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Yoo SW, Yang S, Kim JE, Huh KH, Lee SS, Heo MS, Yi WJ. CACSNet for automatic robust classification and segmentation of carotid artery calcification on panoramic radiographs using a cascaded deep learning network. Sci Rep 2024; 14:13894. [PMID: 38886356 PMCID: PMC11183138 DOI: 10.1038/s41598-024-64265-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 06/06/2024] [Indexed: 06/20/2024] Open
Abstract
Stroke is one of the major causes of death worldwide, and is closely associated with atherosclerosis of the carotid artery. Panoramic radiographs (PRs) are routinely used in dental practice, and can be used to visualize carotid artery calcification (CAC). The purpose of this study was to automatically and robustly classify and segment CACs with large variations in size, shape, and location, and those overlapping with anatomical structures based on deep learning analysis of PRs. We developed a cascaded deep learning network (CACSNet) consisting of classification and segmentation networks for CACs on PRs. This network was trained on ground truth data accurately determined with reference to CT images using the Tversky loss function with optimized weights by balancing between precision and recall. CACSNet with EfficientNet-B4 achieved an AUC of 0.996, accuracy of 0.985, sensitivity of 0.980, and specificity of 0.988 in classification for normal or abnormal PRs. Segmentation performances for CAC lesions were 0.595 for the Jaccard index, 0.722 for the Dice similarity coefficient, 0.749 for precision, and 0.756 for recall. Our network demonstrated superior classification performance to previous methods based on PRs, and had comparable segmentation performance to studies based on other imaging modalities. Therefore, CACSNet can be used for robust classification and segmentation of CAC lesions that are morphologically variable and overlap with surrounding structures over the entire posterior inferior region of the mandibular angle on PRs.
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Affiliation(s)
- Suh-Woo Yoo
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Su Yang
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Jo-Eun Kim
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Kyung-Hoe Huh
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Sam-Sun Lee
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Min-Suk Heo
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Won-Jin Yi
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea.
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea.
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Agacayak KS, Guler R, Sezgin Karatas P. Relation Between the Incidence of Carotid Artery Calcification and Systemic Diseases. Clin Interv Aging 2020; 15:821-826. [PMID: 32581522 PMCID: PMC7276320 DOI: 10.2147/cia.s256588] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background The aim of this study is to investigate the relationship of carotid artery calcifications detected in panoramic radiographs of patients aged 60 or older with isolated systemic diseases. Patients and Methods From October 2018 to December 2019, 867 panoramic radiographs of patients, who applied to Dicle University Faculty of Dentistry for various dental reasons, were collected for examination. Of these 867 panoramic radiographs, 444 panoramic radiographs were included in this study. Medical data were collected from the archival records of the dental school. Results The study population consisted of 240 female (54.1%) and 204 male (45.9%) patients. Their mean age was 66 ± 7.3 (range: 60–92) years. Only 39 (8.8%) of the 444 patients had atherosclerotic plaques. Of the 39 patients with carotid artery calcification, 13 (33.3%) were male and 26 (66.7%) were female. As a result of statistical analysis, carotid artery calcification compared to other systemic diseases was found to be significantly more common in patients with hypertension (p = 0.009). Conclusion Carotid artery calcifications detected coincidentally in standard panoramic radiographs of dental patients may be important markers for preventing serious risks such as coronary artery disease, stroke, and death. The relationship between carotid artery calcifications found on dental panoramic radiographs and hypertension was significant. Therefore, it seems that detection of carotid artery calcifications on panoramic images of hypertension patients must be considered by dentists.
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Affiliation(s)
- Kamil Serkan Agacayak
- Department of Oral and Maxillofacial Surgery, Dicle University School of Dentistry, Diyarbakır, Turkey
| | - Rıdvan Guler
- Department of Oral and Maxillofacial Surgery, Dicle University School of Dentistry, Diyarbakır, Turkey
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Barut O, Ahlqvist J, Garoff M, Johansson E, Johansson M, Wester P, Levring Jäghagen E. Calcifications in the neck region of patients with carotid artery stenosis: a computed tomography angiography study of topographic anatomy. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 129:523-530. [PMID: 31932251 DOI: 10.1016/j.oooo.2019.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 09/15/2019] [Accepted: 09/28/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of this study was to map the vertical locations of calcified carotid plaques (CCPs), osseous anatomic structures, and calcified soft tissues in the area of the carotid artery, determine to what extent CCPs are superimposed on the cervical spine in coronal images, and analyze the differences between men and women. STUDY DESIGN Computed tomography angiography (CTA) scans of 79 patients were studied. CCPs were discovered in 152 of the total 158 neck sides. Evaluations were performed by using sagittal and coronal reformatted CTA images with maximum intensity projection. RESULTS Most of the calcified anatomic structures studied, including the carotid bifurcation, were found in close relationship to the level of the third and fourth cervical vertebrae. In the coronal view, all or most of the areas of the CCPs were superimposed on the cervical spine in 22 of 44 (50%) neck sides with CCP in women and in 37 of 108 (34.2%) in men (P = .070). CONCLUSIONS The carotid bifurcation is in close proximity to various calcified anatomic structures. This should be taken into account when diagnosing CCPs in panoramic radiographs. In the coronal view, CCPs and the cervical spine are often superimposed; thus, coronal images are not recommended for confirmation of putative carotid calcifications diagnosed on the basis of panoramic radiographs.
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Affiliation(s)
- Oya Barut
- Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Sweden.
| | - Jan Ahlqvist
- Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Sweden
| | - Maria Garoff
- Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Sweden
| | - Elias Johansson
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Sweden; Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Magnus Johansson
- Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Sweden
| | - Per Wester
- Department of Public Health and Clinical Medicine, Umeå University, Sweden; Department of Clinical Sciences, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden
| | - Eva Levring Jäghagen
- Oral and Maxillofacial Radiology, Department of Odontology, Umeå University, Sweden
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Schroder AGD, de Araujo CM, Guariza-Filho O, Flores-Mir C, de Luca Canto G, Porporatti AL. Diagnostic accuracy of panoramic radiography in the detection of calcified carotid artery atheroma: a meta-analysis. Clin Oral Investig 2019; 23:2021-2040. [PMID: 30923911 DOI: 10.1007/s00784-019-02880-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 02/07/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the diagnostic accuracy of panoramic radiography (PR) in detecting calcified carotid artery atheroma (CCAA) compared with Doppler ultrasonography or angiography (the reference standard). SOURCES Cochrane, LILACS, PubMed, Scopus, Web of Science, Google Scholar, Open Grey, and ProQuest were searched. The reference lists of the included studies were also screened. DATA Observational studies. METHODS Only studies comparing the diagnostic accuracy of PR in detecting CCAA to Doppler ultrasonography or angiography (the reference standard) were included. The primary outcome measures were sensitivity and specificity. The secondary outcomes were negative predictive values, positive predictive values, diagnostic odds ratios, likelihood ratios (positive and negative), receiver operating characteristic curves, accuracy, and Youden's index. Two reviewers independently participated in the study selection, data extraction, and risk of bias assessment without language restriction. Risk of bias was assessed thought QUADAS-2, and the level of evidence was assessed through GRADE. RESULTS A total of 773 citations were identified after duplicates were removed, and 12 studies including 1002 patients were included in the final study. The sensitivity and specificity of the different selected studies varied substantially, with sensitivity ranging from 0.31 to 0.95 and specificity from 0.19 to 0.99. CONCLUSIONS Most studies reported excellent sensitivity and good specificity. The diagnostic accuracy of PR was good or excellent in 50% of the studies. CLINICAL SIGNIFICANCE The identification of CCAA by PR can be a risk predictor for stroke when used as a secondary screening tool.
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Affiliation(s)
| | | | - Odilon Guariza-Filho
- Department of Orthodontics, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil. .,School of Health and Bioscience, Department of orthodontics, Pontifícia Universidade Católica do Paraná, Street Imaculada Conceição, 1155, Prado Velho, Curitiba, PR, 80215-901, Brazil.
| | | | - Graziela de Luca Canto
- Brazilian Centre for Evidence-based Research, Department of Dentistry, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - André Luís Porporatti
- Brazilian Centre for Evidence-based Research, Department of Dentistry, Federal University of Santa Catarina, Florianópolis, SC, Brazil
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Je UK, Cho HM, Hong DK, Cho HS, Park YO, Park CK, Kim KS, Lim HW, Kim GA, Park SY, Woo TH, Cho SI. 3D reconstruction based on compressed-sensing (CS)-based framework by using a dental panoramic detector. Phys Med 2015; 32:213-7. [PMID: 26494155 DOI: 10.1016/j.ejmp.2015.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/22/2015] [Accepted: 09/24/2015] [Indexed: 10/22/2022] Open
Abstract
In this work, we propose a practical method that can combine the two functionalities of dental panoramic and cone-beam CT (CBCT) features in one by using a single panoramic detector. We implemented a CS-based reconstruction algorithm for the proposed method and performed a systematic simulation to demonstrate its viability for 3D dental X-ray imaging. We successfully reconstructed volumetric images of considerably high accuracy by using a panoramic detector having an active area of 198.4 mm × 6.4 mm and evaluated the reconstruction quality as a function of the pitch (p) and the angle step (Δθ). Our simulation results indicate that the CS-based reconstruction almost completely recovered the phantom structures, as in CBCT, for p≤2.0 and θ≤6°, indicating that it seems very promising for accurate image reconstruction even for large-pitch and few-view data. We expect the proposed method to be applicable to developing a cost-effective, volumetric dental X-ray imaging system.
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Affiliation(s)
- U K Je
- Department of Radiation Convergence Engineering, iTOMO Research Group, Yonsei University, Wonju 220-710, Republic of Korea
| | - H M Cho
- Department of Radiation Convergence Engineering, iTOMO Research Group, Yonsei University, Wonju 220-710, Republic of Korea
| | - D K Hong
- Department of Radiation Convergence Engineering, iTOMO Research Group, Yonsei University, Wonju 220-710, Republic of Korea
| | - H S Cho
- Department of Radiation Convergence Engineering, iTOMO Research Group, Yonsei University, Wonju 220-710, Republic of Korea.
| | - Y O Park
- Department of Radiation Convergence Engineering, iTOMO Research Group, Yonsei University, Wonju 220-710, Republic of Korea
| | - C K Park
- Department of Radiation Convergence Engineering, iTOMO Research Group, Yonsei University, Wonju 220-710, Republic of Korea
| | - K S Kim
- Department of Radiation Convergence Engineering, iTOMO Research Group, Yonsei University, Wonju 220-710, Republic of Korea
| | - H W Lim
- Department of Radiation Convergence Engineering, iTOMO Research Group, Yonsei University, Wonju 220-710, Republic of Korea
| | - G A Kim
- Department of Radiation Convergence Engineering, iTOMO Research Group, Yonsei University, Wonju 220-710, Republic of Korea
| | - S Y Park
- Department of Radiation Convergence Engineering, iTOMO Research Group, Yonsei University, Wonju 220-710, Republic of Korea
| | - T H Woo
- Department of Radiation Convergence Engineering, iTOMO Research Group, Yonsei University, Wonju 220-710, Republic of Korea
| | - S I Cho
- Department of Radiation Convergence Engineering, iTOMO Research Group, Yonsei University, Wonju 220-710, Republic of Korea
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Atalay Y, Asutay F, Agacayak KS, Koparal M, Adali F, Gulsun B. Evaluation of calcified carotid atheroma on panoramic radiographs and Doppler ultrasonography in an older population. Clin Interv Aging 2015; 10:1121-9. [PMID: 26185431 PMCID: PMC4501685 DOI: 10.2147/cia.s84683] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Yusuf Atalay
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Fatih Asutay
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Kamil Serkan Agacayak
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Dicle University, Diyarbakır, Turkey
| | - Mahmut Koparal
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Adıyaman University, Adıyaman, Turkey
| | - Fahri Adali
- Department of Cardiovascular Surgery, Faculty of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Belgin Gulsun
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Dicle University, Diyarbakır, Turkey
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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]
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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.
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Abecasis P, Chimenos-Küstner E, López-López O. Orthopantomography contribution to prevent isquemic stroke. J Clin Exp Dent 2014; 6:e127-31. [PMID: 24790711 PMCID: PMC4002341 DOI: 10.4317/jced.51352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 11/26/2013] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- Pedro Abecasis
- Phd in Odontology. Profesor of Oral radiology in ISC-Egas Moniz. University of Odontology, Portugal
| | - Eduardo Chimenos-Küstner
- Phd in Medicine and Surgery. Profesor Oral Medicine, Facultad de Odontología, Universidad de Barcelona
| | - Osé López-López
- Phd in Medicine and Surgery. Profesor Oral Medicine, Facultad de Odontología, Universidad de Barcelona
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Garoff M, Johansson E, Ahlqvist J, Jäghagen EL, Arnerlöv C, Wester P. Detection of calcifications in panoramic radiographs in patients with carotid stenoses ≥50%. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117:385-91. [PMID: 24528796 DOI: 10.1016/j.oooo.2014.01.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 12/17/2013] [Accepted: 01/05/2014] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- Maria Garoff
- Department of Odontology, Umeå University, Umeå, Sweden.
| | - Elias Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Associate Professor, Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Jan Ahlqvist
- Associate Professor, Department of Odontology, Umeå University, Umeå, Sweden
| | | | - Conny Arnerlöv
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Per Wester
- Professor, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Uchida K, Sugino N, Yamada S, Kuroiwa H, Yoshinari N, Asano A, Taguchi A, Muneyasu M. Clinical Significance of Carotid Artery Calcification seen on Panoramic Radiographs. J HARD TISSUE BIOL 2014. [DOI: 10.2485/jhtb.23.461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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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.
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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
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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]
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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.
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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
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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.
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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.
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Affiliation(s)
- C Gokce
- Department of Endocrinology and Metabolism, Kayseri Training and Research Hospital, Kayseri, Turkey.
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Yoon SJ, Yoon W, Kim OS, Lee JS, Kang BC. Diagnostic accuracy of panoramic radiography in the detection of calcified carotid artery. Dentomaxillofac Radiol 2008; 37:104-8. [PMID: 18239037 DOI: 10.1259/dmfr/86909790] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of this study was to assess the diagnostic accuracy of the panoramic radiograph in the detection of carotid artery calcification using CT as the gold standard. METHODS 110 dental patients (average age 65.2 years, range 50-82 years) with both panoramic radiographs and CT scans available were selected for the evaluation of carotid artery calcification. Two oral and maxillofacial radiologists interpreted the panoramic radiographs for the presence of carotid artery calcification. CT scans were independently interpreted by a neuroradiologist. RESULTS The accuracy of panoramic radiographs in the detection of carotid artery calcification was 62.3%. The sensitivity and the specificity were 22.2% and 90.0%, respectively. CONCLUSIONS Panoramic radiography has a moderate diagnostic accuracy in the detection of carotid artery calcification, but the sensitivity is low.
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Affiliation(s)
- S-J Yoon
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Chonnam National University, Donggu Hakdong 5, Gwangju, 501-757, Korea.
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Uthman AT, Al-Saffar AB. Prevalence in digital panoramic radiographs of carotid area calcification among Iraqi individuals with stroke-related disease. ACTA ACUST UNITED AC 2008; 105:e68-73. [PMID: 18329570 DOI: 10.1016/j.tripleo.2007.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2007] [Revised: 10/24/2007] [Accepted: 11/07/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the prevalence of carotid calcification on digital dental panoramic tomography in a group of the Iraqi population who have some stroke-related vascular and or metabolic disease. STUDY DESIGN Digital dental panoramic tomographic images of 157 adult patients of age range 40-80 years having chronic illnesses such as coronary heart diseases, hypertension, type 2 diabetes, and hyperlipidemia and of 43 control subjects (age range 40-71 years, free of systemic diseases) were made and examined for the presence of carotid artery calcification adjacent or just below the intervertebral space between C3, C4, and C5 on both sides of patient's neck. The study group was subclassified into vascular, metabolic, and vascular-metabolic groups. Determinations were made of the prevalence, number, and distribution of carotid area calcifications. Forward stepwise logistic regression analysis was used to determine which risk factor is more liable to develop carotid artery area calcification. RESULTS The statistical difference between patients with stroke-related diseases (vascular, metabolic, and vascular-metabolic groups) versus patients in the control group was highly significant concerning the prevalence of carotid area calcifications (P < .01). Carotid area calcification was identified in 38.8% of the study group. Bilateral calcifications were observed more than unilateral calcification for both genders (26.6% vs. 13.9% for men; 24.4% vs. 12.8% for women). CONCLUSION People with stroke-related vascular and/or metabolic diseases have greater prevalence of calcified area calcifications seen on panoramic radiographs than people who are otherwise healthy.
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Affiliation(s)
- Asmaa Tahseen Uthman
- Department of Oral Diagnosis, College of Dentistry, University of Baghdad, Baghdad, Iraq.
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Abstract
BACKGROUND Calcified carotid artery atheroma (CCAA) and its identification on panoramic radiographs have been advocated as a predictor of a cerebrovascular accident (CVA). TYPES OF STUDIES REVIEWED The authors conducted an electronic search using 11 databases to evaluate the evidence from the literature that links CCAA detection on panoramic radiographs and the precipitation of CVAs among those people. They used the Reporting Recommendations for Tumor Marker Prognostic Studies (REMARK) checklist to perform this systematic review. RESULTS One study of the 54 studies the authors identified satisfied the REMARK criteria in which CCAA was associated with a negligible increased risk of stroke (95 percent confidence interval, 0 to 0.04 percent) in the population studied. CLINICAL IMPLICATIONS This systematic review suggests the data supporting the hypothesis that radiographically detectable CCAA is associated with an increased risk of stroke are incomplete and inconclusive. Further research is needed, as clinical guidelines for risk prediction using panoramic radiographs cannot be established on the basis of the current evidence.
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Affiliation(s)
- Muralidhar Mupparapu
- Diagnostic Sciences, University of Medicine and Dentistry of New Jersey, New Jersey Dental School, Newark, NJ 07101, USA.
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20
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Farman AG. Utility of panoramic radiographs in detecting cervical calcified carotid atheroma by Richard P. Madden et al. ACTA ACUST UNITED AC 2007; 103:549. [PMID: 17395070 DOI: 10.1016/j.tripleo.2006.06.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2006] [Accepted: 06/27/2006] [Indexed: 10/24/2022]
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Beckstrom BW, Horsley SH, Scheetz JP, Khan Z, Silveira AM, Clark SJ, Greenwell H, Farman AG. Correlation between carotid area calcifications and periodontitis: a retrospective study of digital panoramic radiographic findings in pretreatment cancer patients. ACTA ACUST UNITED AC 2007; 103:359-66. [PMID: 17145189 DOI: 10.1016/j.tripleo.2006.08.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2005] [Revised: 08/07/2006] [Accepted: 08/23/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objective of this study was to examine the prevalence of carotid area calcifications retrospectively detected on digital panoramic radiographs of pretreatment cancer subjects, and to correlate the finding of such calcifications with radiographic evidence of periodontal bone loss in the same subjects. STUDY DESIGN Digital panoramic radiographs of 201 subjects were evaluated for calcifications projected in the carotid artery bifurcation area as well as for alveolar bone loss as a result of periodontal disease. Inclusion criteria were unobscured carotid artery bifurcation regions bilaterally and sufficient index teeth present with a definable cemento-enamel junction and alveolar crest. Radiographs were independently observed for carotid area calcifications and for periodontal status. Image enhancements permitted for detection of calcifications projected in the carotid area included window/level, inverse, and emboss. Periodontal measurements were made on index teeth using proprietary imaging software and a mouse-driven measurement algorithm. A 3-factor analysis of variance was performed with 3 between-subjects comparisons. Percentage of bone loss was the dependent variable. Independent variables were age, subject sex, and the presence or absence of carotid area calcifications. RESULTS Differences measured in percentage of bone loss between sexes were not statistically significant. While bone loss did increase with age, comparison of the mean bone loss of each age category revealed no statistical significance. There was a highly significant correlation between carotid artery area calcifications visible on panoramic radiographs and percent alveolar bone loss. Radiographs showing unilateral and bilateral calcifications had a mean percent bone loss of 24.2% +/- 12.6% and 25.7% +/- 13.0% respectively, compared to those with no calcification at 10.4% +/- 9.9%. CONCLUSIONS Nearly 1 in 4 subjects in this study evidenced calcifications projected in the carotid bifurcation region. The finding of such calcifications was significantly related to the calculated percentage of alveolar bone loss.
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Affiliation(s)
- Brice W Beckstrom
- School of Dentistry, The University of Louisville, Louisville, KY 40292, USA
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Kumagai M, Yamagishi T, Fukui N, Chiba M. Carotid artery calcification seen on panoramic dental radiographs in the Asian population in Japan. Dentomaxillofac Radiol 2007; 36:92-6. [PMID: 17403886 DOI: 10.1259/dmfr/79378783] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To determine the frequency of carotid artery calcification (CAC) seen on panoramic dental radiographs, the relationship between the condition and a history of cerebral infarction (CI), and the history of the risk factors of CI in patients in Japan. METHODS A total of 2374 individuals whose panoramic radiographs were obtained at their first consultation were reviewed. RESULT CAC was found in 95 subjects (4.0%) and was found at a higher frequency in patients with a history of CI than in those without a history of CI. The modifiable risk factors (a history of hypertension, diabetes and hypercholesterolaemia) and CAC showed significant relationship in the chi(2) test for pairwise comparison. When age and gender were added and all of these risk factors were considered simultaneously in the multiple logistic regression analysis, age and history of hypercholesterolaemia remained statistically significant. CONCLUSIONS CAC may be seen on panoramic dental radiographs and is related to the patients' general history of CI, and the risk factors of CI in the Asian population in Japan.
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Affiliation(s)
- M Kumagai
- Department of Oral and Maxillofacial Surgery, Tohoku Kosai Hospital, Sendai, Japan.
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Friedlander AH, Cohen SN. Panoramic radiographic atheromas portend adverse vascular events. ACTA ACUST UNITED AC 2007; 103:830-5. [PMID: 17261373 DOI: 10.1016/j.tripleo.2006.07.016] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2006] [Revised: 07/18/2006] [Accepted: 07/20/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study sought to determine if calcified carotid artery atheromas (CCAA) imaged on panoramic radiographs portend an adverse vascular event. STUDY DESIGN Medical records of 46 males (mean age 66) with a CCAA (Group 1) were reviewed for preimaging vascular risks and for cerebrovascular events subsequent to the radiograph. Matched controls (age, gender, ethnicity, and vascular risks) treated at the same hospital but never radiographed were identified (Group 2) and matched to their cohort. The medical records of Group 2 individuals were re-reviewed for development of vascular events occurring after the date of their cohort's radiograph. RESULTS Twenty adverse vascular events (myocardial infarct, stroke, revascularization procedure, transient ischemic attack, angina requiring hospitalization) occurred in twelve Group 1 patients and 6 events occurred in five Group 2 patients (P = 0.006). CONCLUSION The incidental finding of a CCAA portends significant risk of a future, adverse vascular event.
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Affiliation(s)
- Arthur H Friedlander
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA.
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Bayram B, Uckan S, Acikgoz A, Müderrisoglu H, Aydinalp A. Digital panoramic radiography: a reliable method to diagnose carotid artery atheromas? Dentomaxillofac Radiol 2006; 35:266-70. [PMID: 16798924 DOI: 10.1259/dmfr/50195822] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of the present study is to evaluate the panoramic radiographs of 4106 patients for carotid artery atheromas (CAAs) and to correlate our findings with the literature. MATERIALS AND METHODS The digital panoramic radiographs of 4106 dental patients (2428 female, 1678 male) were evaluated. Radiographs of patients 40 years of age or older were randomly chosen from a computer database. CAA findings were defined as radiopaque masses adjacent to the cervical vertebrae at or below the intervertebral space between C3 and C4 on the panoramic radiograph. The patients who had CAA findings were contacted by telephone, and some of them agreed to further evaluation. Evaluation included carotid ultrasound, ECG, echocardiography and treadmill exercise testing at the Department of Cardiology. RESULTS Of 4106 patients, 88 patients (2.1%; 70 female, 18 male) had one or more radiopaque mass detected on digital images. All 88 patients with CAA findings were contacted by telephone and 23 agreed to further evaluation at the university hospital. Of these 23 patients, 8 (34.7%) had CAAs on carotid ultrasound and 15 (65.3%) had normal carotid arteries. From these eight patients with CAAs on Doppler ultrasound, 7 (30.4%) had plaques that were not haemodynamically significant and only one (4.3%) had significant plaque. The patient with severe carotid artery stenosis consequently underwent endarterectomy operation. There were no statistically significant differences between male and female in CAAs (P>0.05). CONCLUSION Digital panoramic images may have some diagnostic value for detecting CAAs and this early diagnosis could potentially increase the length and quality of life for people with CAAs.
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Affiliation(s)
- B Bayram
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, 11. sokak No:26, Bahcelievier, Ankara, Turkey.
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Suarez-Cunqueiro MM, Duker J, Liebehenschel N, Schön R, Schmelzeisen R. Calcification of the branches of the external carotid artery detected by panoramic radiography: a case report. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2002; 94:636-40. [PMID: 12424461 DOI: 10.1067/moe.2002.127165] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Atherosclerosis, a progressive inflammatory disease, may lead to stroke, coronary artery disease, or peripheral artery disease. The prevalence of atherosclerosis associated with morbidity and mortality is very high in industrialized countries. This report describes the case of a 49-year-old male patient whose panoramic radiograph taken as part of a dental examination showed calcification in the branches of the external carotid artery. The right facial artery and left maxillary, facial, and lingual arteries were also calcified. The patient had a history of thrombosis in the right axillary and brachial veins with extension to half of the brachiocephalic trunk. In addition, selective lesions were found in the aorta and mitral valve. The patient's medical history also included hypertriglyceridemia, essential arterial hypertonia, terminal renal insufficiency, renal anemia, neurogen disturbance micturition, secondary hyperparathyroidism, hyperuricemia, lymphatic edema, polyneuropathy, tachyarrhythmia absoluta, and erysipelas. The case presented reports on the possibility of detecting signs of atherosclerosis in arteries of the maxillofacial region by use of panoramic radiography.
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Affiliation(s)
- Maria M Suarez-Cunqueiro
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Albert-Ludwigs-University, Freiburg, Germany
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Friedlander AH, Altman L. Carotid artery atheromas in postmenopausal women. Their prevalence on panoramic radiographs and their relationship to atherogenic risk factors. J Am Dent Assoc 2001; 132:1130-6. [PMID: 11575022 DOI: 10.14219/jada.archive.2001.0340] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND More than 60 percent of the deaths in the United States attributed to stroke occur in postmenopausal women. As estrogen levels decline, atherosclerotic lesions (that is, atheromas) develop in the region of the carotid bifurcation and have been implicated as the precipitating cause in the majority of these strokes. Atheromas often are calcified and have been detected on the panoramic radiographs of neurologically asymptomatic male veterans; however, similar studies have not been conducted among female veterans. METHODS The authors assessed panoramic radiographs and medical records of 52 neurologically asymptomatic female veterans (mean age, 70.4 years), with a history of amenorrhea of more than 12 months' duration, for atheromas and risk factors associated with atherosclerosis. RESULTS The radiographs of 16 subjects (31 percent) exhibited atheromas located in the neck about 2.0 centimeters inferior and posterior to the angle of the mandible. These findings were confirmed in all instances by the presence of atheromas on anteroposterior cervical spine radiographs. The medical histories of these subjects were heavily laden with atherogenic risk factors (hypertension, 94 percent; body mass index of 27 to 29.9 [characterized as overweight], 25 percent; body mass index of 30 or higher [characterized as obese], 25 percent; smoking more than 15 pack-years, 38 percent; hyperlipidemia, 69 percent; type 2 diabetes mellitus, 21 percent). Hypertension was significantly associated with the presence of atheromas. CONCLUSIONS Some neurologically asymptomatic women at high risk of developing stroke can be identified in the dental office via panoramic radiography. Women whose X-rays show calcified carotid artery atheromas are almost always hypertensive and have medical histories heavily laden with other atherogenic risk factors. CLINICAL IMPLICATIONS Dentists should refer patients with such calcifications to an appropriate physician for further evaluation and treatment.
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Affiliation(s)
- A H Friedlander
- Hospital Dental Service, Medical Center, University of California Los Angeles, School of Dentistry, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, Calif., USA.
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Carter LC. Discrimination between calcified triticeous cartilage and calcified carotid atheroma on panoramic radiography. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2000; 90:108-10. [PMID: 10884645 DOI: 10.1067/moe.2000.106297] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The differential diagnosis of calcified atherosclerotic plaque in the extracranial carotid vasculature includes a number of anatomic and pathologic radiopacities. Most of these are readily distinguishable on the basis of location and morphologic features. The calcified triticeous cartilage, however, can be a confounding alternative that is frequently misdiagnosed as a calcified atheroma. This paper describes the radiographic differences between these 2 entities, enabling clinicians to improve their diagnostic acumen when evaluating cervical soft tissue calcifications.
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Affiliation(s)
- L C Carter
- Oral and Maxillofacial Diagnostic Imaging Clinic, Department of Oral Diagnostic Sciences, School of Dental Medicine, University at Buffalo, State University of New York, Buffalo, USA.
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Freymiller EG, Sung EC, Friedlander AH. Detection of radiation-induced cervical atheromas by panoramic radiography. Oral Oncol 2000; 36:175-9. [PMID: 10745169 DOI: 10.1016/s1368-8375(99)00072-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Therapeutic irradiation of the neck is frequently used to treat patients with head and neck carcinoma. The irradiation, however, has been implicated as the cause of cervical carotid artery atherosclerotic lesions and subsequent stroke. Panoramic radiography previously shown capable of demonstrating isolated lesions was used to assess their development over time. Individuals with a pre-irradiation radiograph free of atheromas were enrolled for study. The prevalence rate of atheroma formation on post-irradiation (bilateral portals at >/=45 Gy) radiographs obtained at an interval of >/=36 months was determined. A control group of non-irradiated patients having similar risk factors for head and neck carcinoma and atherosclerosis and having an initial radiograph free of atheroma formation were likewise enrolled for study. The prevalence rate of atheroma formation on a second radiograph obtained from these individuals at an interval of >/=36 months was determined. The study population consisted of 17 patients, with a mean age of 56.5 (range 21.5-77.8) years who received a mean therapeutic irradiation dose of 53.2 Gy (range 45-71) to each side of their neck. The prevalence rate of atheromas manifested on the post-irradiation radiographs was 53%. These radiographs were obtained, on average, 69.7 (range 37-133) months after completion of radiation therapy. The prevalence rate of atheromas manifested on the second radiograph of patients in the control group was 5.9%. These radiographs were obtained, on average, 53.5 (range 52-55) months after the first. The difference in prevalence rates was statistically significant (p=0.0003). Individuals who have received therapeutic irradiation to the neck are more likely to develop carotid artery atheromas after treatment than are risk-matched control patients who have not been irradiated. These lesions can be detected by panoramic radiography.
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Affiliation(s)
- E G Freymiller
- Oral and Maxillofacial Surgery, University of California Los Angeles School of Dentistry, CHS 53-076, 10833 Le Conte Avenue, Los Angeles, CA 90095-1668, USA
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Friedlander AH, Eichstaedt RM, Friedlander IK, Lambert PM. Detection of radiation-induced, accelerated atherosclerosis in patients with osteoradionecrosis by panoramic radiography. J Oral Maxillofac Surg 1998; 56:455-9. [PMID: 9541345 DOI: 10.1016/s0278-2391(98)90712-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Osteoradionecrosis (ORN) of the mandible has long been considered the most destructive complication of head and neck irradiation. Recently, therapeutic irradiation has been implicated as the cause of induced/accelerated atherosclerosis of the cervical carotid artery and subsequent stroke. Panoramic radiography, previously shown to be capable of identifying carotid artery atherosclerosis in nonirradiated individuals, was used to assess the carotid vasculature of patients being treated for ORN. PATIENTS AND METHODS The panoramic radiographs of 61 men (mean age, 60.5 years; range, 41 to 77 years) who received therapeutic irradiation to the neck 36 months or more previously were assessed for the presence of carotid artery atherosclerotic lesions. Sixty-one control subjects who never received therapeutic irradiation, but who were similarly susceptible to atherosclerosis by virtue of age, were assessed in a like manner. RESULTS The irradiated individuals sustained a dose of 40 to 72 Gy to the area of the carotid bifurcation. Seventeen individuals (27.9%) with an irradiation dosage to the carotid bifurcation that averaged 59.2 Gy had a panoramic radiograph with a carotid atheroma (11 with unilateral lesions and six with bilateral lesions). The radiographs of the control subjects showed that three individuals (4.9%) had calcified carotid lesions. The mean age of these subjects was 66.1 years; two had unilateral lesions, and one had bilateral lesions. The difference in the proportion of individuals with ORN who manifested carotid artery atherosclerosis on their panoramic radiographs was statistically significant (P = .001) when compared with the nonirradiated control subjects. The lesions seen in both populations had a similar morphologic appearance and were radiographically located within the soft tissues of the neck 1.5 to 4.0 cm inferior-posterior to the angle of the mandible. CONCLUSIONS Individuals with radiation doses sufficient to cause osteoradionecrosis of the mandible are at significantly higher risk of developing carotid artery atherosclerotic lesions than age-matched, nonirradiated controls.
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Affiliation(s)
- A H Friedlander
- Dental Service, Veterans Affairs Medical Center, Sepulveda, CA 91343, USA
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Friedlander AH, August M. The role of panoramic radiography in determining an increased risk of cervical atheromas in patients treated with therapeutic irradiation. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1998; 85:339-44. [PMID: 9540095 DOI: 10.1016/s1079-2104(98)90020-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Therapeutic irradiation of the neck is a common component of treatment for those with carcinoma of the oral cavity, pharynx, and larynx. Such irradiation, however, has been implicated as the cause of accelerated atherosclerosis of the cervical carotid artery and subsequent stroke. Panoramic radiography, previously shown to be capable of identifying carotid artery atherosclerosis in non-irradiated individuals, was used to assess the carotid vasculature of patients who had been treated for cancer with therapeutic irradiation. METHODS The panoramic radiographs of 33 male subjects who had received therapeutic irradiation (> or = 50 Gy) to the neck 30 or more months previously were assessed for the presence of calcified carotid artery atherosclerotic lesions. Age-matched controls, similarly liable for oropharyngeal malignancy and atherosclerosis by virtue of their medical and habitual risk factors (hypertension, smoking, obesity) were assessed in a like manner. RESULTS The panoramic radiographs of the irradiation-treated subjects (age range, 32 to 84 years; mean age, 66.1 years) showed that 21% (7 of 33 subjects) had calcified atherosclerotic lesions. The mean age of these seven subjects was 64.6 years; four had unilateral lesions and three had bilateral lesions. The radiographs of the control subjects showed that 4.7% (5 of 107 subjects) had calcified atherosclerotic lesions. The mean age of these five subjects was 67; three had unilateral lesions and two had bilateral lesions. The lesions seen in the two populations had similar morphologic appearances. The discrete radiopaque calcifications were located within the soft tissues of the neck, approximately 2.5 cm inferior-posterior to the angle of the mandible. CONCLUSIONS Subjects who had received therapeutic irradiation of the neck had a statistically higher risk (p = 0.007, according to Fisher's Exact Test) of the development of calcified carotid artery atherosclerotic lesions than age-matched, risk-matched, non-irradiated control subjects. These lesions can be detected on routine panoramic radiographs.
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Affiliation(s)
- A H Friedlander
- Oral and Maxillofacial Surgery Service, Veterans Affairs Medical Center, Sepulveda, Calif., USA
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Friedlander AH, Dounis G, Gratt BM. Lateral cephalometric radiographs: an aid in detecting patients at risk of stroke. J Am Dent Assoc 1996; 127:1745-50. [PMID: 8990744 DOI: 10.14219/jada.archive.1996.0135] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Stroke is often caused by atherosclerotic lesions in the bifurcation of the common carotid artery. The authors evaluated conventional lateral cephalometric radiographs of 1,063 healthy men aged 25 to 85 years for the presence of such lesions. Approximately 2 percent of these people had lesions, which were at the level fo the third and fourth cervical vertebrae and were superimposed over these structures, the pre-vertebral fascia and the pharyngeal air space. People with atherosclerotic lesions should be referred to their physicians because timely medical, surgical and lifestyle interventions can prevent strokes.
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Affiliation(s)
- A H Friedlander
- Veterans Affairs Medical Center, Sepulveda, Calif. 91343, USA
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Friedlander AH. Panoramic radiography: the differential diagnosis of carotid artery atheromas. SPECIAL CARE IN DENTISTRY 1995; 15:223-7. [PMID: 9002923 DOI: 10.1111/j.1754-4505.1995.tb00522.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Cervical carotid artery atherosclerosis, a major cause of stroke (cerebrovascular accident, CVA), commonly occurs in older individuals with a history of hypertension and smoking. These atheromatous plaques, when calcified, may be imaged on conventional panoramic dental radiographs. Dentists caring for "at-risk patients" must be able to identify these lesions and to differentiate them from anatomical and other pathological radiopacities frequently observed in the carotid artery territory. Prompt referral of these individuals to a physician may preclude a stroke.
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Affiliation(s)
- A H Friedlander
- Dental Service, Veteran Affairs Medical Center, Sepulveda, CA 91343, USA
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