Ultrasonographic confirmation of carotid artery atheromas diagnosed via panoramic radiography
Section snippets
BACKGROUND
Traditionally, screening for cervical carotid artery atheromas was solely within the purview of physicians and was based on auscultation of the neck for a bruit. At best, this was a crude screening method because the examination had only a 50 percent specificity and a 50 percent sensitivity. Collateral confirmation was difficult, but occasionally the lesion could be visualized on a plain radiograph of the cervical spine or on the superior aspect of a standard chest radiograph.
Approximately 25
Subjects
The survey population consisted of 1,614 consecutively treated (between Nov. 1, 2002, and March 31, 2004) outpatients attending the oral surgery section of the dental service at the Veterans Affairs Outpatient Clinic, Sepulveda, Calif. Inclusion criteria for patients were as follows:
age 50 years or older;
the ability to undergo panoramic radiography, and if it showed a possible atheroma, the ability to undergo a DUS study.
Exclusion criteria included poor-quality radiographs (that is, overexposed
Sample characteristics and radiographic findings
Of the 1,614 subjects initially evaluated, 66 had radiographs of poor image quality and were excluded. The final sample population of 1,548 consisted of 1,487 men ranging in age from 50 to 83 years (mean age, 61.2 years) and 61 women ranging in age from 50 to 79 years (mean age, 64.3 years).
Of the final sample population of 1,548 patients, 65 (61 men and four women) (4.2 percent) had observable opacities consistent with carotid artery calcification on their panoramic radiographs (Figure 1,
DISCUSSION
The results of this study demonstrated that 4.2 percent of neurologically asymptomatic patients 50 years or older had calcified atheromas in one or both ICAs, as shown on panoramic radiographs. Furthermore, DUS studies demonstrated that 15 patients (23 percent) with radiographically identified atheromas had hemodynamically significant stenotic disease (≥ 50 percent) that placed them at a heightened risk of developing stroke.
CONCLUSION
The results of this study demonstrate that when dentists evaluate carefully the panoramic radiographs of neurologically asymptomatic patients for the presence of calcified carotid artery atheromas, they can, on occasion, identify patients with advanced disease. Clinicians should refer all patients with atheromalike lesions on their radiographs to a physician, because aggressive medical treatment of early and advanced atherosclerotic disease has been shown to decrease the likelihood of fatal and
References (23)
- et al.
Panoramic radiographic identification of carotid arterial plaques
Oral Surg Oral Med Oral Pathol
(1981) - et al.
Carotid endarterectomy without angiography: can clinical evaluation and duplex ultrasonography scanning alone replace traditional arteriography for carotid surgery workup? A prospective study
Surgery
(1999) - et al.
Panoramic radiography: an aid in detecting patients at risk of cerebrovascular accident
JADA
(1994) Carotid ultrasound
Radiol Clin North Am
(2001)- et al.
Correlating carotid artery stenosis detected by panoramic radiography with clinically relevant carotid artery stenosis determined by duplex ultrasound
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(2002) - et al.
Correlation of North American Symptomatic Carotid Endarterectomy Trial (NASCET) angiographic definition of 70% to 99% internal carotid artery stenosis with duplex scanning
J Vasc Surg
(1993) - et al.
Screening for asymptomatic internal carotid artery stenosis: duplex criteria for discriminating 60% to 90% stenosis
J Vasc Surg
(1995) - et al.
Reappraisal of duplex criteria to assess significant carotid stenosis with special reference to reports from the North American Symptomatic Carotid Endarterectomy Trial and the European Carotid Surgery Trial
J Vasc Surg
(1994) - et al.
The association between coronary calcification assessed by electron beam computed tomography and measures of extracoronary atherosclerosis: the Rotterdam Coronary Calcification Study
J Am Coll Cardiol
(2002) - et al.
Carotid calcification on panoramic radiographs: an important marker for vascular risk
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
(2002)
Cited by (64)
Defined shapes of carotid artery calcifications on panoramic radiographs correlate with specific signs of cardiovascular disease on ultrasound examination
2024, Oral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyOverview of Ultrasound in Dentistry for Advancing Research Methodology and Patient Care Quality with Emphasis on Periodontal/Peri-implant Applications
2023, Zeitschrift fur Medizinische PhysikDetection of extracranial and intracranial calcified carotid artery atheromas in cone beam computed tomography using a deep learning convolutional neural network image segmentation approach
2023, Oral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyAssociation of high cardiovascular risk and diabetes with calcified carotid artery atheromas depicted on panoramic radiographs
2022, Oral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyCalcifications in the neck region of patients with carotid artery stenosis: a computed tomography angiography study of topographic anatomy
2020, Oral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyCalcified carotid artery atheromas in panoramic radiographs are associated with a first myocardial infarction: a case-control study
2018, Oral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyCitation Excerpt :Furthermore, 80% of patients with CCAAs on PRs have low-grade stenosis (<50% blockage), when assessed with Doppler ultrasonography.8 Furthermore, no arteries with normal arterial structure have been seen presenting CCAA.25 Previous reports have supported the recommendation that men below age 75 years without a history of cerebrovascular disease, but with CCAAs on PRs, should have a cardiovascular risk profile assessment.2
- 1
Dr. Friedlander is associate chief of staff and director of Graduate Medical Education, VA Greater Los Angeles Healthcare System; director of Quality Assurance, Hospital Dental Service, University of California, Los Angeles Medical Center; and a professor, Oral and Maxillofacial Surgery, School of Dentistry, University of California, Los Angeles.
- 2
Dr. Garrett is an associate professor, Advanced Prosthodontics, Biomaterials and Hospital Dentistry, University of California, Los Angeles; director, Weintraub Center for Reconstructive Biotechnology, School of Dentistry, University of California, Los Angeles; and director, Oral Biology Research Laboratory, VA Greater Los Angeles Healthcare System.
- 3
Dr. Chin is a staff radiologist, Imaging Service, VA Greater Los Angeles Healthcare System, and an assistant clinical professor of radiology, David Geffen School of Medicine, University of California, Los Angeles.
- 4
Dr. Baker is chief, Vascular Surgery Section, VA Greater Los Angeles Healthcare System, and a professor of surgery, David Geffen School of Medicine, University of California, Los Angeles.