Side- and patient-based performance of a deep learning system based on the results of individual detection of carotid artery calcifications on panoramic radiographs

Detection of incidental carotid artery calcifications during dental examinations: Panoramic radiography as an important aid in dentistry

Area detection improves the person-based performance of a deep learning system for classifying the presence of carotid artery calcifications on panoramic radiographs.

Aim of study. -Detection of Carotid Artery Calcification on Digital Panoramic Radiographs. Study Design: A total of 1017 random digital panoramic radiographs used as a part of routine dental examination were reviewed for the presence of Carotid Artery Calcifications. The images were interpreted by trained maxillofacial radiologists for the presence or absence of carotid calcification. Results: Out of 1017 digital panoramic radiographs only 323 digital panoramic radiographs were examined for Carotid Artery Calcifications, 13 (4.02 %) were noted to have Carotid Artery Calcifications on panoramic radiographs. The 13 Carotid Artery Calcifications patients consisted of 11 males and 2 females. All Calcifications were seen in participants above 40 years of age. These calcifications on the panoramic radiograph were unilateral in 11 (84.6%) and bilateral in 2 (15.3%) individuals. Summary and Conclusions: Panoramic radiography is an economical and non-invasive method for detecting cervical calcifications. PRs may help in the early diagnosis and in the assessment of CACs in patients with or without associated risk factors and reduce the morbidity and mortality due to diseases caused by atherosclerosis. Key Words: Carotid Artery Calcifications, digital imaging, panoramic radiography

The detection of carotid artery calcification at an early stage is important to reduce the effects of cardiovascular disease in patients undergoing hemodialysis. This study sought to evaluate the prevalence of carotid artery calcification from panoramic radiographs of patients who were undergoing hemodialysis and to assess the relationship between such calcification and certain medical and periodontal parameters. We evaluated 120 panoramic radiographs from patients who were undergoing hemodialysis for the presence of carotid artery calcification. Full-mouth periodontal clinical and medical parameters were recorded, and patients were diagnosed on the basis of the new periodontal disease classification. Patient medical records from the same period (the same week) during which the panoramic radiographs were taken were also assessed. Among the 120 participating patients, pano - ramic radiographs from 27 patients (22.5%) showed a uni- or bilaterally radiopaque mass. Of the periodontal clinical parameters investigated for associations between patients with and without carotid artery calcification, there was only a significant difference shown for probing pocket depth (P = .017). No significant differences were found between the groups with and without carotid artery calcification with regard to any other medical or periodontal parameter. In our study group, suspected carotid artery calcifications were detected on panoramic radiographs in about one-fourth of total patients receiving hemodialysis. Because of the significant relationship found between probing pocket depth and carotid artery calcification, the presence of periodontal disease may be associated with calcifications in these patients. Dentists should maintain awareness in detecting these lesions when evaluating panoramic radiographs of patients undergoing hemodialysis.

Detection of carotid plaques on panoramic radiographs using deep learning

BackgroundThe 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 MethodsFrom 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.ResultsThe 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).ConclusionCarotid 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.

To evaluate the diagnostic accuracy of digital panoramic radiograph (DPR) for detection of carotid artery calcification (CAC) confirmed by Doppler Ultrasonography (DUSG) and to clarify the relationship between between CAC identified by DPR and cardiovascular events through a 5 year follow-up period. Of 3600 consecutive patients examined, 158 patients presented with CAC as detected by DPR. The final study group was composed of 96 patients who had CAC confirmed by DUSG or CT angiogram. The control group was composed of 62 patients who has normal DUSG. The end point of the study was the occurrence of any cardiovascular event. 72 (75%) of the 96 patients with CAC confirmed by DUSG (16 patients had significant stenosis) had bilateral and 24 (25%) had unilateral CAS as detected by DUSG. There was a low agreement between the examination results with a κ value of 0.488 (p < 0.005) for calcification. Study data revealed that smoking, chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM) and diastolic hypertension were significantly more common in patients with CAC than the control group (p < 0.05). During the follow-up period, 13 subjects had myocardial infarction and 1 subject died; in the control group, 1 patient died after MI and 1 patient died of a non-cardiac event. Patients with CAC detectable by DPR concomitant with COPD, DM, smoking or diastolic hypertension are more likely to suffer from vascular events. Therefore, patients with detectable carotid plaque in DPR require referral to a cardiovascular surgery clinic for further investigations.

Background: Atherosclerosis is characterized by the deposition of lipids on the internal walls of blood vessels, damaging various tissues of the body by complete or partial occlusion of the vessels. Sometimes the calcified plaques in the carotid artery can be detected on panoramic radiographs, helping the practitioners decrease the risk of Cerebrovascular Accident (CAV). Objective: This study aimed to assess the frequency of Carotid Artery Calcification (CAC) detected in panoramic radiographs of patients with hypertension or myocardial infarction. Methods: A total of 400 panoramic radiographs of patients &gt;40 years of age were evaluated. The images belonged to patients with a history of hypertension or myocardial infarction and healthy individuals referred from the AL Zahra Cardiology Department to Isfahan School of Dentistry and a private oral and maxillofacial imaging center. All the images were evaluated for the presence of CAC. Data were analyzed with SPSS 19, using the Chi-squared test, Fisher's exact test, t-test and ANOVA (α=0.05). Results: The prevalence rate of CAC was 4%. According to the results, there was a significant relationship between CAC and hypertension (P=0.003), with no significant relationship between the prevalence of these lesions, stage of hypertension and myocardial infarction. Conclusion: According to the results, the prevalence of CAC on panoramic radiographs was significant; therefore, it seems that the detection of CAC on panoramic radiographs of patients must be considered by dentists.

Carotid artery calcification is responsible for an estimated 5% of ischaemic strokes. Carotid doppler sonography (DS) is a frequently used non-invasive method for assessing carotid artery stenosis and calcification. This study assessed the utility of panoramic radiography to detect any carotid artery calcification in patients with and without coronary artery disease, as well as the level of agreement between panoramic radiographs and DS findings. Ninety subjects who underwent coronary angiography for any reason in Namazi Hospital, Shiraz University of Medical Science during an 11 month period received a DS assessment and panoramic radiograph. The radiopacities adjacent to the cervical vertebrae at or below the intervertebral space between C3-C4 were diagnosed as carotid artery calcifications. Carotid calcifications were scored as present or absent and pattern of calcification was noted by a maxillofacial radiologist who was blind to the angiogram and sonogram results. The final sample population was 84 subjects, providing data on 168 carotid arteries. The panoramic radiograph had a sensitivity of 66.6% and a positive predictive value of 45% for detecting carotid artery calcifications in patients whose angiograms confirmed the coronary artery disease. It had 50% sensitivity in patients with normal angiogram. The level of agreement between panoramic radiographs and DS results was weak. Because of low sensitivity and positive predictive value, the panoramic radiograph can not be considered an accurate or reliable method for detecting carotid artery calcification.

Objectives Carotid artery calcification is responsible for an estimated 5% of ischaemic strokes. Carotid doppler sonography (DS) is a frequently used non-invasive method for assessing carotid artery stenosis and calcification. This study assessed the utility of panoramic radiography to detect any carotid artery calcification in patients with and without coronary artery disease, as well as the level of agreement between panoramic radiographs and DS findings. Methods Ninety subjects who underwent coronary angiography for any reason in Namazi Hospital, Shiraz University of Medical Science during an 11 month period received a DS assessment and panoramic radiograph. The radiopacities adjacent to the cervical vertebrae at or below the intervertebral space between C3-C4 were diagnosed as carotid artery calcifications. Carotid calcifications were scored as present or absent and pattern of calcification was noted by a maxillofacial radiologist who was blind to the angiogram and sonogram results. The final sample population was 84 subjects, providing data on 168 carotid arteries. Results The panoramic radiograph had a sensitivity of 66.6% and a positive predictive value of 45% for detecting carotid artery calcifications in patients whose angiograms confimed the coronary artery disease. It had 50% sensitivity in patients with normal angiogram. The level of agreement between panoramic radiographs and DS results was weak. Conclusion Because of low sensitivity and positive predictive value, the panoramic radiograph can not be considered an accurate or reliable method for detecting carotid artery calcification.

BackgroundAtherosclerosis and its secondary diseases display a major threat to patient’s health. Sequelae, like carotid artery calcification (CAC), usually develop over decades and remain asymptomatic for a long time, making preventive measures to reduce mortality and morbidity extremely important. Through panoramic radiography (PR) and cone beam computed tomography (CBCT), dentists may have helpful tools in aiding the holistic care of patients. In this context, the correlation of atherosclerotic risk factors and CAC development have not yet been sufficiently investigated. Thus, the aim of this observational radiological study was to evaluate the diagnostic value of PR compared with CBCT for the detection of CAC in patients older than 60 years. The radiological findings were correlated with gender, age, and cardiac risk factors.MethodsPRs and CBCTs of N = 607 patients were used for the qualitative analysis and compared. Basic patient information such as age, gender, body mass index (BMI), smoking history as well as patient’s detailed medical history, including heart disease and cardiovascular risk factors such as hypercholesterolemia, arterial hypertension and diabetes mellitus type II were documented and their relation to CAC provided by radiological data was estimated in the form of odds ratios (OR), which were calculated using logistic regression models. Proportions of CAC in different risk groups were compared using Fisher’s exact test, the significance level was set to α ≤ 0.05. The interrater reliability of two physicians was estimated using Cohen’s kappa.ResultsWith an accuracy of 90.6%, a sensitivity of 67.5% and a specificity of 99.5% compared to CBCT, PR was a reliable method for the diagnosis of CAC. The overall detection rate for CAC was 27.8% across all age groups. Age (OR: 1.351; p = 0.021), the male sex (OR: 1.645; p = 0.006), arterial hypertension (OR: 2.217; p = < 0.001), heart disease (OR: 1.675; p = 0.006), hypercholesterolemia (OR: 1.904; p = 0.003) and chronic obstructive pulmonary disease (OR: 2.016; p = 0.036) were statistically significant risk factors. When correlated, neither history of stroke nor nicotine abuse showed any statistical significance.ConclusionsDue to the capabilities of PR in the diagnosis of CAC, dentists can play a vital role in the early diagnosis of vascular disease. Awareness should therefore be raised among dentists regarding the detection of CAC in patients over 60 years of age, with a particular focus on those with arterial hypertension and hypercholesterolaemia.

BackgroundIn 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.MethodsThe 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.ResultsPatients 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.ConclusionsFindings of bilateral vessel-outlining CACs in PRs are independent risk markers for future vascular events.

Incidental findings of carotid artery stenosis detected by calcifications on panoramic radiographs: report of three cases

Carotid artery calcifications and pulpal stones are radiopaque findings that may be found accidentally in panoramic views. The risk of affliction with atherosclerotic events in diabetic patients with dystrophic calcification is questionable. This study aimed to investigate the relative frequency of carotid calcifications and pulp stones in panoramic radiographs of diabetic patients. This retrospective observational study employed a convenience sampling method involving 107 diabetic patients. For comparison, 300 panoramic views from individuals estimated to be healthy in the community were included. The samples were randomly selected from the statistical population using a random numbers table. Data analysis was conducted using descriptive statistics, including mean and standard deviation, as well as analytical tests such as the chi-square test, all performed with SPSS 17 software (Chicago, USA). In this study, panoramic radiographs of 107 diabetic patients (67 women and 40 men) and 300 healthy individuals (196 women and 104 men) were evaluated. The age range was 25 to 64years, with a mean age of 49.7. The frequency of carotid artery calcification was 42 (14%) in healthy individuals and 44 (41.1%) in diabetic patients. Furthermore, the relative frequency of unilateral and bilateral carotid artery calcification in diabetic patients was significantly higher than in healthy subjects (P < 0.05). The Relative Risk (RR) of pulp stones in the diabetic patient group compared to healthy individuals was 1.8. With a 95% confidence interval, the relative risk ranged from 1.3 to 2.48, which was statistically significant (P < 0.05). Based on the findings, the frequency of carotid artery calcification and pulp stones was higher in diabetic patients. Panoramic radiographic screening in diabetic patients is useful for early detection of carotid artery calcification and timely referral of patients to endocrinologists to prevent adverse sequelae.

Osteoporosis, osteoporotic fractures, and carotid artery calcification detected on panoramic radiographs in Japanese men and women