Carotid Calcification Research Articles

Bone mass density and bone metabolism marker are associated with progression of carotid and cardiac calcified plaque in Chinese elderly population.

Bone mineral density (BMD) and bone metabolism marker may contribute to the progression of carotid and cardiac arterial calcifications. The aim of this study was to investigate whether low bone mass and the change of bone biomarker are associated with the prevalence of calcified atherosclerotic plaque in elderly Chinese. We conducted a five-year prospective study. BMD was measured by dual-energy X-ray absorptiometry scanning. Carotid and cardiac computed tomography angiography (CTA) was conducted using a 64-multidetector row scanner to assess carotid and cardiac arterial plaque at baseline and during follow-up. Of 1571 community residents over 60years of age, 184 (11.7%) subjects developed carotid calcified plaque, 510 (32.5%) subjects developed cardiac calcified plaque and 97 (6.2%) subjects developed co-existence calcified plaques in carotid and cardiac arteries. After adjustment for age and all relevant confounders, Q1, Q2 quartile of BMD, and osteoprotegerin (OPG), osteocalcin (OC), and C-terminal cross-linked telopeptide of type I collagen (CTX) were associated with increased risk of calcified plaques. This study suggested that lower BMD and change of bone metabolism biomarker were associated with a higher risk of carotid and cardiac calcified plaque development.

Assessing carotid plaque neovascularity and calcifications in patients prior to endarterectomy

ObjectiveThe objective was to use two ultrasound image and signal processing techniques (MicroPure and superb microvascular imaging [SMI]; Toshiba Medical, Tokyo, Japan) to investigate carotid plaque calcification and intraplaque neovascularity flow as biomarkers for plaque vulnerability in patients before endarterectomy. MethodsThirty patients, with preoperative computed tomography angiography and scheduled for carotid endarterectomy, were enrolled in an institutional review board-approved study. Bilateral grayscale, power Doppler, SMI and MicroPure imaging of the carotids were performed using an Aplio 500 Platinum scanner (Toshiba). MicroPure combines nonlinear imaging and speckle suppression to mark calcifications as white spots in a blue overlay, and SMI uses clutter suppression to extract microvascular flow signals. Readers counted calcifications and scored them as present or absent; intraplaque neovascularity was scored on a 4-point scale by ultrasound imaging as well as by pathology (as the reference). MicroPure and SMI assessments were compared with conventional ultrasound examination and computed tomography angiography with pathology as the reference standard. ResultsOwing to technical difficulties and cancelled operations, 57 carotids were studied; endarterectomies yielded 28 specimens. Intraplaque neovascularization was detected by SMI in significantly more plagues than by power Doppler (41 vs 22 out 57 examined plaques or 72% vs 39%; P < .0001). There was no statistical difference between either reader compared with pathology (P > .37). Sensitivity specificity and accuracy for detecting intraplaque neovascularity based on color SMI and PDI were 84% (95% confidence interval [CI], 64%-96%), 33% (95% CI, 1%-91%), 79% (95% CI, 59%-92%), and 52% (95% CI, 31%-72%), 100% (95% CI, 23%-100%), and 57% (95% CI, 37%-76%), respectively. MicroPure did not correlate with any measures of intraplaque flow (P > .13). ConclusionsSMI may have potential for providing evidence of plaque vulnerability. MicroPure appears less useful in carotid applications.

Arterial Stiffness Due to Carotid Calcification Disrupts Cerebral Blood Flow Regulation and Leads to Cognitive Deficits.

BackgroundArterial stiffness is associated with cognitive decline and dementia; however, the precise mechanisms by which it affects the brain remain unclear.Methods and ResultsUsing a mouse model based on carotid calcification this study characterized mechanisms that could contribute to brain degeneration due to arterial stiffness. At 2 weeks postcalcification, carotid stiffness attenuated resting cerebral blood flow in several brain regions including the perirhinal/entorhinal cortex, hippocampus, and thalamus, determined by autoradiography (P<0.05). Carotid calcification impaired cerebral autoregulation and diminished cerebral blood flow responses to neuronal activity and to acetylcholine, examined by laser Doppler flowmetry (P<0.05, P<0.01). Carotid stiffness significantly affected spatial memory at 3 weeks (P<0.05), but not at 2 weeks, suggesting that cerebrovascular impairments precede cognitive dysfunction. In line with the endothelial deficits, carotid stiffness led to increased blood‐brain barrier permeability in the hippocampus (P<0.01). This region also exhibited reductions in vessel number containing collagen IV (P<0.01), as did the somatosensory cortex (P<0.05). No evidence of cerebral microhemorrhages was present. Carotid stiffness did not affect the production of mouse amyloid‐β (Aβ) or tau phosphorylation, although it led to a modest increase in the Aβ40/Aβ42 ratio in frontal cortex (P<0.01).ConclusionsThese findings suggest that carotid stiffness alters brain microcirculation and increases blood‐brain barrier permeability associated with cognitive impairments. Therefore, arterial stiffness should be considered a relevant target to protect the brain and prevent cognitive dysfunctions.

Vascular Calcification-Induced Cognitive Impairment in Pseudoxanthoma Elasticum

Background: With no approved effective therapies for cognitive impairment, the need for new targetable phenotypes is high. We hypothesize that medial arterial calcification of the intracranial arteries, which is a modifiable process, results in increased arterial pulsatility, brain damage, and cognitive decline. Pseudoxanthoma elasticum (PXE) is a monogenetic disorder which results in non-atherosclerotic medial arterial calcification and was therefore used to investigate the effect of medial calcification of the carotid siphon on arterial pulsatility, brain volumes, small vessel disease and cognition. Methods: Magnetic resonance imaging and neurocognitive testing in 50 PXE patients and 42 age-matched controls were performed to compare arterial pulsatility, brain volumes, small vessel disease burden and cognition. Also, in the PXE patients we tested the association of carotid siphon calcification, measured by computed tomography, with arterial pulsatility and its association with brain volumes, small vessel disease and cognition. Results: PXE patients had a significantly higher pulsatility index (1.05(0.94-1.20) vs. 0.94(0.82-1.04), p=0.01), lower grey matter volumes (598±53 vs. 632±53ml, p=0.004), more white matter lesions (WML) (2.6(0.5-7.6) vs. 1.1(0.5-2.4)ml, p=0.04) and more lacunar infarctions (total 64 vs. 8, p=0.04) than controls. Patients scored lower on concentration and processing speed, but higher on memory. Carotid siphon calcification was associated with higher pulsatility indexes (β:0.09, 95%CI: 0.01;0.18), more WMLs (β:5.7, 95%CI: 0.9;10.5) and infarctions (RR:2.8, 95%CI: 1.1;7.0). Higher pulsatility was associated with lower grey matter volumes (β:-54.1, 95%CI: -107.8;-0.5), more WMLs (β:15.5, 95%CI: 7.7;23.3) and lower concentration and processing speed (β:-0.9, 95%CI: -1.8;-0.1). Conclusions: In PXE patients, medial calcification of the carotid siphon, was associated with higher pulsatility index which might contribute to grey matter damage, small vessel disease and cognitive impairment, particularly involving concentration and processing speed. Since arterial calcification is a modifiable process, we identified a potential novel target for the treatment of cognitive impairment. Funding: Dr. Zwanenburg is supported by the European Reasearch Council under the European Union’s Seventh Framework Programme (FP7/2007-2013), grant agreement no. 337333. The research of Prof. Dr. Hendrikse has received funding from the European Research Council under the European Union's Horizon 2020 Programme (H2020)/ERC grant agreement n° 637024 (HEARTOFSTROKE) and H2020 grant agreement No 666881, SVDs@target. Declaration of Interest: J. Bartstra has nothing to disclose Dr. Spiering has nothing to disclose Dr. Kranenburg has nothing to disclose Dr. Geurts has nothing to disclose Dr. den Harder has nothing to disclose Dr. Witkamp has nothing to disclose Dr. Wolterink has nothing to disclose Dr. Zwanenburg reports grants from European research council, from null, during the conduct of the study. Dr. van Valen has nothing to disclose Dr. Koek has nothing to disclose Prof. dr. Mali has nothing to disclose Prof. dr. de Jong has nothing to disclose Prof. Dr. Hendrikse reports grants from European research council, from null, during the conduct of the study. Ethical Approval: The study was approved by the institutional review board of the UMCU (number 16-622/M-X) and written informed consent was obtained from all participants.

Carotid Region Calcifications and Orthopantomogram

Carotid Region Calcifications and Orthopantomogram

Highly-calcific carotid lesions endovascular management in symptomatic and increased-stroke-risk asymptomatic patients using the CGuard™ dual-layer carotid stent system: Analysis from the PARADIGM study.

To assess feasibility, safety, angiographic, and clinical outcome of highly-calcific carotid stenosis (HCCS) endovascular management using CGuard™ dual-layer carotid stents. HCCS has been a challenge to carotid artery stenting (CAS) using conventional stents. CGuard combines a high-radial-force open-cell frame conformability with MicroNet sealing properties. The PARADIGM study is prospectively assessing routine CGuard use in all-comer carotid revascularization patients; the focus of the present analysis is HCCS versus non-HCCS lesions. Angiographic HCCS (core laboratory evaluation) required calcific segment length to lesion length ≥2/3, minimal calcification thickness ≥3 mm, circularity (≥3 quadrants), and calcification severity grade ≥3 (carotid calcification severity scoring system [CCSS]; G0-G4). One hundred and one consecutive patients (51-86 years, 54.4% symptomatic; 106 lesions) received CAS (16 HCCS and 90 non-HCCS); eight others (two HCCS) were treated surgically. CCSS evaluation was reproducible, with weighted kappa (95% CI) of 0.73 (0.58-0.88) and 0.83 (0.71-0.94) for inter- and intra-observer reproducibility respectively. HCCS postdilatation pressures were higher than those in non-HCCS; 22 (20-24) versus 20 (18-24) atm, p = .028; median (Q1-Q3). Angiography-optimized HCCS-CAS was feasible and free of contrast extravasation or clinical complications. Overall residual diameter stenosis was single-digit but it was higher in HCCS; 9 (4-17) versus 3 (1-7) %, p = .002. At 30 days and 12 months HCCS in-stent velocities were normal and there were no adverse clinical events. CGuard HCCS endovascular management was feasible and safe. A novel algorithm to grade carotid artery calcification severity was reproducible and applicable in clinical study setting. Larger HCCS series and longer-term follow-up are warranted.

Diagnostic accuracy of panoramic radiography in the detection of calcified carotid artery atheroma: a meta-analysis.

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). 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. Observational studies. 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. 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. Most studies reported excellent sensitivity and good specificity. The diagnostic accuracy of PR was good or excellent in 50% of the studies. The identification of CCAA by PR can be a risk predictor for stroke when used as a secondary screening tool.

Detection of carotid artery calcification on digital panoramic radiographs: a retrospective double blinded study

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

Influence factors of carotid endarterectomy improving vascular cognitive impairment

Objective: To investigate the influence factors of carotid endarterectomy(CEA) improving cognitive function in patients with carotid stenosis. Methods: The clinical data of carotid stenosis patients with cognitive impairment who underwent CEA in Nanjing Drum Tower Hospital and the First People's Hospital of Lianyungang from December 2011 to July 2017 were retrospectively analyzed. One week before operation, carotid CT angiography and cranial magnetic resonance imaging were performed, and the cognitive function of patients was evaluated with Montreal Cognitive Scale (MoCA). The magnetic resonance imaging and MoCA were reexamined 4 weeks after the procedure. The patients were divided into improved group (COI+) and un-improved group (COI-) according to whether the cognitive function score was improved or not after operation. The general data, carotid artery occlusiontime, surgical site, preoperative carotid calcification score (CS) and the Fazekas score, pre-operative and post-operative cerebral perfusion parameters, like mean transit time(MTT), time to peak(TTP) and arrivetime (T0), and any new infarcts after operation between the two groups were compared. Results: A total of 70 patients were selected, including 50 patients in group COI+ and 20 patients in group COI-. There were no significant differences in age, gender, hypertension, diabetes mellitus, smoking and drinking habits, as well as in carotid artery occlusiontime and preoperative Fazekas score between the two groups (all P>0.05). The preoperative carotid artery calcification scores of the two groups were 469.75±50.86 and 393.51±77.41, respectively. The changes of pre-and post-operation perfusion parameters between the two groups were statistically significant, with ΔMTT were 7.79±9.51 and 3.03±6.40, ΔTTP were 5.83±8.98 and 1.17±4.77, T0 were 5.89±8.08 and 3.05±5.95, respectively(t=4.844, 2.053, 2.192 and 1.423, respectively, all P<0.05). Proportion of cases with new infarcts after operation(0.38 vs 0.65) or undergoing left CEA (0.66 vs 0.40)between the two groups was statistically different (χ(2)=4.197 and 9.677, respectively, both P<0.05). Conclusion: Higher preoperative CS score, undergoing left CEA, significantly improved cerebral perfusion and without new infarct postoperatively, are independent factors contributing to improving cognitive function through CEA operation.

Noninvasive evaluation of density of coronary and carotid calcification in patients with type 2 diabetes mellitus

Objective. To estimate the density of calcium deposits of atherosclerotic plaques of coronary and carotid arteries in patients with diabetes mellitus (DM) type 2 using multislice computed tomography (MSCT).Material and methods. 251 patients with multifocal atherosclerosis (MA) were examined using MSCT. Determined equivalent density of calcium deposits (EDCD) atherosclerotic plaque of coronary and carotid arteries.Results. According to the data of MSCT in patients with MA irrespective of concomitant diabetes was a high incidence of calcification of the coronary and carotid arteries. In Group 1 EDCD coronary arteries was 0.235 (0.214; 0.254) mg/mm3, in the group 2 - 0,219 (0,192; 0,242) mg/mm3. EDCD of carotid arteries in patients with diabetes was 0.183 (0.171; 0.193) mg/mm3, in patients without diabetes - 0.226 (0.199; 0.247) mg/mm3. There was a significant difference in the groups EDCD values for coronary (p = 0.017), and the carotid (p = 0.000003) artery.Conclusion. Using index EDCD obtained on the basis of routine MSCT coronary and carotid arteries in patients with MA with DM compared with those without diabetes had significantly higher density calcifications in projection of coronary and low density of calcium deposits carotid arteries without regard to the degree of Agatston calcification scale.

Chronic kidney disease is linked to carotid calcified atherosclerotic plaque in patients with metabolic syndrome

Background The prevalence of metabolic syndrome (MetS) is rising continuously. MetS is recently proposed as a predictor for the occurrence of vascular defects causing stroke. Objective Carotid atherosclerosis is a major cause of disabling stroke and death. The presence of carotid plaques is associated with future cardiovascular (CV) events, with local plaque composition being an independent outcome predictor. We examined the association between ultrasonographically determined carotid plaque calcification and CV risk factors in MetS. Methods This was a cross-sectional study with a total of 58 patients with MetS who underwent routine carotid ultrasonography of both carotid arteries to detect presence of calcified atherosclerotic plaque. Plaques with high echogenic nodules and posterior shadowing were considered calcified. Those who had no apparent cardiovascular vascular disease (CVD). After careful clinical examinations and biochemical evaluations. We used logistic regression models to assess the relationship between CV risk factors and carotid plaque calcification in studied subjects. Results Of this study subjects, the mean age was 63.8 ± 7.8 years. Carotid calcification was detected in 19.3% of the patients. We found that presence of carotid plaque calcification had statistically significantly positive correlations with the prevalence of autonomic dysfunction (p = 0.03), CKD (p = 0.001), framingham stroke risk score (FSRS) (p = 0.005), mean arterial pressure (MAP) (p = 0.05), and log creatinine (log cre) (p = 0.02), and negative correlations with log estimated Glomerular filtration rate (log eGFR) (p = -0.01). Results of logistic regression analysis showed that prevalence of CKD (p = 0.02) was significantly associated with carotid plaque calcification after adjustment of confounding risk factors. Conclusions Our results suggest that carotid plaque calcification presence significantly related to CKD.

Carotid endarterectomy(CEA) to treat repeated calcified cerebral emboli resulting from carotid calcifications: a case report

Carotid endarterectomy(CEA) to treat repeated calcified cerebral emboli resulting from carotid calcifications: a case report

Chronic Kidney Disease Is Linked to Carotid Nodular Calcification, An Unstable Plaque Not Correlated to Inflammation.

The incidence and the different type of carotid calcifications, nodular and non-nodular, and their role in the acute cerebrovascular disease has not yet been defined. Various studies have correlated the presence of specific risk factors, in particular the chronic kidney disease, with the presence of calcification, but not with the type of calcification. Since it is likely that carotid nodular calcifications rather than those with non-nodular aspect may represent a plaque at high risk of rupture, the purpose of our study was to evaluate the role of nodular calcification in the pathogenesis of cerebrovascular syndromes and their possible correlation with specific risk factors. A total of 168 carotid plaques from symptomatic and asymptomatic patients submitted to endarterectomy, whom complete clinical and laboratory assessment of major cardiovascular risk factors was available, were studied. In 21 endarterectomies (5 from symptomatic and 16 from asymptomatic patients) an eruptive calcified nodule, consisting of calcified plates associated to a small amount of fibrous tissue without extracellular lipids and inflammatory cells, was found protruding into the lumen. Nodular calcifications were significantly observed in patients affected by chronic kidney disease (with GFR<60 ml / min / 1.73 m2), with a normal lipidic and glycemic profile. On the contrary, non-nodular calcification, mainly correlated to diabetes, were stable lesions. Results of our study suggest that the mechanisms and the clinical significance of carotid atherosclerotic calcification may be different. The nodular calcification could represent a type of unstable plaque, significantly related to chronic kidney disease, without inflammation, morphologically different from the classical vulnerable plaques.

The parameters of carotid plaques' calcifications and clinical nature of the lesions in the context of revascularization treatment. The enlargement of calcifications is still the most important.

It remains achallenge to determine criteria according to which patients with asymptomatic carotid stenosis could be properly qualified for revascularization treatment. Carotid calcification assessment seems to be here quite attractive. The aim of the study was the histological analysis of various parameters of calcifications in human carotid plaques in relation to the symptomatic/asymptomatic nature of the lesions. The study involved carotid plaques taken from patients who have undergone endarterectomy of the internal carotid artery. Calcified plaques (with enlarged calcifications) were significantly more frequently asymptomatic than non-calcified plaques. The remaining calcification characteristics played no role. Calcified lesions disclosed the dominance of the fibrous component and the small lipid core significantly more frequently than non-calcified plaques. The percentage of females in the patients group with calcified lesions was significantly higher than in the group with non-calcified plaques. The percentage of males was lower. The former patients group used statins and angiotensin inhibitors significantly more frequently than patients with non-calcified plaques. Enlarged calcifications were independently associated with the asymptomatic nature of the carotid plaques. The enlargement of calcifications in carotid plaques is the only calcification parameter important for the clinical outcome of carotid atherosclerosis. Patients with calcified carotid plaques have asignificantly lower risk of ischemic stroke than patients with non-calcified lesions.

More frequent detection of calcified carotid atherosclerotic plaques and mineralized laryngeal cartilages on digital than on film-based panoramic radiographs.

PurposeTo determine whether calcified carotid atherosclerotic plaques (CCAPs) and mineralized laryngeal cartilages (MLCs) were more frequently detected on digital or film-based panoramic radiographs. The clinical relevance of this question is that some radiopacities seen on digital radiographs may correspond to medium-density tissues that are not necessarily mineralized.Materials and MethodsData were collected from panoramic radiographs and the respective reports issued by 2 private oral radiology centers. A total of 388 radiographs and reports were divided into film-based (group A) and digital (group D) radiographs. The frequencies of CCAPs and MLCs were analyzed using the Fisher exact test, and odds ratios were also calculated (α=1%).ResultsThe mean age of patients whose reports and radiographs showed CCAPs and/or MLCs ranged from 50.1 to 54.1 years. There was a predominance of females. A higher frequency of CCAPs and MLCs was observed in group D than in group A at both centers (P<0.01). CCAPs and MLCs were detected 4 times more frequently in group D than in group A at one of the centers.ConclusionCCAPs and MLCs were more frequently detected on digital than on film-based panoramic radiographs. Further studies are needed to determine whether such radiopacities do indeed correspond to mineralized, rather than medium-density, tissues.

A Case of Carotid Calcification in Panoramic Radiographs during Periodontal Disease Treatment

A Case of Carotid Calcification in Panoramic Radiographs during Periodontal Disease Treatment

ASSOCIATION BETWEEN INTERNAL AND EXTERNAL CAROTID ARTERY CALCIFICATIONS IN PATIENTS UNDERGOING DENTAL IMPLANT THERAPY

Background Vascular calcifications are often carefully assessed by oral and maxillofacial (OMF) radiologists on cone beam computed tomography (CBCT) scans. This is done because of the risk for cerebral ischemia and legal liabilities. Scans with a large field of view (FOV) often depict both extra- and intracranial carotid calcifications. Because of radiation dose concerns, the FOV is often reduced in certain examinations that tend to show extracranial carotid calcifications more often than intracranial vessels. It is valuable to predict the presence of intracranial carotid calcifications, which often pose a higher risk for cerebral ischemia in the presence of extracranial carotid calcification. Therefore, the current study aimed to assess the association between extra- and intracranial carotid calcifications. Materials and Methods Retrospective evaluation of 1000 CBCT scans of patients referred for dental implant therapy was done, and on the basis of FOV, 450 CBCT scans that included both the intra- and extracranial carotid calcifications were chosen for evaluation. The scans were evaluated for the presence/absence of vascular calcifications. The association between intra- and extracranial carotid calcifications was evaluated by using the χ2 test. Results Overall, 171 (38%) extracranial and 172 (38.2%) intracranial calcifications were detected. Of the 171 extracranial findings, 74 were bilateral, 45 were on the left, and 52 were on the right. Of the 172 intracranial findings, 112 were bilateral, 29 were on the left, and 31 were on the right. When extracranial calcification was present, intracranial calcifications were also noted in 61.9% cases. There was a strong association between extra- and intracranial calcifications (Pearson χ2 107.643; P Conclusions In this patient population, there is a significant association between extra- and intracranial carotid artery calcifications. Future studies should be performed on a larger patient population to better understand this association.

Long-term skill improvement among general dental practitioners after a short training programme in diagnosing calcified carotid artery atheromas on panoramic radiographs.

PurposeTo study general dental practitioners (GDPs) ability to detect calcified carotid artery atheromas (CCAAs) in panoramic radiographs (PRs) and if their diagnostic accuracy in long term is improved after a short training programme.MethodsFourteen GDPs had their diagnostic accuracy regarding CCAA in PR assessed at baseline, 2 weeks and 1 year after training. Comparison was made with a reference standard based on consensus results from two experienced oral and maxillofacial radiologists. At each session, 100 radiographs were assessed individually by the GDPs. After the baseline assessment, the GDPs participated in a 2‐hour training programme comprising a lecture and diagnostic training by calibration. The GDPs results before and after training were compared, as well as between follow‐up sessions.ResultsA significant improvement in diagnostic accuracy was observed with increased sensitivity (from 41.8% to 55.7%, P = 0.02) without a significant decrease in specificity (from 87.2% to 86.7%, P = 0.87). The Kappa values also increased (from 0.66 to 0.71, P = 0.04). At 1‐year follow‐up, the improvement compared to baseline remained significant. There were no significant changes between the 2‐week and 1‐year follow‐up assessment.ConclusionA short training programme can significantly and sustainable improve GDPs diagnostic accuracy regarding CCAA.

Carotid Artery Calcification on Orthopantomograms (CACO Study) - is it indicative of carotid stenosis?

It is unclear whether incidental carotid artery calcification (CAC) on radiographs has a defined relationship to clinically significant carotid artery stenosis, and therefore risk of stroke. The primary objective of this study was to ascertain the relationship between dental radiograph detected carotid calcification and carotid artery stenoses ≥50% on carotid duplex ultrasound. We carried out an observational study of patients undergoing routine dental orthopantomogram (OPG) examinations. Consecutive patients with CAC on OPG were prospectively matched to those without CAC based on age and gender. Ultrasound of the carotid arteries was performed to determine the presence of stenosis (≥50%) in either vessel. Of 5780 consecutive OPG examinations with suitable images for analysis, CAC was detected in 10.8%. A total of 233 patients underwent carotid ultrasound (130 with and 103 without CAC on OPG). The prevalence of a clinically significant (≥50%) carotid stenosis on ultrasound was 15.4% (20/130) in those with CAC and 5.8% (6/103) for those without CAC on OPG. Incidental CAC detected on routine OPG requires both radiological reporting and clinical follow-up since 1 in 7 patients will have a clinically significant carotid artery stenosis as compared with 1 in 20 patients who do not have CAC. Trial Registration: Australian and New Zealand Clinical Trials Registry website (U1111-1148-1066). http://www.ANZCTR.org.au/ACTRN12613001038785.aspx.

Assessment of carotid calcifications on panoramic radiographs and its relationship with periodontal condition and smoking status

Assessment of carotid calcifications on panoramic radiographs and its relationship with periodontal condition and smoking status