
| |
Collapse
|
14
|
Friedlander AH, Giaconi JA, Tsui I, Aghazadehsanai N, Chang TI, Garrett NR. Meaningful correlation between asymptomatic retinal arteriole emboli and calcified carotid plaque found on panoramic dental imaging of males with diabetes. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121:434-40. [PMID: 26972542 DOI: 10.1016/j.oooo.2015.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/01/2015] [Accepted: 12/14/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE There is ongoing controversy with regard to the stability of calcified carotid artery plaques (CCAPs) seen in the bifurcation area on panoramic images (PIs). Therefore, we sought to evaluate the possibility of these plaques shedding emboli by observing their relationship with ipsilateral retinal emboli. STUDY DESIGN The study group included 50 neurologically and visually asymptomatic males with diabetes, with PIs that incidentally demonstrated CCAPs (CCAP+) and contemporaneous digital retinal images that had been obtained for evaluation of diabetic retinopathy. The control group consisted of 50 males with diabetes who were matched for age and body mass index and had undergone both imaging studies and whose PIs were devoid of carotid plaques (CCAP-). The presence of retinal emboli was determined by two ophthalmologists blinded to the patients' medical histories, and the prevalence rates for the two groups were calculated. RESULTS The presence of asymptomatic retinal arteriolar emboli was found in the eye ipsilateral to the radiographically observed carotid atheroma in 10 of 50 (20%) of the patients in the CCAP+ group, compared with 2 of 50 (4%) in the CCAP- group, and this difference was statistically significant (Fisher's exact P < .03). CONCLUSIONS Some male patients with diabetes mellitus type II having calcified carotid artery atheromas in the bifurcation area, as visualized on PIs, may have significant sequelae as evidenced by retinal artery emboli.
Collapse
Affiliation(s)
- Arthur H Friedlander
- Associate Chief of Staff and Director of Graduate Medical Education, Veterans Affairs Greater Los Angeles Healthcare System; Director of Quality Assurance, Hospital Dental Service, Ronald Reagan UCLA Medical Center; Professor-in-Residence of Oral and Maxillofacial Surgery, School of Dentistry, University of California, Los Angeles, CA, USA.
| | - JoAnn A Giaconi
- Chief of Ophthalmology, Veterans Affairs Greater Los Angeles Healthcare System; Associate Clinical Professor at the UCLA Jules Stein Eye Institute, Los Angeles, CA, USA
| | - Irena Tsui
- Staff Ophthalmologist, Veterans Affairs Greater Los Angeles Healthcare System and Assistant Professor at the UCLA Jules Stein Eye Institute, Los Angeles, CA, USA
| | - Nona Aghazadehsanai
- Oral and Maxillofacial Surgery Research Fellow, Veterans Affairs, Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Tina I Chang
- Director of the Research Fellowship and Inpatient Oral and Maxillofacial Surgery, Veterans Affairs Greater Los Angeles Healthcare System; Instructor of Oral and Maxillofacial Surgery, School of Dentistry, University of California, Los Angeles, CA, USA
| | - Neal R Garrett
- Professor Emeritus, School of Dentistry, University of California, Los Angeles, CA, USA
| |
Collapse
|
15
|
Kamak G, Yildirim E, Rencber E. Evaluation of the relationship between periodontal risk and carotid artery calcifications on panoramic radiographs. Eur J Dent 2016; 9:483-489. [PMID: 26929685 PMCID: PMC4745228 DOI: 10.4103/1305-7456.172614] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective: To evaluate if there is a relationship between findings of carotid artery calcification (CAC) and periodontal risk in nonsmoker subjects by using panoramic radiographs (DPR). Materials and Methods: A total of 1146 DPRs were investigated. Gender, age, severity of bone loss, tooth loss, periodontal risk, and findings of carotid calcification were recorded. The periodontal risk was evaluated and classified according to the degree of alveolar bone loss. Results: CAC was diagnosed in %13.6 (n: 156) of DPRs. Of 1146 patients, 338 (29.5%) had low, 668 (60%) had moderate, and 120 (10.5%) had high periodontal risk. A statistically significant relation was observed between carotid calcification and periodontal risk. Conclusion: Positive findings of carotid calcification may be related with periodontal problems. Clinicians must be careful about diagnosing CACs on DPRs during routine examinations. In the case of positive findings of CAC and periodontitis together, the patient may be consulted to a specialist for further investigation.
Collapse
Affiliation(s)
- Gulen Kamak
- Department of Periodontology, Faculty of Dentistry, Kirikkale University, Kirikkale, Turkiye
| | - Eren Yildirim
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Kirikkale University, Kirikkale, Turkiye
| | - Emin Rencber
- Department of Public Health, School of Medicine, Ondokuz Mayıs University, Samsun, Turkiye
| |
Collapse
|
16
|
Barona-Dorado C, Gutierrez-Bonet C, Leco-Berrocal I, Fernández-Cáliz F, Martínez-González JM. Relation between diagnosis of atheromatous plaque from orthopantomographs and cardiovascular risk factors. A study of cases and control subjects. Med Oral Patol Oral Cir Bucal 2016; 21:e66-71. [PMID: 26595828 PMCID: PMC4765754 DOI: 10.4317/medoral.20183] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/20/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In recent years the use of orthopantomography has been proposed as a low-cost, reliable and non-invasive diagnostic medium for detecting atheromatous plaque. The purpose of this study was to correlate the presence of carotid calcifications (atheroma) in orthopantomographs with specific risk factors for cerebrovascular accidents (previous cerebrovascular accidents, arterial hypertension, and diabetes). PATIENT AND METHODS The methods used in this observational study of cases and control subjects followed STROBE (Strengthening the Reporting of Observational studies in Epidemiology) recommendations. The study analyzed a total of 1,602 panoramic radiographs taken for dental diagnostic purposes between January 2010 and February 2014. The main variables analyzed were the incidence of atheromatous plaque and other cardiovascular risk factors. Epidat 3.1 statistical software was used to determine minimum sample sizes and the results were analyzed using PASW (Predictive Analytics Software) Statistics 10.0.0. RESULTS For all the variables analyzed, the correlation between radiographic detection of atheromatous plaque and the presence of cardiovascular disease risk factors was found to be statistically significant (RR>1.5). CONCLUSIONS The presence of cardiovascular risk factors is related to the incidence of radiopaque lesions at the carotid artery bifurcation, indicating the presence of atheromatous plaque.
Collapse
|
17
|
Yeluri G, Kumar CA, Raghav N. Correlation of dental pulp stones, carotid artery and renal calcifications using digital panoramic radiography and ultrasonography. Contemp Clin Dent 2015; 6:S147-51. [PMID: 26604565 PMCID: PMC4632214 DOI: 10.4103/0976-237x.166837] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: The human tissues continuously undergo modification as deposition of calcium (CA) salts either in an organized or disorganized pattern. The latter pattern usually occurs in the soft tissues such as in arteries, brain, kidneys, lungs, and dental pulp. The purpose of this study is to evaluate the presence of pulp calcification and carotid artery calcification (CDC) as a marker for renal calcification and altered serum biomarkers such as serum CA, phosphorus (P), and alkaline phosphatase (ALP). Materials and Methods: Digital panoramic radiographs of 50 patients with the presence of pulp stones and suspected CAC were subjected to carotid artery and renal ultrasonography (USG) examination for the presence of vascular calcification and also to evaluate the alterations in serum CA, P, and ALP levels. Data were analyzed statistically using Chi-square test. Results: Panoramic radiographs of 50 patients showed 88.28% of teeth with the presence of pulp stones stones and 91% carotid arteries with calcification. The sensitivity of panoramic radiograph was greater than that of USG (93.67%), but the specificity of USG was more than the panoramic radiograph (44.44%) in detecting CAC. The prevalence rate of renal calcification on USG was 92%. The statistical difference between the patients with or without alteration in serum Ca levels was not significant (χ2 = 0.581 and P = 0.446). On comparison of serum P and ALP, the difference was found to be statistically significant. Conclusion: Presence of pulp stones and CAC's on panoramic radiograph have remarkably proved to establish the chances of renal artery calcification associated with alterations in serum CA levels.
Collapse
Affiliation(s)
- Garima Yeluri
- Department of Oral Medicine and Radiology, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, Uttar Pradesh, India
| | - C Anand Kumar
- Department of Oral Medicine and Radiology, Vananchal Dental College and Hospital, Garhwa, Ranchi, Jharkhand, India
| | - Namita Raghav
- Department of Oral Medicine and Radiology, K.D. Dental College and Hospital, Mathura, Uttar Pradesh, India
| |
Collapse
|
18
|
Lee JS, Kim OS, Chung HJ, Kim YJ, Kweon SS, Lee YH, Shin MH, Yoon SJ. The correlation of carotid artery calcification on panoramic radiographs and determination of carotid artery atherosclerosis with ultrasonography. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:739-45. [DOI: 10.1016/j.oooo.2014.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/26/2014] [Accepted: 09/11/2014] [Indexed: 10/24/2022]
|
19
|
Bengtsson VW, Persson GR, Renvert S. Assessment of carotid calcifications on panoramic radiographs in relation to other used methods and relationship to periodontitis and stroke: a literature review. Acta Odontol Scand 2014; 72:401-12. [PMID: 24432815 DOI: 10.3109/00016357.2013.847489] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To assess the literature on carotid calcifications defined from panoramic radiographs (PMX) and concurrent diagnosis of stroke and periodontitis. MATERIALS AND METHODS A literature search screening for publications using search terms such as PMX and carotid calcification, stroke and periodontitis was performed in November 2012. RESULTS A total of 189 articles were retrieved, among which 30 were included in the review. The sensitivity for PMX findings of carotid calcifications (CC) compared to a diagnosis by Doppler sonography varied between 31.1-100%. The specificity for PMX findings of carotid calcifications compared to a diagnosis by Doppler sonography varied between 21.4-87.5%. Individuals with CC findings from PMX have more periodontitis and risk for stroke. CONCLUSIONS There is a shortage of well-designed studies in older dentate individuals assessing the associations between periodontitis and radiographic evidence of CC and in relation to stroke or other cardiovascular diseases. STATEMENT OF CLINICAL RELEVANCE: Carotid calcifications are prevalent in patients with periodontitis and such individuals may have an increased risk for stroke. The absence of signs of carotid calcification on panoramic radiographs is indicative of no calcification of carotid arteries.
Collapse
|
20
|
Ngamsom S, Arayasantiparb R, Pornprasertsuk-Damrongsri S, Sureephong B. Relationship between calcified carotid atheromas in digital panoramic radiographs and underlying systemic diseases in implant patients. ACTA ACUST UNITED AC 2014; 6:301-6. [DOI: 10.1111/jicd.12104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 03/27/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Supak Ngamsom
- Department of Oral and Maxillofacial Radiology; Faculty of Dentistry; Mahidol University; Bangkok Thailand
| | - Raweewan Arayasantiparb
- Department of Oral and Maxillofacial Radiology; Faculty of Dentistry; Mahidol University; Bangkok Thailand
| | | | | |
Collapse
|
21
|
Yoon SJ, Shim SK, Lee JS, Kang BC, Lim HJ, Kim MS, Kim SH. Interobserver agreement on the diagnosis of carotid artery calcifications on panoramic radiographs. Imaging Sci Dent 2014; 44:137-41. [PMID: 24944963 PMCID: PMC4061297 DOI: 10.5624/isd.2014.44.2.137] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 12/09/2013] [Accepted: 12/21/2013] [Indexed: 12/02/2022] Open
Abstract
Purpose This study was performed to investigate the interobserver agreement on the detection of carotid artery calcifications on panoramic radiographs. Materials and Methods This study consisted of panoramic radiographs acquired from 634 male patients of the age of 50 years or older. Having excluded carotids of no diagnostic quality, 1008 carotids from the panoramic radiographs of the patients were interpreted by two oral and maxillofacial radiologists independently for the presence of carotid artery calcifications. Statistical analysis was used to calculate the interobserver agreement. Results Interobserver agreement was obtained for 932 carotids (92.4%). Inconsistent interpretation of 76 carotids (7.5%) between the two observers was found. Cohen's kappa value was 0.688 (p<0.001). Conclusion The probability of a match between the two observers was substantially high.
Collapse
Affiliation(s)
- Suk-Ja Yoon
- Department of Oral and Maxillofacial Radiology, Dental Science Research Institute, School of Dentistry, Chonnam National University, Gwangju, Korea
| | - Sung-Kyun Shim
- School of Dentistry, Chonnam National University, Gwangju, Korea
| | - Jae-Seo Lee
- Department of Oral and Maxillofacial Radiology, Dental Science Research Institute, School of Dentistry, Chonnam National University, Gwangju, Korea
| | - Byung-Cheol Kang
- Department of Oral and Maxillofacial Radiology, Dental Science Research Institute, School of Dentistry, Chonnam National University, Gwangju, Korea
| | - Hoi-Jeong Lim
- Department of Orthodontics, Dental Science Research Institute, School of Dentistry, Chonnam National University, Gwangju, Korea
| | - Min-Seok Kim
- Department of Oral Anatomy, Dental Science Research Institute, School of Dentistry, Chonnam National University, Gwangju, Korea
| | - Sun-Hun Kim
- Department of Oral Anatomy, Dental Science Research Institute, School of Dentistry, Chonnam National University, Gwangju, Korea
| |
Collapse
|
22
|
Alman AC, Johnson LR, Calverley DC, Grunwald GK, Lezotte DC, Hokanson JE. Validation of a method for quantifying carotid artery calcification from panoramic radiographs. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 116:518-24. [PMID: 24035118 DOI: 10.1016/j.oooo.2013.06.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 06/14/2013] [Accepted: 06/21/2013] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Carotid artery calcification can be visualized on panoramic radiographs. Incidental observation of these calcifications could identify patients in need of further screening. The purpose of this study was to validate the assessment and quantification of calcification on panoramic radiographs with the stenosis and the calculated resistive index (RI) from Doppler ultrasonography. STUDY DESIGN Digital panoramic radiographs were used to assess the area of carotid artery calcification using tools available in NIH's ImageJ. Inpatient and outpatient discharge records were reviewed to identify subjects with a completed carotid Doppler ultrasound exam (n = 122). RESULTS The quantification of carotid artery calcification was found to correlate well with the degree of stenosis (area under the curve [AUC] 0.81 [95% confidence interval [CI] 0.64, 0.98]) and the RI of the common carotid artery (AUC 0.79 [95% CI 0.59, 0.98]). CONCLUSION This method for quantification of carotid artery calcification could identify patients in need of further evaluation.
Collapse
Affiliation(s)
- Amy C Alman
- Assistant Professor, Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA.
| | | | | | | | | | | |
Collapse
|
23
|
Brasileiro Junior VL, Luna AHB, Sales MAOD, Rodrigues TLC, Sarmento PLDFA, Mello Junior CFD. Reliability of digital panoramic radiography in the diagnosis of carotid artery calcifications. Radiol Bras 2014. [DOI: 10.1590/s0100-39842014000100011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective The present study evaluated the reliability of digital panoramic radiography in the diagnosis of carotid artery calcifications. Materials and Methods Thirty-five patients under high-risk for development of carotid artery calcifications who had digital panoramic radiography were referred to undergo ultrasonography. Thus, 70 arteries were assessed by both methods. The main parameters utilized to evaluate the panoramic radiography reliability in the diagnosis of carotid artery calcifications were accuracy, sensitivity, specificity and positive predictive value of this method as compared with ultrasonography. Additionally, the McNemar's test was utilized to verify whether there was a statistically significant difference between digital panoramic radiography and ultrasonography. Results Ultrasonography demonstrated carotid artery calcifications in 17 (48.57%) patients. Such individuals presented with a total of 29 (41.43%) carotid arteries affected by calcification. Radiography was accurate in 71.43% (n = 50) of cases evaluated. The degree of sensitivity of this method was 37.93%, specificity of 95.12% and positive predictive value of 84.61%. A statistically significant difference (p < 0.001) was observed between the methods evaluated in their capacity to diagnose carotid artery calcifications. Conclusion Digital panoramic radiography should not be indicated as a method of choice in the investigation of carotid artery calcifications.
Collapse
|
24
|
Brooks SL. Prescribing Diagnostic Imaging. Oral Radiol 2014. [DOI: 10.1016/b978-0-323-09633-1.00016-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
25
|
Patil S, Sinha N. Pulp Stone, Haemodialysis, End-stage Renal Disease, Carotid Atherosclerosis. J Clin Diagn Res 2013; 7:1228-31. [PMID: 23905147 PMCID: PMC3708242 DOI: 10.7860/jcdr/2013/5087.3042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 03/25/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim of this study was to determine the relationship between the presence of pulp calcification and carotid artery calcification on the dental panoramic radiographs in End Stage Renal Disease (ESRD) patients who were on haemodialysis. METHODS A total of 112 End Stage Renal Disease (ESRD) patients on who were haemodialysis participated in this study. The periapical and the panoramic radiographs for all the patients were evaluated for the presence or absence of the narrowing of the dental pulps and for pulp stones in the pulp chambers and the pulp canals. The panoramic radiographs were also evaluated to determine the carotid calcification. RESULTS Carotid calcifications were detected in none of the patients. 84 (74.99%) patients had dental pulp narrowing, and 38 (33.92%) patients had pulp stones. There was no statistical correlation between pulp narrowing and Carotid Artery Calcification (CAC) in the haemodialysis patient group. There was also no statistical correlation between pulp stones and CAC in the haemodialysis patients. CONCLUSION However, the incidental finding of CAC on a panoramic radiograph can provide life-saving information for the vascular disease patients, but in the present study, no significant relationship was found between the presence of the pulpal calcification and CAC in the ESRD patients who were on haemodialysis. Therefore, the presence of pulp calcification does not seem to serve as a diagnostic marker for carotid atherosclerosis.
Collapse
Affiliation(s)
- Santosh Patil
- Department of Oral medicine and radiology, Jodhpur Dental College, Jodhpur National University, Jodhpur, Rajasthan, India
| | - Nidhi Sinha
- Department of Conservative Dentistry and Endodontics, Jodhpur Dental College, Jodhpur National University, Jodhpur, Rajasthan, India
| |
Collapse
|
26
|
The relationship between cephalometric carotid artery calcification and Framingham Risk Score profile in patients with obstructive sleep apnea. Sleep Breath 2012. [PMID: 23208741 DOI: 10.1007/s11325-012-0790-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE The morbidity rate of arteriosclerosis becomes clinically manifested as acute cardiovascular events. In the progress of atherosclerosis, the carotid artery calcifies and sometimes appears as a calcified mass on a cephalometric radiograph. This study was designed to evaluate cardiovascular risks according to the Framingham Risk Score (FRS) between subjects with and without visible carotid artery calcification on a cephalogram. METHODS Subjects diagnosed with obstructive sleep apnea (OSA) were divided into two groups according to whether or not calcification was visible on a cephalometric radiograph in the carotid artery area, and the characteristic differences between the two groups were analyzed. The evaluated variables included age, BMI, apnea-hypopnea index (AHI), SpO2, ESS, blood pressure, medication history, diabetes mellitus (DM), drinking, smoking, and lipid-related measurements. FRSs for stroke, general cardiovascular disease (GCD), and coronary heart disease (CHD) were calculated. Statistical analyses were performed (SPSS 18.0) with significance defined as a two-tailed p value less than 0.05. RESULTS A total of 811 subjects completed the data collection (727 males, age 53.0 ± 12.5 years, AHI 31.7 ± 22.6, times/h). From FRSs, probabilities of a GCD, stroke, and CHD within 10 years were 16.0 ± 9.7, 9.8 ± 6.7, and 11.9 ± 8.3 %, respectively. Some 84 subjects exhibited calcification in the carotid arterial area. Calcification subjects were higher GCD risk and older than subjects who had no identified calcification (20.3 ± 10.1 vs 15.6 ± 20.3 %, p = 0.013, 58.8 ± 11.4 vs. 52.3 ± 12.5 years, p < 0.001). Although there is no significant difference in OSA-related variables and FRSs, subjects with visible calcifications have higher prevalence of high blood pressure medication and DM (p < 0.01). CONCLUSION While the presence of a calcified mass on a cephalometric radiograph is not diagnostic of atherosclerosis, this information indicates some cardiovascular risk.
Collapse
|
27
|
Imanimoghaddam M, Rah Rooh M, Mahmoudi Hashemi E, Javadzade Blouri A. Doppler sonography confirmation in patients showing calcified carotid artery atheroma in panoramic radiography and evaluation of related risk factors. J Dent Res Dent Clin Dent Prospects 2012; 6:6-11. [PMID: 22991627 PMCID: PMC3442447 DOI: 10.5681/joddd.2012.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Accepted: 10/18/2011] [Indexed: 12/02/2022] Open
Abstract
Background and aims
The purpose of this study was to identify patients at the risk of cerebrovascular attack (CVA) by detecting calcified carotid artery atheroma (CCAA) in panoramic radiography and evaluating their risk factors.
Materials and methods
A total of 960 panoramic radiographs of patients above 40 years old were evaluated. Doppler Sonography (DS) was performed for patients who showed calcified carotid artery atheroma (CCAA) in panoramic radiogra-phy in order to determine the presence of CCAA and the degree of stenosis. Cardiovascular risk factors in both groups of patients with CCAA (12 subjects) and without CCAA (3 subjects) were compared using a questionnaire filled out by the patients. Statistical analysis including Fisher and independent t-test applied for data analysis.
Results
Fifteen patients (30 sides) showed calcification in their panoramic radiographs, and underwent DS which revealed CCAA in 16 sides (12 patients). Two patients (13.33%) showed stenosis greater than 70%. Among the risk factors, only age showed a significant association with the occurrence of carotid calcified atheroma (P=0.026).
Conclusion Considering the results, dentists should refer especially elderly patients with radiographically identified atheromas for further examinations, as asymptomatic CCAA might be associated with high degrees of stenosis.
Collapse
Affiliation(s)
- Mahrokh Imanimoghaddam
- Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran ; Associate Professor, Department of Oral and Maxillofacial Radiology, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | | | | |
Collapse
|
28
|
Khambete N, Kumar R, Risbud M, Joshi A. Evaluation of carotid artery atheromatous plaques using digital panoramic radiographs with Doppler sonography as the ground truth. J Oral Biol Craniofac Res 2012; 2:149-53. [PMID: 25737857 PMCID: PMC3941988 DOI: 10.1016/j.jobcr.2012.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 10/11/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The objective of the study was to determine whether digital panoramic radiography is a reliable method to detect calcified carotid artery atheromatous plaques (CCAAP) as compared to ultrasonography. STUDY DESIGN Digital panoramic radiographs were obtained from 50 patients who also underwent carotid ultrasound examination. The images were interpreted by trained maxillofacial radiologist for the presence or absence of calcified atheromatous plaques. The extent of carotid calcification on carotid ultrasonography was determined by a trained sonologist which was considered as gold standard assessment. RESULTS Digital panoramic radiographs had sensitivity of 76% and specificity of 98.66% in determining calcified carotid artery atheromatous plaques. There was a high level of agreement between diagnoses, with a kappa value of 0.8. CONCLUSION To conclude, digital panoramic radiographs had good sensitivity and high specificity in detecting calcified carotid artery atheromatous plaques. If properly trained, dentists can detect such plaques and can refer patients to physician for timely medical treatment.
Collapse
Affiliation(s)
- Neha Khambete
- Department of Oral Medicine, Diagnosis and Radiology, CSMSS Dental College & Hospital, Aurangabad, India
| | - Rahul Kumar
- Department of Conservative Dentistry & Endodontics, MGM Dental College & Hospital, Navi Mumbai, India
| | - Mukund Risbud
- Department of Oral Medicine, Diagnosis and Radiology, Vasantdada Patil Dental College & Hospital, Sangli, India
| | - Anil Joshi
- Department of Radiology, Al-Ameen Medical College, Bijapur, India
| |
Collapse
|
29
|
Ertas ET, Sisman Y. Detection of incidental carotid artery calcifications during dental examinations: Panoramic radiography as an important aid in dentistry. ACTA ACUST UNITED AC 2011; 112:e11-7. [DOI: 10.1016/j.tripleo.2011.02.048] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 02/25/2011] [Accepted: 02/28/2011] [Indexed: 10/18/2022]
|
30
|
Guimarães Henriques JC, Kreich EM, Helena Baldani M, Luciano M, Cezar de Melo Castilho J, Cesar de Moraes L. Panoramic radiography in the diagnosis of carotid artery atheromas and the associated risk factors. Open Dent J 2011; 5:79-83. [PMID: 21760860 PMCID: PMC3134975 DOI: 10.2174/1874210601105010079] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Revised: 02/08/2011] [Accepted: 02/21/2011] [Indexed: 11/22/2022] Open
Abstract
Atherosclerosis is a serious chronic disease, responsible for thousands of deaths worldwide and is characterized by thickening and loss of elasticity of the arterial walls, associated with the presence of atheromatous plaques. Various risk factors act directly on predisposition to the disease, among which the following are pointed out: diabetes mellitus, arterial hypertension and inadequate diet and eating habits. More recent researches have elucidated new risk factors acting in the development of this disease, such as, for example: periodontitis, chronic renal disease and menopause. The panoramic radiograph, commonly used in dental practice, makes it possible to see calcified atherosclerotic plaques that are eventually deposited in the carotid arteries. The aim of this review article was to emphasize the dentist’s important role in the detection of carotid artery atheromas in panoramic radiographs and the immediate referral of patients affected by these calcifications to doctors. In addition, the study intended to guide the dentist, especially the dental radiologist, with regard to differential diagnosis, which should be made taking into consideration particularly the triticeal cartilage when it is calcified.
Collapse
|
31
|
Pornprasertsuk-Damrongsri S, Virayavanich W, Thanakun S, Siriwongpairat P, Amaekchok P, Khovidhunkit W. Carotid atheroma detected by panoramic radiography and ultrasonography in patients with metabolic syndrome. Oral Radiol 2011. [DOI: 10.1007/s11282-011-0064-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
32
|
Incidental findings of carotid artery stenosis detected by calcifications on panoramic radiographs: report of three cases. Oral Radiol 2010. [DOI: 10.1007/s11282-010-0047-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
33
|
Modern dental imaging: a review of the current technology and clinical applications in dental practice. Eur Radiol 2010; 20:2637-55. [PMID: 20544352 DOI: 10.1007/s00330-010-1836-1] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 04/15/2010] [Accepted: 04/29/2010] [Indexed: 02/02/2023]
Abstract
A review of modern imaging techniques commonly used in dental practice and their clinical applications is presented. The current dental examinations consist of intraoral imaging with digital indirect and direct receptors, while extraoral imaging is divided into traditional tomographic/panoramic imaging and the more recently introduced cone beam computed tomography. Applications, limitations and current trends of these dental "in-office" radiographic techniques are discussed.
Collapse
|
34
|
Friedlander AH. Calcified carotid artery imaged by computed tomography. J Oral Maxillofac Surg 2010; 68:1457-8; author reply 1458. [PMID: 20493388 DOI: 10.1016/j.joms.2010.01.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Accepted: 01/08/2010] [Indexed: 11/25/2022]
|
35
|
Bayer S, Helfgen EH, Bös C, Kraus D, Enkling N, Mues S. Prevalence of findings compatible with carotid artery calcifications on dental panoramic radiographs. Clin Oral Investig 2010; 15:563-9. [PMID: 20431901 DOI: 10.1007/s00784-010-0418-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Accepted: 04/19/2010] [Indexed: 11/28/2022]
Abstract
Cerebrovascular accidents are responsible for killing or disabling more than half a million Americans every year. They are the third leading cause of death in this country. In Germany, the annual stroke incidence reaches 182 cases per 100,000 inhabitants. Stroke there is the fourth leading cause of death. There is a need of finding cost-effective means of decreasing stroke mortality and morbidity. Instruments for early diagnosis are of great humanitarian and economic importance. All possible clinical findings should be taken into account. It is not the demand of this study to present the panoramic radiograph as a screening test method for early diagnosis of atherosclerosis. The aim is to show the potential of this radiograph used in everyday clinical dental practice by the prevalence of radiopaque findings in the carotid region. This study included panoramic dental radiographs of 2,557 patients older than 30 years of age. Fifty-nine percent of the patients were women and 41% were men. The radiographs were adjudged for signs compatible with carotid arterial calcifications appearing as a radiopaque nodular mass adjacent to the cervical vertebrae at or below the intervertebral space C3-4. Of all these radiographs, 4.8% showed radiopaque findings compatible with atherosclerotic lesions. The proportion of women reached 64.8% and that of men reached 35.2%. In accordance to recent literature, the results of this study show that about 5% of the patients show radiological findings compatible with carotid arterial calcifications. Some of these patients at risk for a cerebrovascular accident may be identified in the dentist's office by appropriate review of the panoramic dental radiograph. The suspicion of carotid artery calcifications demands an impetuous referral to an appropriate practitioner who can assist in the control of risk factors and if necessary arrange surgical removal of the carotid arterial plaque. So, the dentist should be aware of this problem and able to make a contribution to stroke prevention.
Collapse
Affiliation(s)
- Stefan Bayer
- Department of Prosthodontics, Preclinical Education and Dental Materials Science, University of Bonn, Bonn, Germany.
| | | | | | | | | | | |
Collapse
|
36
|
Tsuda H, Almeida FR, Tsuda T, Moritsuchi Y, Lowe AA. Cephalometric calcified carotid artery atheromas in patients with obstructive sleep apnea. Sleep Breath 2010; 14:365-70. [PMID: 20084549 DOI: 10.1007/s11325-009-0324-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 12/09/2009] [Accepted: 12/15/2009] [Indexed: 12/31/2022]
Abstract
BACKGROUND In the progress of atherosclerosis, the carotid artery calcifies and sometimes appears as a calcified mass on a cephalometric radiograph. PURPOSE This study was designed to evaluate the prevalence of calcification in cephalometric radiographs of OSA patients and to identify the differences between subjects with and without carotid artery calcification. METHODS A total of 1,520 X-rays were evaluated. Data for group A, 508 traditional X-rays, were collected from the UBC Sleep Apnea Dental Clinic and data for group B, 1,012 digital X-rays, were obtained from the Tsuda Hospital in Japan. Subjects were divided into two groups according to whether or not calcification was present in the carotid artery area and the characteristic differences between these two groups were analyzed. DISCUSSION Group A had 34 (6.7%) subjects who exhibited calcification in the carotid arterial area, while group B had 96 (9.5%) subjects who revealed calcification. Group A calcification subjects had a significantly lower body mass index (BMI) than subjects who had no calcification (26.9 ± 3.2 vs. 29.7 ± 5.6, p<0.01). Group B calcification subjects were older than subjects who had no calcification (57.6 ± 12.6 vs. 49.8 ± 14.5, p<0.000). Previous reports have found the prevalence of calcification on X-rays of OSA patients to be higher than the prevalence of calcification found in the general population. CONCLUSION While the presence of a calcified mass on a cephalometric radiograph is not diagnostic of atherosclerosis, this information might help to aid in screening for the condition.
Collapse
Affiliation(s)
- Hiroko Tsuda
- Department of Oral Health Sciences, The University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, Canada.
| | | | | | | | | |
Collapse
|
37
|
Levy C, Mandel L. Calcified carotid artery imaged by computed tomography. J Oral Maxillofac Surg 2010; 68:218-20. [PMID: 20006182 DOI: 10.1016/j.joms.2009.04.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Accepted: 04/17/2009] [Indexed: 11/15/2022]
Affiliation(s)
- Charley Levy
- Salivary Gland Center, Columbia University College of Dental Medicine, New York, NY 10032, USA
| | | |
Collapse
|
38
|
Evaluation of carotid calcification detected using panoramic radiography and carotid Doppler sonography in patients with and without coronary artery disease. Br Dent J 2009; 207:E8; discussion 162-3. [PMID: 19696808 DOI: 10.1038/sj.bdj.2009.762] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2009] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Carotid artery calcification is responsible for an estimated 5% of ischaemic strokes. Carotid doppler sonography (DS) is a frequently used non-invasive method for assessing carotid artery stenosis and calcification. This study assessed the utility of panoramic radiography to detect any carotid artery calcification in patients with and without coronary artery disease, as well as the level of agreement between panoramic radiographs and DS findings. METHODS Ninety subjects who underwent coronary angiography for any reason in Namazi Hospital, Shiraz University of Medical Science during an 11 month period received a DS assessment and panoramic radiograph. The radiopacities adjacent to the cervical vertebrae at or below the intervertebral space between C3-C4 were diagnosed as carotid artery calcifications. Carotid calcifications were scored as present or absent and pattern of calcification was noted by a maxillofacial radiologist who was blind to the angiogram and sonogram results. The final sample population was 84 subjects, providing data on 168 carotid arteries. RESULTS The panoramic radiograph had a sensitivity of 66.6% and a positive predictive value of 45% for detecting carotid artery calcifications in patients whose angiograms confirmed the coronary artery disease. It had 50% sensitivity in patients with normal angiogram. The level of agreement between panoramic radiographs and DS results was weak. CONCLUSION Because of low sensitivity and positive predictive value, the panoramic radiograph can not be considered an accurate or reliable method for detecting carotid artery calcification.
Collapse
|
39
|
Yasar F, Sener S, Yesilova E, Akgünlü F. Mandibular cortical index evaluation in masked and unmasked panoramic radiographs. Dentomaxillofac Radiol 2009; 38:86-91. [PMID: 19176650 DOI: 10.1259/dmfr/56808511] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The first aim of this study was to evaluate intra- and interobserver agreement in evaluating the mandibular cortical index (MCI) in masked and unmasked panoramic radiographs. The second aim was to evaluate the effect of previous experience of MCI classification on the observers' performance. METHODS Three observers separately evaluated MCI, twice in masked and twice in unmasked panoramic radiographs, with 2 week intervals. The observations were repeated more than 9 months later. The second and third observers were inexperienced in evaluating MCI. Weighted kappa statistics were used to evaluate the inter- and intraobserver agreement. RESULTS In the first session of the study, the kappa values for intraobserver agreements in masked panoramic radiographs were between 0.565 and 0.789; in unmasked panoramic radiographs, they were between 0.420 and 0.732. The kappa values for interobserver agreement were between 0.131 and 0.392 in masked radiographs and between 0.043 and 0.225 in unmasked radiographs. In the second session of the study, the kappa values for intraobserver agreements in masked panoramic radiographs were between 0.586 and 0.786. The kappa values for intraobserver agreements in unmasked panoramic radiographs were between 0.558 and 0.781. The kappa values for interobserver agreement were between 0.146 and 0.510 in masked radiographs and between 0.174 and 0.568 in unmasked radiographs. CONCLUSIONS Masking has no effect on the evaluation of panoramic radiographs for MCI. Previous experience causes higher intraobserver agreement. Intra- and interobserver agreement increases along with the increased experience in MCI evaluations.
Collapse
Affiliation(s)
- F Yasar
- Department of Oral Diagnosis and Radiology, Faculty of Dentistry, Selcuk University, Kampüs Selcuklu, Konya, Turkey.
| | | | | | | |
Collapse
|
40
|
Taheri JB, Moshfeghi M. Prevalence of calcified carotid artery on panoramic radiographs in postmenopausal women. J Dent Res Dent Clin Dent Prospects 2009; 3:46-51. [PMID: 23230481 PMCID: PMC3517284 DOI: 10.5681/joddd.2009.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2008] [Accepted: 05/14/2009] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND AIMS This study was designed to evaluate the prevalence of calcified carotid artery in 50 year-old and older postmenopausal dental outpatients for early diagnosis of individuals at risk of stroke. MATERIALS AND METHODS This is a descriptive study of 200 panoramic radiographs. These radiographs included post-menopausal women referring to the Department of Oral Medicine at Shahid Beheshti Faculty of Dentistry during 2006-2007. The x-ray machine, developer and film type were the same for all the radiographs. Statistical analysis included chi-square test and Fisher's exact test. RESULTS We found 22 calcified carotid arteries. The left and right carotid arteries were involved in 7 and 9 cases, respec-tively. In 6 cases both carotid arteries were calcified. Four individuals had no vascular risk factor excluding age and others had at least one risk factor. We found significant statistical correlation between hypertension, past history of myocardial infarction, and hypercholesterolemia with calcified carotid artery on panoramic radiographs. CONCLUSION Under the limitations of the present study, prevalence of calcified carotid arteries is 11.0 % in 50 year-old and older postmenopausal dental outpatients.
Collapse
Affiliation(s)
- Jamileh Beigom Taheri
- Associate Professor, Department of Oral Medicine, Faculty of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahkameh Moshfeghi
- Assistant Professor, Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
41
|
Griniatsos J, Damaskos S, Tsekouras N, Klonaris C, Georgopoulos S. Correlation of calcified carotid plaques detected by panoramic radiograph with risk factors for stroke development. ACTA ACUST UNITED AC 2009; 108:600-3. [PMID: 19446477 DOI: 10.1016/j.tripleo.2009.03.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Revised: 01/25/2009] [Accepted: 03/25/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim was to evaluate whether patients with calcifications in the carotid region detectable by panoramic radiograph differ in the prevalence of risk factors for stroke development compared with those without calcifications. STUDY DESIGN Forty consecutive individuals suffering from proven carotid artery atherosclerotic occlusive disease were submitted to carotid endarterectomy. Seventeen patients were symptomatic at the time of referral, having suffered at least 1 episode of ischemic cerebral event during the preceding 6 months, mainly transient ischemic attacks or amaurosis fugax, and the remaining 23 patients were asymptomatic and the diagnosis was reached during a thorough investigation of coexisting coronary or peripheral vascular disease. Preoperatively, all patients had undergone panoramic radiograph examination, as the presurgical protocol commanded. Based on the panoramic radiograph results, patients in whom calcifications were detected either unilaterally (n = 10) or bilaterally (n = 18) constituted group A (n = 28) and patients in whom no calcifications were detected constituted group B (n = 12) of this study. RESULTS Univariate analysis among several risk factors for stroke development between the 2 groups of patients disclosed a stastistically significant lower incidence of diabetes mellitus (P = .005) but a higher incidence of symptomatic plaques (P < .030) in the group of patients with detectable calcifications in the panoramic radiograph. CONCLUSION Patients with calcified carotid plaques detectable by panoramic radiography are more likely to have suffered cerebrovascular events. Therefore, patients with detectable carotid plaque in panoramic radiographs require referral to their physician for further investigation.
Collapse
Affiliation(s)
- John Griniatsos
- First Department of Surgery, School of Medicine, Laiko Hospital, University of Athens, Athens, Greece.
| | | | | | | | | |
Collapse
|
42
|
Romano-Sousa CM, Krejci L, Medeiros FMM, Graciosa-Filho RG, Martins MFF, Guedes VN, Fenyo-Pereira M. Diagnostic agreement between panoramic radiographs and color Doppler images of carotid atheroma. J Appl Oral Sci 2009; 17:45-8. [PMID: 19148405 PMCID: PMC4327613 DOI: 10.1590/s1678-77572009000100009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Accepted: 08/13/2008] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to investigate the agreement between diagnoses of calcified atheroma seen on panoramic radiographs and color Doppler images. Our interest stems from the fact that panoramic images can show the presence of atheroma regardless of the level of obstruction detected by color Doppler images. Panoramic and color Doppler images of 16 patients obtained from the archives of the Health Department of the city of Valença, RJ, Brazil, were analyzed in this study. Both sides of each patient were observed on the images, with a total of 32 analyzed cervical regions. The level of agreement between diagnoses was analyzed using the Kappa statistics. There was a high level of agreement, with a Kappa value of 0.78. In conclusion, panoramic radiographs can help detecting calcifications in the cervical region of patients susceptible to vascular diseases predisposing to myocardial infarction and cerebrovascular accidents. If properly trained and informed, dentists can refer their patients to a physician for a cardiovascular evaluation in order to receive proper and timely medical treatment.
Collapse
|
43
|
Cross-sectional study of the radiographic appearance of radiopaque lesions of the jawbones in a sample of Greek dental patients. ACTA ACUST UNITED AC 2008; 106:e38-43. [PMID: 18602290 DOI: 10.1016/j.tripleo.2008.04.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2007] [Revised: 03/18/2008] [Accepted: 04/19/2008] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of the study was to assess the prevalence of radiopacities in the jaws of a Greek population sample. STUDY DESIGN Panoramic radiographs of 3,513 patients retrieved from 10 practices in Northern Greece were examined for the presence of radiopacities without the knowledge of the medical histories. Of the initial sample size, 47 radiographs were excluded owing to technical errors. Descriptive characteristics of radiopacities including shape, size, and location, as well as information concerning the tooth involved and the adjacent and opposing teeth, were recorded. All analyses were performed using SPSS software. The Pearson chi-squared test was used to examine the distributions of gender, shape, size, and location. RESULTS A total of 72 radiopacities were identified in 69 patients (1.96% of the total sample of panoramic radiographs), showing a greater predilection in the mandibular premolar-molar region (78.3% of radiopacities observed); 44.9% of the radiopacities were associated with intact teeth or teeth with shallow filling/caries, whereas 26.1% were associated with heavily decayed/filled teeth. One-half of the radiopacities identified were circular, and the diameter varied from 1 to 2 cm. CONCLUSION The results indicate the rarity of radiopacities (1.96%) in the Greek population sample that was examined and the predilection for their occurrence in the jaws.
Collapse
|
44
|
Damaskos S, Griniatsos J, Tsekouras N, Georgopoulos S, Klonaris C, Bastounis E, Tsiklakis K. Reliability of panoramic radiograph for carotid atheroma detection: a study in patients who fulfill the criteria for carotid endarterectomy. ACTA ACUST UNITED AC 2008; 106:736-42. [PMID: 18602315 DOI: 10.1016/j.tripleo.2008.03.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 03/27/2008] [Accepted: 03/30/2008] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the reliability of panoramic radiograph (PR) for carotid artery atheroma detection, by comparing its results with the carotid-vertebral digital subtraction angiography (DSA) findings, as well as with the detected calcium deposition in the carotid plaques, which were surgically resected, using direct radiographs. STUDY DESIGN Forty consecutive patients suffering from carotid artery atherosclerotic occlusive disease confirmed by preoperative DSA, fulfilling the criteria for carotid endarterectomy, were operated on. Preoperatively, all of the patients had undergone PR, while postoperatively all of the surgically resected carotid plaques were radiographed using radiographic films and submitted to histologic examination. Compared with the DSA and the radiographic film findings, the PR results were classified as: 1) true-positive; 2) true-negative; 3) false-positive; or 4) false-negative. RESULTS Panoramic radiograph has low sensitivity and specificity compared with the DSA findings and the direct radiographs results. However, a positive predictive value (PPV) of 100% per patient as well as for luminal stenosis >80% was documented. CONCLUSION Even in the subgroup of patients who fulfill the criteria for carotid endarterectomy, PR has a low sensitivity and specificity; therefore, it cannot be considered to be a useful screening tool for atheroma detection in the general dental population. However, the 100% PPV per patient and for luminal stenosis >80%, indicates that positive calcification PR findings at the C(3)-C(4) region are highly suggestive for carotid artery atherosclerotic occlusive disease. Therefore, especially asymptomatic patients should be referred for further examination.
Collapse
Affiliation(s)
- Spyros Damaskos
- Oral Diagnosis and Radiology Department, School of Dentistry, University of Athens, Athens, Greece.
| | | | | | | | | | | | | |
Collapse
|
45
|
Gokce C, Sisman Y, Sipahioglu M, Ertas ET, Akgunlu F, Unal A, Tokgoz B, Oymak O, Utas C. The prevalence of carotid artery calcification on the panoramic radiographs of end-stage renal disease patients with peritoneal dialysis: do incidental findings provide life-saving information? J Int Med Res 2008; 36:47-53. [PMID: 18230267 DOI: 10.1177/147323000803600107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study investigated the presence of carotid artery calcifications (CACs) on panoramic radiographs (PRs) in end-stage renal disease (ESRD) patients treated with peritoneal dialysis (PD), and analysed the relationship between CAC prevalence and PD duration. A random sample of 110 PRs were collected from ESRD patients (15 with questionable CACs were subsequently excluded). CACs were found in 26 (27.4%) patients; 10 males (23.3% of all males) and 16 females (30.8% of all females). The overall mean PD period was 4.0 +/- 3.2 years. There was a significant difference in PD period between patients with and without CACs (5.3 +/- 3.1 years versus 3.5 +/- 3.1 years, respectively). To our knowledge, this study has the highest CAC prevalence, is the first to be carried out in ESRD patients being treated with PD and has the largest sample of ESRD patients (n = 95). We believe dentists should carefully evaluate patients' PRs for evidence of CACs, enabling these incidental findings to provide life-saving information.
Collapse
Affiliation(s)
- C Gokce
- Department of Endocrinology and Metabolism, Kayseri Training and Research Hospital, Kayseri, Turkey.
| | | | | | | | | | | | | | | | | |
Collapse
|