Carotid Artery Calcification Research Articles

Lipoprotein(a) is associated with a larger systemic burden of arterial calcification.

Lipoprotein(a) [Lp(a)] is a genetically determined risk factor for cardiovascular disease. However, population-based evidence on the link between Lp(a) and subclinical arteriosclerosis is lacking. We assessed associations of Lp(a) concentrations with arteriosclerosis in multiple arteries. From the population-based Rotterdam study, 2354 participants (mean age: 69.5 years, 52.3% women) underwent non-contrast computed tomography to assess arterial calcification as a hallmark of arteriosclerosis. We quantified the volume of coronary artery calcification (CAC), aortic arch calcification (AAC), extracranial (ECAC), and intracranial carotid artery calcification (ICAC). All participants underwent blood sampling, from which plasma Lp(a) concentrations were derived. The association of plasma Lp(a) levels was assessed with calcification volumes and with severe calcification (upper quartile of calcification volume) using sex-stratified multivariable linear and logistic regression models. Higher Lp(a) levels were associated with larger ln-transformed volumes of CAC [fully adjusted beta 95% confidence interval (CI) per 1 standard deviation (SD) in women: 0.09, 95% CI 0.04-0.14, men: 0.09, 95% CI 0.03-0.14], AAC (women: 0.06, 95% CI 0.01-0.11, men: 0.09, 95% CI 0.03-0.14), ECAC (women: 0.07, 95% CI 0.02-0.13, men: 0.08, 95% CI 0.03-0.14), and ICAC (women: 0.09, 95% CI 0.03-0.14, men: 0.05, 95% CI -0.02 to 0.11]. In the highest Lp(a) percentile, severe ICAC was most prevalent in women [fully adjusted odds ratio (OR) 2.41, 95% CI 1.25-4.63] and severe AAC in men (fully adjusted OR 3.29, 95% CI 1.67-6.49). Higher Lp(a) was consistently associated with a larger calcification burden in all major arteries. The findings of this study indicate that Lp(a) is a systemic risk factor for arteriosclerosis and thus potentially an effective target for treatment. Lp(a)-reducing therapies may reduce the burden from arteriosclerotic events throughout the arterial system. In 2354 participants from the Rotterdam study, we assessed the link between Lp(a) concentrations and arterial calcifications, as proxy for arteriosclerosis, in major arteries. We found that higher Lp(a) levels were consistently associated with larger volumes of calcification in the coronary arteries, aortic arch, extracranial carotid arteries, and intracranial carotid arteries. The findings of our study indicate that Lp(a) is a systemic risk factor for arteriosclerosis, suggesting that the systemic burden of arteriosclerosis throughout the arterial system could be reduced by targeting Lp(a).

Can convolutional neural networks identify external carotid artery calcifications?

We developed and evaluated the accuracy and reliability of a convolutional neural network (CNN) in detecting external carotid artery calcifications (ECACs) in cone beam computed tomography scans. Using TensorFlow, we developed a program to identify calcification in 427 cone beam computed tomography scans evaluated to determine the presence of ECACs. We compared the results to the findings of a human evaluator. Using an 80:20 training-to-validation ratio, we calculated the k-fold cross-validation accuracy of the initial dataset and extrapolated the F1 score and Matthews Correlation Coefficient. We calculated a k-fold cross-validation accuracy of 76%, with a recall and precision of 66% and 79%, respectively, and a combined F1 score of 0.72. We extrapolated a Matthews correlation coefficient of 0.53, showing a strong balance between confusion matrix categories. Our CNN model can reliably identify ECACs in cone beam computed tomography scans.

Deep convolution neural network for screening carotid calcification in dental panoramic radiographs.

Ischemic stroke, a leading global cause of death and disability, is commonly caused by carotid arteries atherosclerosis. Carotid artery calcification (CAC) is a well-known marker of atherosclerosis. Such calcifications are classically detected by ultrasound screening. In recent years it was shown that these calcifications can also be inferred from routine panoramic dental radiographs. In this work, we focused on panoramic dental radiographs taken from 500 patients, manually labelling each of the patients' sides (each radiograph was treated as two sides), which were used to develop an artificial intelligence (AI)-based algorithm to automatically detect carotid calcifications. The algorithm uses deep learning convolutional neural networks (CNN), with transfer learning (TL) approach that achieved true labels for each corner, and reached a sensitivity (recall) of 0.82 and a specificity of 0.97 for individual arteries, and a recall of 0.87 and specificity of 0.97 for individual patients. Applying and integrating the algorithm in healthcare units and dental clinics has the potential of reducing stroke events and their mortality and morbidity consequences.

ASSESSMENT OF CARDIOVASCULAR RISK IN WOMEN WITH PCOS: A NARRATIVE REVIEW

Polycystic ovarian syndrome (PCOS) is one of the commonest endocrinopathy of women of reproductive age globally. This clinical condition not only dysregulates the reproductive axis, but also a risk factor for hyperinsulinemia, insulin resistance, dyslipidaemia, T2DM. All these metabolic states aggravate the cardiovascular risk in women with PCOS. The aim of this review is to provide an overview of evidences of subclinical cardiovascular risk in PCOS women and synthesize the result. To attain this aim, the published research articles were reviewed using the databases PubMed, Google scholar and EMBASE employing key words PCOS, cardiovascular risk, arterial stiffness, endothelial function to obtain relevant information. Total 162 articles were searched and after applying eligibility criteria, 12 articles have been included for qualitative synthesis of the information. Most of the studies are cross-sectional, case-control study conducted on pre-, peri and menopausal, obese, lean women with PCOS. The study participants were mostly diagnosed on the basis of Rotterdam criteria. But, other criteria such as National Institutes of Health criteria (NIH), Androgen Excess Society criteria (AES) were also used to diagnose the condition. Mostly these studies recorded arterial stiffness as assessed by pulse wave velocity (PWV), augmentation index (AIx) and endothelial dysfunction as assessed by brachial artery ow mediated vasodilatation (FMD). The ndings of few cardinal systematic review and metaanalysis were also reported. These studies mainly analysed the data obtained for subclinical cardiovascular status of women with PCOS as assessed by carotid intima media thickness (cIMT), carotid artery calcium (CAC) score and FMD. Majority of the studies concluded that women with PCOS display enhanced arterial stiffness and endothelial dysfunction in comparison to age and BMI-matched healthy control group, though controversy exists is the literature. In this regard, the existing traditional cardiovascular risk factors in PCOS women, make them more prone to cardiovascular disease. It needs further prospective study with hard cardiovascular outcome to prove this point undoubtedly. It must be emphasized that regular cardiovascular screening might be advocated for this vulnerable population to prevent any major cardiovascular eventuality.

Intracranial carotid artery calcification morphology differs in patients with lacunar and nonlacunar acute ischemic strokes.

Intracranial carotid artery calcifications (ICACs) are a common finding on noncontrast computed tomography (NCCT) and have been associated with an increased risk of ischemic stroke. However, no data are available about the association between ICAC patterns and stroke etiology. We investigated the association between ICAC patterns and etiological subtypes of ischemic stroke. We retrospectively analyzed a single center cohort of patients admitted for ischemic stroke with known etiology. Each carotid artery was evaluated separately on NCCT scans to define the ICAC pattern (intimal, medial, mixed). The association between ICAC patterns and stroke etiology was investigated using logistic regression models adjusting for relevant confounders. A total of 485 patients were included (median age=78 [interquartile range (IQR) = 70-85] years, 243 [50%] female, median National Institutes of Health Stroke Scale=6 [IQR=3-12]). Frequencies of ICAC patterns were: intimal, n= 96 (20%); medial, n= 273 (56%); mixed, n= 51 (11%), indistinct/absent, n= 65 (13%) patients. Intimal pattern was more frequent in lacunar compared with nonlacunar (33% vs. 16%, p< 0.001) stroke etiology, whereas medial pattern was less frequent in lacunar compared with nonlacunar stroke (36% vs. 62%, p< 0.001). After adjustment for confounders, intimal ICAC predominant pattern remained associated with lacunar stroke etiology in two multivariate models (Model 1: adjusted odds ratio [aOR]=2.08, 95% confidence interval [CI]=1.20-3.56; Model 2: aOR=2.01, 95% CI=1.16-3.46). Our study suggests that intimal ICAC pattern is associated with lacunar stroke and may serve as a marker for lacunar stroke etiology, possibly strengthening the relation between endothelial dysfunction and lacunar stroke.

Carotid artery calcification score is associated with the occurrence of cerebral hyperperfusion syndrome after carotid artery stenting

Carotid artery calcification score is associated with the occurrence of cerebral hyperperfusion syndrome after carotid artery stenting

Evaluation of using panoramic radiography and ultrasonography for diagnosing carotid artery calcifications

Evaluation of using panoramic radiography and ultrasonography for diagnosing carotid artery calcifications

Calcified carotid artery atheromas in individuals with cognitive dysfunction

Objective The aim of this case-control study was to investigate whether cognitively impaired individuals have a higher burden of calcified carotid artery atheroma (CCAA) than controls without cognitive impairment. Material and methods The study included 154 cases with Alzheimer’s disease (n = 52), mild cognitive impairment (n = 51), or subjective cognitive decline (n = 51) diagnosed at a university memory clinic. Seventy-six cognitively healthy controls were sampled through the Swedish population register. All participants underwent clinical oral and panoramic radiographic examinations. Two oral and maxillofacial radiologists performed blinded analyses of the panoramic radiographs for signs of CCAA, which was registered as absent or present and, if present, unilateral or bilateral. Consensus assessment was used for all statistical analyses. Results CCAA was common (40%) in this middle-aged and older Swedish population. We found no differences in the prevalence of CCAA between cases and controls (40% vs. 42%). Conclusion Cognitively impaired patients do not have a higher burden of CCAA than matched controls without cognitive impairment.

Intracranial Carotid Arteriosclerosis Mediates the Association Between Blood Pressure and Cerebral Small Vessel Disease.

Intracranial arteriosclerosis could explain the association between blood pressure (BP) and cerebral small vessel disease (CSVD). Therefore, we tested whether intracranial carotid artery calcification (ICAC) mediates the association between BP and CSVD and determined pathophysiological mechanisms based on ICAC subtypes. One thousand four hundred fifty-eight stroke-free participants from the Rotterdam Study (mean age, 68 years; 52% women) underwent nonenhanced computed tomography scans to quantify ICAC volume (mm3) between 2003 and 2015. ICAC was categorized into intimal and internal elastic lamina calcifications. CSVD included white matter hyperintensities volume, the presence of lacunes, and cerebral microbleeds visualized on magnetic resonance imaging. Office BP included systolic BP, diastolic BP, pulse pressure, and mean arterial pressure. Mediation analysis included a 2-way decomposition to determine the direct association between BP and CSVD and the indirect or mediated effect (negative or positive mediations expressed in %) of log-ICAC volume on such association. BP and log-ICAC were correlated and were also associated with CSVD. In all participants, total log-ICAC volume mediated the association of diastolic BP (-14.5%) and pulse pressure (16.5%) with log-white matter hyperintensities. Internal elastic lamina log-ICAC volume mediated -19.5% of the association between diastolic BP and log-white matter hyperintensities; intimal log-ICAC volume did not mediate associations. For lacunes, total and internal elastic lamina log-ICAC volume mediated the association of diastolic BP (-40% and -45.8%) and pulse pressure (26.9% and 18.2%). We did not observe mediations for cerebral microbleeds. Intracranial arteriosclerosis mediates the association between BP and CSVD. Internal elastic lamina calcification, considered a proxy of arterial stiffness, is the leading mechanism explaining the link between BP and CSVD.

Carotid Artery Calcification in Panoramic Radiography and Related Risk Factors

Background and Objectives: The carotid artery calcification (CAC) can be seen in panoramic radiographs that are usually used in dentistry. This study aims to determine the prevalence of CAC in Qom, Iran using panoramic radiographs, and find its related factors. Methods: This is a descriptive cross-sectional study. Panoramic radiographs of 417 patients aged ≥40 years referred to a specialized oral and maxillofacial radiology center in Qom city in 2021 were examined for the presence of CAC and a questionnaire was used to find the related risk factors. The collected data were analyzed in SPSS software, vertion 22 using Chi-square test and t-test. Results: Of 417 participants, 141 (33.8%) were male and 276 (66.2%) were female. The prevalence of CAC was 1.4%. There was a significant association between CAC and history of cardiovascular diseases (P=0.03), but the incidence of CAC had no association with the history of diabetes, smoking, hypertension, cerebrovascular accident, and myocardial infarction (P&gt;0.05). Conclusion: The incidence of CAC is associated with the history of cardiovascular diseases. Further prospective studies with larger sample sizes are recommended.

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.

Comparison of detection performance of soft tissue calcifications using artificial intelligence in panoramic radiography

Artificial intelligence (AI) is limited to teeth and periodontal disease in the dental field, and is used for diagnosis assistance or data analysis, and there has been no research conducted in actual clinical situations. So, we created an environment similar to actual clinical practice and conducted research by selecting three of the soft tissue diseases (carotid artery calcification, lymph node calcification, and sialolith) that are difficult for general dentists to see. Therefore, in this study, the accuracy and reading time are evaluated using panoramic images and AI. A total of 20,000 panoramic images including three diseases were used to develop and train a fast R-CNN model. To compare the performance of the developed model, two oral and maxillofacial radiologists (OMRs) and two general dentists (GDs) read 352 images, excluding the panoramic images used in development for soft tissue calcification diagnosis. On the first visit, the observers read images without AI; on the second visit, the same observers used AI to read the same image. The diagnostic accuracy and specificity for soft tissue calcification of AI were high from 0.727 to 0.926 and from 0.171 to 1.000, whereas the sensitivity for lymph node calcification and sialolith were low at 0.250 and 0.188, respectively. The reading time of AI increased in the GD group (619 to 1049) and decreased in the OMR group (1347 to 1372). In addition, reading scores increased in both groups (GD from 11.4 to 39.8 and OMR from 3.4 to 10.8). Using AI, although the detection sensitivity of sialolith and lymph node calcification was lower than that of carotid artery calcification, the total reading time of the OMR specialists was reduced and the GDs reading accuracy was improved. The AI used in this study helped to improve the diagnostic accuracy of the GD group, who were not familiar with the soft tissue calcification diagnosis, but more data sets are needed to improve the detection performance of the two diseases with low sensitivity of AI.

Carotid plaque components and other carotid artery features associated with risk of stroke: A systematic review and meta-analysis

ObjectiveTo compare the difference in the risk of stroke for four kinds of carotid artery plaque and carotid artery stenosis. MethodsLiterature was collected by searching the PubMed, Embase, Cochrane library and Ovid databases up to June 2022, using the free search terms "carotid plaque" and "stroke". Meta-analysis was performed on the selected articles using Stata16 to analyse the relationship of stroke risk factors. ResultsA total of 11 studies including 6661 participants were included. Meta-analysis results showed that the incidence of stroke was statistically significantly different between IPH (intraplaque haemorrhage) plaques and LRNC (lipid-rich necrotic core) plaques (RR: 1.27, 95% CI: 1.04–1.55, P < 0.05) and IPH plaques and calcification plaques (RR: 2.99, 95% CI: 1.74–5.14, P < 0.0001). Furthermore, there was a statistically significant difference between TRFC (thinned or ruptured fibrous caps) plaques and carotid artery stenosis (RR: 10.84, 95% CI: 5.60–20.98, P < 0.0001) and calcification plaques and carotid artery stenosis (RR: 0.83, 95% CI: 0.75–0.92, P < 0.0001). However, there was no statistically significant difference between the IPH and carotid artery stenosis (RR: 1.55, 95% CI: 0.68–3.52, P > 0.05), LRNC and TRFC (RR: 0.80, 95% CI: 0.11–5.82, P > 0.05), LRNC and calcification (RR: 1.81, 95% CI: 0.90–3.66, P > 0.05) and LRNC and carotid artery stenosis (RR: 1.40, 95% CI: 0.69–2.81, P > 0.05). ConclusionIPH was associated with a higher incidence of stroke compared to LRNC and calcification plaques and TRFC has a higher risk of stroke than calcification plaques and carotid stenosis. This evidence suggests that IPH and TRFC may play an important role in predicting stroke.

Carotid Artery Calcifications on Panoramic Radiographs.

The objective of this study was to evaluate the prevalence of carotid artery calcifications (CACs) on panoramic radiographs of Polish dental patients. Panoramic radiographs made between 2005 and 2012 in 4000 patients born between 1922 and 1958 were accessed from the server of the Department of Radiology and analyzed for the presence or absence of CACs by a group of trained dentists. The anatomical area covered by the analysis was visible in 2189 images (54.73%). Calcifications in the carotid arteries were found in 468 (21.68%) patients, including 327 (14.94%) unilaterally and 141 (6.44%) bilaterally. CACs were found in 284 (60.68%) women and 184 (39.32%) men. The prevalence rate of CACs detected on panoramic radiographs in patients aged 54 and older was 21.68%, which makes it an important clinical problem.

Ultrasonographic Evaluation of Soft Tissue Calcifications in the Head and Neck Region Detected on Panoramic Radiographs.

The aim of this study is to present a comparison between panoramic radiographs and USG imaging with a focus on revealing the advantages of USG over radiographs, and to show the distribution of calcifications detected in USG by considering the age and gender. A total of 148 patients with soft tissue calcifications as seen on panoramic radiographs were examined with USG imaging. Sialoliths, carotid artery calcifications, tonsilloliths, phleboliths and lymph node calcifications were examined in terms of anatomical localization, distribution and shape. In the USG evaluation of these 148 patients, soft tissue calcifications were observed in 113 (76.4%) patients. The mean age of the patients with calcification was 55.6 ± 13.1 (min: 22-max: 77). Bilateral calcifications were detected in 25 (22.1%) patients, whereas unilateral calcifications were found in 88 (77.9%) patients. While the rates of tonsilloliths, sialoliths, phleboliths, and lymph node calcifications were statistically similar in male and female patients, the rate of carotid artery calcifications was found to be higher in men than in women (P=0.017). No statistical significance was found between age groups in terms of the formation of soft tissue calcifications (P=0.117). Panoramic radiographs may mislead clinicians in the diagnosis and differential diagnosis of soft tissue calcifications in the head and neck region due to the presence of distortion, superpositions, metal artefacts, and ghost images. USG is an important diagnostic tool in determining the localization of soft tissue calcifications that can be confused on two-dimensional radiographs, their relationship with neighboring structures, and defining calcification. It can be used safely in the detection of soft tissue calcifications as it provides dynamic imaging without the use of radiation or contrast material compared to other advanced imaging methods.

Automated Detection of Cervical Carotid Artery Calcifications in Cone Beam Computed Tomographic Images Using Deep Convolutional Neural Networks.

The aim of this study was to determine if a convolutional neural network (CNN) can be trained to automatically detect and localize cervical carotid artery calcifications (CACs) in CBCT. A total of 56 CBCT studies (15,257 axial slices) were utilized to train, validate, and test the deep learning model. The study comprised of two steps: Step 1: Localizing axial slices that are below the C2–C3 disc space. For this step the openly available Inception V3 architecture was trained on the ImageNet dataset of real-world images, and retrained on 40 CBCT studies. Step 2: Detecting CACs in slices from step 1. For this step, two methods were implemented; Method A: Segmentation neural network trained using small patches at random coordinates of the original axial slices; Method B: Segmentation neural network trained using two larger patches at fixed coordinates of the original axial slices with an improved loss function to account for class imbalance. Our approach resulted in 94.2% sensitivity and 96.5% specificity. The mean intersection over union metric for Method A was 76.26% and Method B improved this metric to 82.51%. The proposed CNN model shows the feasibility of deep learning in the detection and localization of CAC in CBCT images.

Arterial calcification over time in pseudoxanthoma elasticum: a repeated measurements study

Abstract Background Pseudoxanthoma elasticum (PXE) is a rare genetic disorder, characterized by progressive systemic arterial calcification and an elevated cardiovascular disease risk. Although arterial calcification is an established risk factor of cardiovascular morbidity and mortality, insights into its artery-specific changes over time in PXE remain lacking. Objectives To assess artery-specific changes in arterial calcification over time in PXE and to investigate the associations of cardiovascular risk factors with these changes. Methods We prospectively included 311 PXE patients (mean age 53.1 years, 185 [59.5%] females). During a median follow-up of 3.7 (25th–75th percentiles 1.3–4.2) years patients underwent 472 full-body, non-contrast computed tomography (CT) scans (maximum of 6 CTs per patient) to quantify the volume (μL) of intracranial carotid artery calcification (ICAC), extracranial carotid artery calcification (ECAC), coronary artery calcification (CAC), aortic calcification (AoC), iliac artery calcification (IAC), and leg artery calcification (LAC) and total body calcification (sum of all arteries). We calculated absolute yearly change (follow-up volume × baseline volume / time difference) and relative yearly change (absolute change divided by baseline volume × 100%) in calcification. The correlations amongst arteries in absolute and relative calcification change were assessed using Spearman's correlation coefficients. Risk factors for change in arterial calcification were assessed using linear mixed models (including age as time variable and with all risk factors entered simultaneously into models). Results Calcification volume change ranged from 3% to 12% increase per year, with a total body calcification progression of 11% per year. The correlations amongst arteries in absolute and relative yearly progression of calcification were only weak to moderate (correlation coefficients ranged from 0.23 between CAC and ECAC to 0.38 between CAC and LAC). Hypertension was markedly associated with increased AoC (multiplicative change in calcification per 5 years of age 1.46 [95% CI 1.13–1.89]). Moreover, the strongest predictor of ICAC change was ever smoking (1.23 [95% CI 1.03–1.46]) and of ECAC change was hypercholesterolemia (1.21 [95% CI 1.02–1.43]). Conclusions Arterial calcification volume progressed with 11% per year in PXE, with considerable variation between and only moderate correlation amongst arteries. Moreover, we found several modifiable, artery-specific risk factors for the progression of calcification. Although both PXE and risk factor presence are considered systemic in nature, our findings highlight that considerable differences exist between arteries in susceptibility to calcification. As such, our results provide important insights into the mechanisms underlying arterial calcification in PXE, which might be used for more targeted treatment and prevention. Funding Acknowledgement Type of funding sources: None.

Do bisphosphonates and RANKL inhibitors alter the progression of coronary artery calcification? A systematic review and meta-analysis protocol

IntroductionWhether bisphosphonates and RANKL inhibitors play a novel role in delaying cardiovascular calcification is unknown. Their action on regulatory enzymes in the mevalonic acid pathway, which is implicated in both...

Soft Tissue Calcifications in the Head and Neck Region

Background: Soft tissue calcifications are most commonly seen in two-dimensional radiographs. Some may be physiological, and some may be pathological and need treatment. CBCT images provide valuable information about anatomic structures and pathologies. These soft tissue calcifications can be seen clearly in CBCT without superimposition and can be diagnosed appropriately. Aim and Objectives: This study aimed to assess the type and prevalence of calcifications found in CBCT volumes obtained for various diagnostic purposes. The objective of the present study was to determine the prevalence of soft tissue and to find their anatomic location, size, and type as well as their relation to age and gender. Materials and Method: Three hundred full-skull CBCT volumes were retrieved retrospectively from the age-group of 9–75 yrs and were evaluated for calcifications. The study sample included CBCT volumes taken for all diagnostic purposes, and those which contained artifacts were excluded. Results: Of 300 CBCT volumes, 133 were females, and 167 were males. Among them, 446 calcifications were encountered in 177 individuals. Their distribution was pineal gland calcification (24.8%), tonsillolith (18%), choroid plexus calcification (24%), pulp stone (12.4%), calcified stylohyoid chain (8%), sialolith (4%), triticeous cartilage calcification (2%), phlebolith (3%), and extracranial carotid artery calcification (1%). Conclusion: Although most of the calcifications are asymptomatic and require no treatment, correct identification of these findings will reduce further diagnostic assessment and provide more appropriate treatment plans. It will also provide the ability to evaluate underlying diseases comprehensively, and practitioners will have life-saving information by early diagnosis.

CALCIFIED CAROTID ARTERY ATHEROMA ON STANDARD DENTAL RADIOGRAPHS: A PUBLIC HEALTH OPPORTUNITY FOR CARDIOVASCULAR RISK REDUCTION

CALCIFIED CAROTID ARTERY ATHEROMA ON STANDARD DENTAL RADIOGRAPHS: A PUBLIC HEALTH OPPORTUNITY FOR CARDIOVASCULAR RISK REDUCTION