Evaluation of carotid artery atheromatous plaques using digital panoramic radiographs with Doppler sonography as the ground truth

Abstract

Objectives: The objective of the study was to determine whether digital panoramic radiography is a reliable method to detect calcified carotid artery atheromatous plaques (CCAAP) as compared to ultrasonography.Study design: Digital panoramic radiographs were obtained from 50 patients who also underwent carotid ultrasound examination. The images were interpreted by trained maxillofacial radiologist for the presence or absence of calcified atheromatous plaques. The extent of carotid calcification on carotid ultrasonography was determined by a trained sonologist which was considered as gold standard assessment.Results: Digital panoramic radiographs had sensitivity of 76% and specificity of 98.66% in determining calcified carotid artery atheromatous plaques. There was a high level of agreement between diagnoses, with a kappa value of 0.8. Conclusion:To conclude, digital panoramic radiographs had good sensitivity and high specificity in detecting calcified carotid artery atheromatous plaques. If properly trained, dentists can detect such plaques and can refer patients to physician for timely medical treatment.

Association between intracranial carotid artery calcifications and periodontitis: A cone‐beam computed tomography study

“…The authors found that the panoramic radiographs had a sensitivity of 66.6%, and a positive predictive value of 45% was found for the detection of carotid artery calcifications in patients whose angiograms confirmed the presence of coronary artery disease and a sensitivity of 50% in patients with a normal angiogram 20 . However, the sensitivity and specificity reached 76% and 98% in digital panoramic X‐rays, respectively, in the portrayal of carotid artery calcifications 21 . In addition, a statistically significant association was found between the presence of ECACs in panoramic radiographs and the percentage of alveolar bone loss in patients with periodontitis 19 …”

Prevalence of suggestive images of atheroma in panoramic radiographs: clinical profile and risk factors for cardiovascular disease / Prevalência de imagens sugestivas de ateroma em radiografias panorâmicas: perfil clínico e fatores de risco para a doença cardiovascular

“…In 1981 Friedlander first unveiled the presence of soft tissue calcifications in this unvisited territory of panoramic radiographs (2,5). CCAAs are closely related to cerebrovascular accidents and such calcifications can be radiographically detected while performing routine medical procedures (11).…”

“…The PRs analysis investigated radiopaque images in the soft tissues compatible with images suggestive of CCAA. They were interpreted either as nodular or as verticolinear radiopacity below the mandibular angle, adjacent or inferior to the hyoid bone, epiglottis, and cervical vertebrae at, above, or below the intervertebral space of C3-C4, and at a 1.5-2.5-cm distance (1,2,7,10,12,16).…”

“…This gives dentists an additional responsibility to examine this much ignored but vital area on PR. Although calcifications may not imply significant stenosis and not all atherosclerotic lesions are calcified, it is hypothesized that presence of calcifications seen on dental radiographs may be associated with significant latent carotid disease (2).…”

Panoramic Radiography — Diagnosis of Relevant Structures That Might Compromise Oral and General Health of the Patient

“…The reliability of digital panoramic radiographs in detecting atheroma in the carotid artery was assessed [69] and the authors compared with ultrasound examinations. The results showed that digital panoramic radiography has a high level of agreement with ultrasonography with 76% of sensitivity and 98.66% of specificity.…”