Ultrasound screening for asymptomatic carotid stenosis in subjects with calcifications in the area of the carotid arteries on panoramic radiographs: a cross-sectional study

Detection of extracranial and intracranial calcified carotid artery atheromas in cone beam computed tomography using a deep learning convolutional neural network image segmentation approach

OBJECTIVE

We leveraged an artificial intelligence deep-learning convolutional neural network (DL CNN) to detect calcified carotid artery atheromas (CCAAs) on cone beam computed tomography (CBCT) images.

STUDY DESIGN

We obtained 137 full-volume CBCT scans with previously diagnosed CCAAs. The DL model was trained on 170 single axial CBCT slices, 90 with extracranial CCAAs and 80 with intracranial CCAAs. A board-certified oral and maxillofacial radiologist confirmed the presence of each CCAA. Transfer learning through a U-Net-based CNN architecture was utilized. Data allocation was 60% training, 10% validation, and 30% testing. We determined the accuracy of the DL model in detecting CCAA by calculating the mean training and validation accuracy and the area under the receiver operating characteristic curve (AUC). We reserved 5 randomly selected unseen full CBCT volumes for final testing.

RESULTS

The mean training and validation accuracy of the model in detecting extracranial CCAAs was 92% and 82%, respectively, and the AUC was 0.84 with 1.0 sensitivity and 0.69 specificity. The mean training and validation accuracy in detecting intracranial CCAAs was 61% and 70%, respectively, and the AUC was 0.5 with 0.93 sensitivity and 0.08 specificity. Testing of full-volume scans yielded an AUC of 0.72 and 0.55 for extracranial and intracranial CCAAs, respectively.

CONCLUSION

Our DL model showed excellent discrimination in detecting extracranial CCAAs on axial CBCT images and acceptable discrimination on full-volumes but poor discrimination in detecting intracranial CCAAs, for which further research is required.

Evaluation of Cone-Beam Computed Tomography Scans to Develop a Staging Method of External Carotid Artery Calcification

Background: The objective of this study was to develop a practical staging method for reporting external carotid artery calcifications (ECACs) using cone-beam computed tomography (CBCT) imaging, specifically to standardize reporting for oral and maxillofacial radiologists. Methods: This retrospective study evaluated 489 CBCT scans for the presence of ECACs. Two calibrated evaluators assessed the scans in all three orthogonal planes, using the axial plane to develop the staging system. Calcifications were graded on a scale from 0 to 5. Results: ECACs were found in 170 out of 489 scans (34.7%). There was a statistically significant increase in ECAC distribution with age progression. The prevalence of ECACs was similar between genders. Grade 1 calcifications were most common in the 51-60 age group, Grade 2 in the 61-70 and 71-80 groups, and Grades 3 and 4 in the 81-90 group. No Grade 5 calcifications were observed in any age group. The inter-rater reliability showed an excellent correlation in the identification and grading of ECACs. Conclusions: The proposed grading system enables oral and maxillofacial radiologists to quantitatively report ECACs, facilitating timely referrals to physicians for further evaluation and early intervention, thereby potentially reducing the risk of cardiovascular events.

Carotid Artery Calcification Detected on Panoramic Radiography Is Significantly Related to Cerebrovascular Accident, Coronary Artery Disease, and Poor Oral Health: A Retrospective Cross-Sectional Study

Panoramic radiography imaging modality is widely used by dentists for diagnosing dental and jaw conditions. It can also detect carotid artery calcification (CAC), indicative of calcified atherosclerotic plaques in the carotid arteries. This cross-sectional retrospective study at the University of Tennessee Health Science Center investigated the link between CAC identified on panoramic radiograph (PR) and cerebrovascular accident (CVA), coronary artery disease (CAD), and poor oral health. Data from 314 CAC patients collected from 2014 to 2023 included age at diagnosis, gender, and clinical histories of hypertension, hyperlipidemia, diabetes mellitus, CVA, CAD, and the decay, missing, and filled permanent teeth (DMFT) index. These patients were age- and gender-matched with non-CAC patients for analysis. The findings revealed high prevalences of hypertension (86.2%), hyperlipidemia (57.6%), diabetes mellitus (30.7%), CVA (15.5%), and CAD (28.7%) amongst CAC patients and the average DMFT index was 26.6. A comparative analysis of 276 matched controls demonstrated significant differences in hypertension (85.9% vs. 57.6%), hyperlipidemia (58.3% vs. 33.7%), diabetes (32.6% vs. 22.1%), CVA history (14.9% vs. 5.1%), CAD (26.1% vs. 9.8%), and DMFT scores (26.3 vs. 23.7), all indicating strong associations between CAC and these health conditions. The adjusted analysis showed that hypertension (aOR: 3.20 [95% CI: 2.06-5.07]), hyperlipidemia (aOR: 1.70 [95% CI: 1.14-2.50]), CVA (aOR: 2.20 [95% CI: 1.13-4.30]), and CAD (aOR: 2.10 [95% CI: 1.28-3.60]) were significantly associated with CAC. Notably, only 41.7% of the patients received a medical consultation after CAC detection on PR. It is crucial for dentists to refer patients for further evaluation.

Defined shapes of carotid artery calcifications on panoramic radiographs correlate with specific signs of cardiovascular disease on ultrasound examination

OBJECTIVE

The aim was to optimize diagnostics for carotid artery calcifications (CACs) on panoramic radiographs (PRs) to identify cardiovascular disease (CVD) by investigating how 4 defined CAC shapes are associated with ultrasound (US) findings indicating CVD.

STUDY DESIGN

The study included 414 participants (802 neck sides) from the Malmö Offspring Dental Study, examined with PRs. The PRs were assessed for CAC shapes stratified into 4 categories: single, scattered, vessel-width defining, and vessel-outlining. The carotid arteries were examined with US for signs of CVD: the presence of plaques, largest individual area of a plaque, number of plaques, and percentage reduction of the lumen. Associations between the different CAC categories and US characteristics were analyzed.

RESULTS

All categories of CAC were significantly associated with a higher degree of US findings indicating CVD compared with no CAC (P < .001). The most significant differences were found for vessel-outlining CAC, with the mean of the largest individual plaque area of 17.9 vs 2.3 mm2, mean number of plaques 1.6 vs 0.2, and mean percentage reduction of the lumen 24.1% vs 3.5% (all P < .001).

CONCLUSIONS

Independent of shape, CACs detected on PRs were associated with a higher degree of US findings of CVD. This was most pronounced for vessel-outlining CAC. With refined differential diagnostics of CACs in PRs, dentists may contribute to improved identification of patients in need of cardiovascular prevention.

Comparison of carotid artery calcification between stroke and nonstroke patients using CT angiographic and panoramic images

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.

Prevalence of soft tissue calcifications in panoramic radiographs of the maxillofacial region of older adults

OBJECTIVES

To investigate the presence of soft tissue calcifications in the head and neck region on panoramic radiographs of older adults.

METHODS

We analysed 1176 panoramic radiographs obtained between January 2013 and December 2018 from individuals of both sexes aged 60 years or older, who were referred by dental specialities to the Dental Imaginology Service of the Federal University of Rio Grande do Norte, Brazil. The types of soft tissue calcification evaluated were as follows: carotid artery calcification (CAC), thyroid cartilage calcifications, triticeous cartilage calcifications, sialoliths, tonsilloliths and lymph node calcifications. The presence of soft tissue calcifications was correlated with age and sex. The chi-square test with continuity correction was used for the calculation of p values and the evaluation of the proposed associations. Prevalence ratios and 95% confidence intervals were also calculated.

RESULTS

At least one type of soft tissue calcification was found in 43% of the sample. The main calcifications detected were CAC, thyroid and triticeous cartilage calcifications, tonsilloliths, sialoliths, calcified lymph nodes, and phleboliths. Mean patient age was 67.47 years and there was a predominance of females (62.8%) in the sample. Bivariate analysis showed a statistically significant association between female sex and the presence of thyroid and triticeous cartilage calcifications and between male sex and the presence of tonsilloliths.

CONCLUSION

Routine panoramic radiography permits the identification of soft tissue calcifications that may be indicators of future cardiovascular disorders, the referral to a medical service and the establishment of therapies for stroke prevention.

Association of high cardiovascular risk and diabetes with calcified carotid artery atheromas depicted on panoramic radiographs

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.

Can carotid artery calcifications on dental radiographs predict adverse vascular events? A systematic review

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.

Bilateral vessel-outlining carotid artery calcifications in panoramic radiographs: an independent risk marker for vascular events

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.

Calcifications in the neck region of patients with carotid artery stenosis: a computed tomography angiography study of topographic anatomy

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.

Diagnostic accuracy of panoramic radiography in the detection of calcified carotid artery atheroma: a meta-analysis

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.

Long-term skill improvement among general dental practitioners after a short training programme in diagnosing calcified carotid artery atheromas on panoramic radiographs

PURPOSE

To study general dental practitioners (GDPs) ability to detect calcified carotid artery atheromas (CCAAs) in panoramic radiographs (PRs) and if their diagnostic accuracy in long term is improved after a short training programme.

METHODS

Fourteen GDPs had their diagnostic accuracy regarding CCAA in PR assessed at baseline, 2 weeks and 1 year after training. Comparison was made with a reference standard based on consensus results from two experienced oral and maxillofacial radiologists. At each session, 100 radiographs were assessed individually by the GDPs. After the baseline assessment, the GDPs participated in a 2-hour training programme comprising a lecture and diagnostic training by calibration. The GDPs results before and after training were compared, as well as between follow-up sessions.

RESULTS

A significant improvement in diagnostic accuracy was observed with increased sensitivity (from 41.8% to 55.7%, P = 0.02) without a significant decrease in specificity (from 87.2% to 86.7%, P = 0.87). The Kappa values also increased (from 0.66 to 0.71, P = 0.04). At 1-year follow-up, the improvement compared to baseline remained significant. There were no significant changes between the 2-week and 1-year follow-up assessment.

CONCLUSION

A short training programme can significantly and sustainable improve GDPs diagnostic accuracy regarding CCAA.

Calcified carotid artery atheromas in panoramic radiographs are associated with a first myocardial infarction: a case-control study

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.

Carotid calcification in panoramic radiographs: radiographic appearance and the degree of carotid stenosis

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.

Evaluation of calcified carotid atheroma on panoramic radiographs and Doppler ultrasonography in an older population

Aim

The aim of this study is to determine the reliability of panoramic radiograph (PR) as a screening tool for the detection of calcified carotid atheroma (CCA) by comparing it with Doppler ultrasonography (DU) examination. A second aim was to evaluate the relationship among CCA, systemic diseases, smoking, and body mass index in an older population.

Materials and methods

A total of 1,650 PRs of patients aged over 45 years (736 males and 914 females) were randomly selected. All the patients had been referred to the Faculty of Dentistry, Afyon Kocatepe University, Afyonkarahisar, Turkey, during 2013–2014 for routine PR screening. Medical data were collected from the archival records of the dental school. The patients were divided into two groups: Group A (study group), CCA findings were confirmed by DU (n=59); and Group B (control group), CCA findings were not confirmed by DU (n=34).

Results

Of the 1,650 individuals, 93 (5.63%) were detected to have CCA on PR. The population consisted of 43 males and 50 females with mean age of 59.84±10.92 years. No difference was determined in respect of CCA between the sexes (P=0.745). There was a significant difference between Group A and Group B in respect of hypertension (P=0.004). But there was no difference between Group A and Group B in respect of age (P=0.495), BMI (P=0.756), diabetes (P=0.168), and smoking (P=0.482) distribution.

Conclusion

Although PR cannot be used as an initial diagnostic method when searching for CCA, dentists should be aware of CCA on a routine PR, particularly in older patients who may also have the risk factors of obesity, diabetes mellitus, hypertension, and smoking. Recognizing of CCA especially in hypertensive patients could potentially increase the length and quality of life for individuals.

Carotid calcifications on panoramic radiographs: a 5-year follow-up study

OBJECTIVE

The aim of this study was to determine whether people with calcifications in the area of the carotid arteries on panoramic radiographs (CALPANs) have an increased prevalence of vascular risk factors or an increased risk of future vascular events.

MATERIALS AND METHODS

We included 113 consecutive patients with CALPANs and 116 gender- and age-matched controls without CALPANs. Vascular risk factors were generally known in the study population, since it was recorded in a population-based community-screening program.

RESULTS

Patients with CALPANs had a higher prevalence of vascular risk factors than controls independent of previous vascular events. During the 5.4-year follow-up, patients with CALPANs had a higher risk of a combined endpoint of vascular events (5.6%/yr) compared with the controls (2.4%/yr) (P = .004 by log rank test; unadjusted hazard ratio (HR) 2.4; 95% CI 1.3-4.3). This difference was not significant when previous vascular events and risk factors were taken into account (adjusted HR; 1.2; 95% CI 0.6-2.3; P = .62; Cox regression).

CONCLUSIONS

People with CALPANs are very likely to have vascular risk factors, but these factors might be unknown when CALPANs are detected. Accordingly, patients with CALPANs should be advised to have their vascular risk factors regularly checked in order to receive advice on preventive lifestyle modifications and medical treatment when indicated. However, it remains unknown whether CALPANs add information about the independent risk of future vascular events. Therefore, further studies are warranted to investigate whether the detection of CALPANs indicates a need for additional or more intense vascular treatment.

Detection of common carotid artery calcifications on panoramic radiographs: prevalence and reliability

The aim of this study was to determine the prevalence of common carotid artery calcifications (CCAC) detected by panoramic radiographs (PR) in the population and main risk factors with review of the literature. Furthermore, the reliability of PR was verified to detect these calcifications. CCAC detected on PR was powerful markers for future cardiovascular or cerebrovascular events. We found that the prevalence of CCAC identified by PR may range from 0.43% to 9.4%, depending on the age and lifestyle of the population studied. In individuals with systemic diseases the prevalence was higher than in the general population, reaching up to 38.8%. The radiopaque masses compatible with CCAC identified by PR were more common in women and occurred unilaterally or both sides, without preference for one or the other. According to the literature reviewed PR had low sensitivity and acceptable accuracy for detecting CCAC. We conclude that calcified atheroma in the common carotid artery can be demonstrated in PR, and this is an important tool for early detection of CCAC. However, it is always necessary to refer the patient to a cardiology service to confirm the findings, determine the real extent of the disease and establish its corresponding treatment.

Assessment of carotid calcifications on panoramic radiographs in relation to other used methods and relationship to periodontitis and stroke: a literature review

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.

Validation of a method for quantifying carotid artery calcification from panoramic radiographs

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.

Orthopantomography contribution to prevent isquemic stroke

OBJECTIVES

The ortopantomography (OPG) can be a valuable way for an early detection of calcified atheroma plaques, thus contributing for a preliminary stroke risk evaluation. The study looks for the existence of calcified atheroma plates through the use of OPG, comparing the results with the stenosis percentage found through eco-doppler. It has been analyzed the correlation of the number of years as a smoker, arterial hypertension and body mass index, against the risk of having calcified atheroma plaques.

STUDY DESIGN

Observational, transversal and prospective study with 84 patients from the Dental Center of Hospital Particular de Lisboa. First the patients answered to an inquiry and them they were submitted to an OPG and an eco-doppler.

RESULTS AND CONCLUSIONS

It is possible to detect calcified atheroma plaques in the carotid artery through an OPG and patients who have them have got a fifteen fold greater risk of suffering from carotid stenosis. In this study, it has been confirmed the increase in carotid stenosis for long term smokers (OR = 1,033, n=18, 42,9%). The study results show that hypertension patients have a probability 5,426 greater than normal of developing atheroma plaques (with sig=0,049). Amid analyzed patients, the correlation between obesity and the existence of carotid atheroma plaques was significant, although negative (sig=0,047). OPG can help find patients with higher risk of isquemic stroke. Key words:Orthopantomography, Stroke, Carotid disease, Calcified atheroma.

Reliability of digital panoramic radiography in the diagnosis of carotid artery calcifications

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.

Detection of calcifications in panoramic radiographs in patients with carotid stenoses ≥50%

OBJECTIVE

Carotid stenoses ≥50% are associated with increased risk for stroke that can be reduced by prophylactic carotid endarterectomy (CEA). Calcifications in arteries can be detected in panoramic radiographs (PRs). In a cross-sectional study, we analyzed (1) extirpated plaques for calcification, (2) how often PRs disclosed calcified plaques, (3) how often patients with stenoses ≥50% presented calcifications in PRs, and (4) the additional value of frontal radiographs (FRs).

STUDY DESIGN

Patients (n = 100) with carotid stenosis ≥50% were examined with PRs and FRs before CEA. Extirpated carotid plaques were radiographically examined (n = 101).

RESULTS

It was found that 100 of 101 (99%) extirpated plaques were calcified, of which 75 of 100 (75%) were detected in PRs; 84 of 100 (84%) patients presented carotid calcifications in the PRs, in 9.5% contralateral to the stenosis ≥50%.

CONCLUSIONS

Carotid calcifications are seen in PRs in 84% of patients with carotid stenosis ≥50%, independent of gender. FRs do not contribute significantly to this identification.