Calcified Carotid Atheromas Research Articles

Are Panoramic Images a Good Tool to Detect Calcified Carotid Atheroma? A Systematic Review.

To investigate the reliability of panoramic dental images to detect calcified carotid atheroma, electronic databases (PubMed, IEEE/Xplore and Embase) were searched. Outcomes included cerebrovascular disease events, cardiovascular disease events, patient previous diseases, and combined endpoints. Risk of bias was evaluated using the Newcastle-Ottawa Scale. Hence, 15 studies were selected from 507 potential manuscripts. Five studies had a low risk of bias, while the remaining nine studies were found to have a moderate risk. Heterogeneous results were obtained but showed that patients with risk factors, such as obesity, diabetes mellitus, hypertension, and smoking, and with calcified carotid atheroma on panoramic images, have a higher prevalence than healthy patients. The evidence in the literature was found to be equivocal. However, the findings of this systematic review exhibit that panoramic radiographs can be used for dental diagnosis and treatment planning, as well as to detect calcified carotid artery atheroma.

Diagnostic Reporting of Calcified Carotid Atheroma in Digital Panoramic Radiograph – A Retrospective Study

Context: Cerebrovascular disease remains one of the leading causes of death in many countries. Aim: To evaluate the presence of calcified carotid atheroma in digital panoramic radiographs, thereby referring the patients to cardiology for early management and prevention of stroke. Settings and Design: Hospital- based, cross- sectional retrospective study. Materials and Methods: The study design included 1000 digital panoramic radiographs taken for the needful patients in the Department of Oral Medicine and Radiology for a period of one year from November 2018 to October 2019. Two examiners (experienced maxillofacial radiologists) evaluated the presence of calcified carotid atheroma in panoramic radiographs. Results: Out of 1000 digital panoramic radiographs, 39 panoramic radiographs were found to have the presence of calcified carotid atheroma, of which 9 were male and 30 were female panoramic radiographs. The prevalence was found to be higher in the age group between 45 to 54 years. Conclusion: Panoramic radiographs help to assess the presence of calcified carotid atheromas. Careful evaluation of panoramic radiographs by maxillofacial radiologists for carotid atheromas could be life-saving in the prevention of stroke.

Detection of calcified carotid atheroma on panoramic dental radiography and its confirmation by Doppler ultrasound.

A aterosclerose da arteria carotida e uma das principais causas do acidente vascular cerebral (AVC).() Em radiografia panorâmica odontologica (RPO), imagens radiopacas adjacentes a coluna cervical podem ser indicativas de calcificacoes na bifurcacao da arteria carotida. Elas podem representar ateromas calcificados,() cuja confirmacao diagnostica e feita por meio da ultrassonografia com Doppler.(,) Cirurgioes-dentistas podem identificar essas areas em RPO e diferencia-las de radiopacidades que podem ser observadas na regiao carotidea. A identificacao dessas areas e o encaminhamento desses individuos a [...]

Prevalence of soft tissue calcifications in cone beam computed tomography images in the region of head and neck

Objective: to evaluate the prevalence of calcifications in the soft tissues of the cervical-facial region using cone beam computed tomography (CBCT) images. Material and Methods: two hundred and ten CBCT exames was analyzed by 01 examiner previously trained, with fild of view (FOV) of 16 x 13 cm and voxel of 0.25 mm, in ICAT Vision software (Imaging Science International, Hatfield, PA, USA) in coronal, axial and sagittal sections. The following calcifications were evaluated: tonsiloliths, sialolites, calcification of the styloid complex, calcified carotid atheromas, calcifications in laryngeal cartilages, calcified lymph nodes and osteoma cutis. The findings were tabulated according to the total of the sample, related to the gender, age group of the individuals. Results: Calcification of the styloid complex was the most frequent in the sample studied in both genres (39.04%), followed by the presence of tonsiloliths (19.52%), and calcified lymph nodes (6,67%). Conclusion: calcifications are frequent radiographic findings in CBCT and important for the diagnosis of some possible pathologies that do not present clinical symptoms.KEYWORDSCone-beam computed tomography; Prevalence; Soft tissue calcification.

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

AimThe 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 methodsA 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).ResultsOf 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.ConclusionAlthough 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.

Relationship between calcified carotid atheromas in digital panoramic radiographs and underlying systemic diseases in implant patients.

The aim of the present study was to evaluate the correlation between calcified carotid atheromas (CCA) detected on digital panoramic radiographs and underlying systemic diseases. Panoramic radiographs and underlying systemic diseases of retained mandibular denture implants in 265 patients (56 males, 209 females) aged over 50 years were retrospectively evaluated at the Dental Unit of Prasat Neurological Institute, Bangkok, Thailand. The mean age of the patients was 71 ± 7.1 years. The prevalence of CCA was 38.49%. The major underlying systemic diseases were hypertension, hyperlipidemia, diabetes mellitus, and cardiovascular diseases (CVD), respectively. No relationship was found among these four systemic diseases in detecting CCA on panoramic radiographs. Similar findings were also observed in patients with only one systemic disease versus in combination with other diseases. The presence of CCA on dental panoramic radiographs was not found to be related to the presence of underlying systemic diseases, including hypertension, hyperlipidemia, diabetes mellitus, and CVD.

Association of calcified carotid atheromas visualized on panoramic images and aortic arch calcifications seen on chest radiographs of postmenopausal women

Occult atherosclerotic disease is the leading cause of death among older women. The authors hypothesized that women with calcified carotid artery plaque (CCAP) visualized on panoramic images were more likely to have aortic arch calcifications (AAC) that were visible on chest radiographs (CRs), a risk indicator of experiencing cardiovascular events, than would matched cohorts who did not have atheromas. The authors obtained the CRs of 36 female veterans (≥ 50 years) who had CCAP and atherogenically risk-matched them to those of 36 women without CCAP. A radiologist evaluated the CRs for AAC. Other study variables included age, ethnicity, body mass index and presence or absence of hypertension, diabetes and dyslipidemia. The authors computed descriptive and bivariate statistics. Women 60 years or older who had evidence of CCAP on their panoramic radiographs were significantly (P = .022; 95 percent confidence interval, 1.298-26.223) more likely to have evidence of AAC on their CRs than were similarly aged women who did not have evidence of CCAP. This association was not evident in women younger than 60 years. Among women who were both younger and older than 60 years, there was no evident association between the presence of CCAP and the severity (on a four point scale [0-3]) of AAC calcification. Prevalence of carotid plaque on panoramic images of women 60 years or older is significantly associated with presence of aortic arch calcifications on CRs. Panoramic images of women 60 years or older must be evaluated for CCAP, given their association with AAC. Patients with atheromas should be referred to their physicians for further evaluation given the systemic implications.

Evaluation of Positive Predictive Value for Digital Panoramic Radiography in Comparison to Ultrasound in the Diagnosis of Calcified Carotid Atheroma

Aim: Detection of calcified carotid atheroma (CCA) has an important role in reducing the incidence of Cerebro Vascular Accident (CVA). The aim of this study was to evaluate efficacy of panoramic digital radiography in detecting atherosclerosis. Methods: It is descriptive-analytical diagnostic study. The people (22 to 62 years old) were referred to a radiology clinic to perform panoramic radiography for diagnosis of CCA. Individuals who were suspected were introduced to the radiology department of dental school to undergo ultrasound evaluation to CCA. For the 41 patients (55 sides), ultrasound was performed. For data analysis, the Chi-square and Fisher's exact test were used. Results: The prevalence of CCA was 2.43%. The PPV of digital panoramic was 45.5%. There was no significant relationship between age (P = 0.14) and sex (P = 0.539) and PPV of digital panoramic. The PPV of digital panoramic was significantly associated with hypertension (P = 0.032). Conclusion: It seems that panoramic can be used to screen patients with a history of hypertension for atherosclerosis.

Sensitivity and accuracy of panoramic radiography in identifying calcified carotid atheroma plaques

Atherosclerosis is a chronic inflammatory disease that can cause death and physical and/or mental disabilities. It represents a serious public health problem owing to the high healthcare costs involved in rehabilitating patients. Among the different methods available for diagnosing atherosclerotic disease, color Doppler examination may be considered the “gold standard.” On the other hand, panoramic radiography of the jaws (PRJ) is a diagnostic resource commonly used by dentists, and the obtained images allow examining other structures apart from the maxilla and the mandible. Aim: To evaluate the sensitivity and accuracy of panoramic radiography in identifying calcified carotid atheroma, and compare the results to those obtained with color Doppler examination. Methods: Forty-two cervical regions were evaluated in panoramic radiographs and color Doppler scans. The kappa test (p < 0.05) was used to assess agreement between the examinations. Data were tested for sensitivity, specificity and negative predictive value, as well as positive and negative likelihood ratios. Results: The kappa value was 0.11. The sensitivity and specificity of PRJ were 73.9 and 36.8%, respectively, and the positive and negative likelihood ratios were 1.2 and 0.7, respectively. Conclusions: Although a low correlation between PRJ and color Doppler examination was observed, as shown by the kappa test, the sensitivity of PRJ in identifying calcified carotid atheroma was considered acceptable.

Bilateral tonsilloliths and calcified carotid atheromas: case report and literature review

Tonsilloliths and calcified carotid atheromas are dystrophic calcifications that can be identified in routine oral radiographs. This case report is the first description in the English literature of the simultaneous occurrence of bilateral tonsilloliths and calcified carotid atheromas. Panoramic oral radiographs from a 62-year-old woman presented bilateral radiopaque images of the left and right ramus of the mandible; multiple and well-defined radiopacities below the left angle of the mandible, next to the C3–C4 cervical vertebrae; and a single radiopacity on the right side between the hyoid bone and the mandible base. Computed tomography confirmed the exact location of the calcifications in the oropharyngeal and carotid spaces. A diagnosis of bilateral tonsilloliths and calcified carotid atheromas was reached. Doppler ultrasound indicated a degree of stenosis of ±20% within the right and left carotids. The patient was referred to a vascular surgeon to evaluate the calcified carotid atheromas. Follow-up of the tonsilloliths was also performed.

Fibroblast growth factor (FGF)‐23 and fetuin‐A in calcified carotid atheroma

Human atheroma calcification occurs secondary to repetitive injury/remodelling of the vessel wall and might be initiated by adherence of mineral-loaded fetuin-A whether or not professional matrix mineralizing cells are present. The aim was to investigate the contribution of fibroblast growth factor (FGF)-23 to ectopic mineralization. Serial sections of formalin-fixed paraffin-embedded human carotid atheroma (n = 54) were investigated with respect to (i) size and distribution of calcific deposits, (ii) indicators of chondrogenic/osteogenic transformation, and (iii) expression of fetuin-A and FGF-23. All specimens were calcified and SOX-9, collagen type II, cathepsin-K, fetuin-A and FGF-23 expression was seen in 46, 53, 53, 54 and 48 specimens, respectively. The intracellular detection of FGF-23 (45/48) indicates local synthesis. Whereas fetuin-A expression was seen also within areas of vascular smooth muscle actin-positive cells adjacent to calcific deposits, FGF-23 expression was apparently restricted to the mineralization-prone areas. Both local expression and FGF-23 serum concentrations were significantly associated with the degree of atheroma calcification. Besides the induction of bone islets and subsequent mineral deposition, severe remodelling of the vessel wall is sufficient to create a mineralizable fetuin-A-attracting microenvironment. FGF-23 might contribute to the formation of proper mineral, i.e. control local phosphate concentration.

Panoramic Radiography Does Not Reliably Detect Carotid Artery Calcification Nor Stenosis

Article Title and Bibliographic Information Utility of Panoramic Radiographs in Detecting Cervical Calcified Carotid Atheroma Madden RP, Hodges JS, Salmen CW, Rindal DB, Tunio J, Michalowicz BS, et al. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103(4):543-8 Level of Evidence 2b Purpose/Question This study sought to determine whether panoramic radiographs can help accurately detect extracranial calcified carotid atheroma and/or carotid luminal stenosis. Source of Funding University of Minnesota School of Dentistry and HealthPartners Research Foundation Type of Study/Design Cohort Study

Utility of panoramic radiographs in detecting cervical calcified carotid atheroma

The objective of this study was to determine the utility of panoramic radiographs for detecting extracranial calcified carotid atheroma and carotid luminal stenosis. Panoramic radiographs were obtained on 52 adult participants who had carotid ultrasound examination. Extent of carotid calcification and stenosis was determined by a cardiologist from ultrasound reports, which were considered gold standard assessments. A trained and calibrated oral and maxillofacial radiologist interpreted the radiographs for presence or absence of carotid calcifications. We examined the utility of panoramic radiographs to diagnose any carotid artery changes (diagnostic scheme 1) or only moderate to severe changes (scheme 2). Generalized estimating equations were used to account for clustering of observations within subjects. Under diagnostic schemes 1 and 2, radiographs had low sensitivity to detect carotid calcifications (31.1% and 25.0%, respectively) and stenoses (22.7% and 21.4%, respectively). When compared to ultrasonography, panoramic radiography is not a reliable means to detect carotid artery calcifications or stenoses.

Study of the localization of radiopacities similar to calcified carotid atheroma by means of panoramic radiography

To determine the location in soft tissues of the calcifications, similar to calcified carotid atheromas, that can be observed radiographically in the cervical region in panoramic radiographs. In each anatomic cadaver specimen preserved in formol, consisting of the head and neck, radiopaque spheres (made from gutta-percha) were positioned in anatomic structures of the cervical region that can be sites of calcification. For each anatomic structure marked in this way, panoramic radiography was performed, consisting of 17 radiographs. The images obtained were analyzed by 24 examiners who indicated which radiographs, in their opinion, presented the radiopaque reference projected in the region of bifurcation of the carotid artery. Analysis of 2 proportions from agreement and disagreement was used to determine radiopacities that could be confused in panoramic radiographs with calcified atheromas in the carotid artery. The results showed that 75% (18) of the examiners correctly indicated the reference in the bifurcation of the carotid artery and 79.2% (19) indicated a triticeous cartilage as calcified atheroma of the carotid artery. Calcified atheromas of the carotid artery are not the only features that can produce radiopaque images lateral to the panoramic radiograph; the presence of calcification in the triticeous cartilage also can induce an erroneous diagnosis of calcified carotid atheroma.

Triticeous cartilage: Prevalence on panoramic radiographs and diagnostic criteria

To determine (1) the prevalence of calcified triticeous cartilage on panoramic radiographs of subjects older than 40 years of age, (2) the age and sex distribution of the subjects who have calcified triticeous cartilage, and (3) if the shape of triticeous cartilage differs from that of calcified carotid atheroma. In this retrospective study, triticeous cartilages were diagnosed from 847 panoramic radiographs. The shapes of triticeous cartilages and calcified carotid atheromas were determined using SigmaScan software. Prevalence of triticeous cartilage was 5.0% in males and 12.0% in females. The prevalence was 9.3% in the 40- to 60-year-old group (n=464) and 7.8% in the group older than 60 years (n=383). The triticeous cartilages were oval with smooth borders, whereas calcified carotid atheromas were mostly linear. Calcified triticeous cartilage was more prevalent in females. The prevalence was not age dependent. Shape, outline, and location of the triticeous cartilage can help in differentiating it from a carotid atheroma.

The prevalence of calcified carotid atheromas on the panoramic radiographs of patients with dilated cardiomyopathy

Objective Individuals with dilated cardiomyopathy (DCM) often die from heart failure without a transplant. Of those who do receive a transplant, a significant number suffer a perioperative stroke, although the cause is often in doubt. Our study attempts to determine whether the prevalence of calcified carotid artery atheromas, a known cause of stroke, is greater on the panoramic radiographs of individuals with DCM than it is among controls. Study design Twenty-seven persons [mean age 62.3 years] enrolled in the UCLA Cardiac Transplantation Program were provided a panoramic radiograph. An age-matched, atherogenic risk-matched cohort of 54 patients free of DCM served as controls. The radiographs of patients in each group were examined for the presence of calcified carotid atheromas. Results Nine of the 27 patients with DCM had calcified atheromas, whereas only 2 of the 54 patients in the control group had such lesions. This difference was statistically significant ( P<.001). Conclusions Panoramic radiographs may be helpful in identifying some DCM patients with occult carotid artery atherosclerosis who may be at risk for a subsequent stroke.

Image characteristics of digital panoramic radiography—potential for computer-aided diagnosis of calcified carotid atheromatous plaque

A retrospective analysis of panoramic radiographs from patients with head and neck cancer, taken prior to radiation therapy, revealed a prevalence of carotid calcifications of 12.6% in men aged 50–59 years, but only 3.3% in women of the same age. By age 70–79 years, the prevalence of calcified carotid atheromas was similar for both genders. Evaluation of the image layer characteristics of a prototype Instrumentarium OP 100D digital panoramic X-ray machine shows this unit to be suitable for detection of calcifications, within the carotid artery at the region of the bifurcation.

Discrimination between calcified triticeous cartilage and calcified carotid atheroma on panoramic radiography

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. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:108-10)

The prevalence of calcified carotid artery atheromas in patients with obstructive sleep apnea syndrome

Purpose: Persons with obstructive sleep apnea syndrome (OSAS) suffer cerebrovascular accidents at three to six times the rate of other Americans. Atherosclerosis of the cervical portion of the carotid artery has been suggested as a possible cause of these strokes. Lateral cephalometric radiographs used to determine the site of upper airway obstruction in sleep apnea patients can also image calcified cervical carotid artery atheromas. However, their prevalence in this group of patients has not been previously reported. Patients and Methods: The radiographs of 47 male subjects (mean age 59.2 years, range 45 to 77 years) diagnosed as having OSAS (apnea/hypopnea index [AHI] of ≥15 and a history of snoring and excessive daytime sleepiness) were assessed for calcified carotid atheromas. Healthy, age-matched (±18 months) controls were likewise assessed. Results: The radiographs of the subjects with OSAS showed that 21.3% had calcified atheromas. The radiographs of the controls showed that only 2.5% had calcified atheromas. This finding was statistically significant ( P = < .000001). The lesions seen in both populations were similar, and located within the soft tissues of the neck at the level of C 3 and C 4. The lesions were superimposed over these tissues, the prevertebral fascia, and the pharyngeal airspace. Conclusions: The results of this study seem to indicate that persons with OSAS have a greater prevalence of calcified carotid artery atheromas than healthy, age-matched persons. These lesions, a possible cause of future stroke, can be detected on lateral cephalometric radiographs.

Identification of stroke-prone patients by panoramic and cervical spine radiography.

To determine if calcified atherosclerotic lesions in the region of the bifurcation of the common carotid artery (a major cause of stroke) can be identified by conventional panoramic dental radiography. All those aged 65 years or older, of 500 consecutive out-patients enrolled in the dental clinic for comprehensive treatment and for whom it was possible to obtain a technically satisfactory panoramic radiograph, were included. The radiographs were evaluated for the presence of radiopacities within the soft tissues of the neck at the level of the lower margin of the third cervical vertebra. An antero-posterior cervical spine radiograph was obtained of those individuals with any such calcifications. Medical histories were obtained from patients with suspected lesions in order to determine the presence of risk factors known to be associated with stroke. Six individuals (4.5% of the final study population) had radiopacities which were confirmed by radiographs of the cervical spine to be calcified atheromas. The medical histories revealed risk factors associated with stroke. Panoramic radiographs obtained during the course of routine dental treatment may demonstrate calcified carotid atheromas in patients at risk of stroke.