The prevalence and correlation of carotid artery calcification on panoramic radiographs and peripheral arterial disease in a population from the Republic of Korea: the Dong-gu study

Objectives:

The aim of this study was to determine the prevalence of carotid artery calcification (CAC) detected on panoramic radiographs and peripheral arterial disease (PAD), and to evaluate the difference in the prevalence of PAD between patients with CAC and patients without CAC detectable by panoramic radiograph.

Methods:

The surveyed population consisted of 4078 subjects aged 50 years and older (1410 males and 2668 females) who underwent medical and dental examination in Gwangju city, South Korea. Two oral and maxillofacial radiologists interpreted the panoramic radiographs for the presence of carotid artery calcification. A trained research technician measured the ankle–brachial index (ABI). An ABI <0.9 in either leg was considered evidence of PAD.

Results:

The prevalence of CAC on panoramic radiographs was 6.2% and that of PAD was 2.6%. Subjects with CAC had a significantly higher prevalence of PAD than those without CAC (5.5% vs 2.4%, respectively). The presence of CAC on panoramic radiographs was associated with PAD (odds ratio 1.84; 95% confidence interval 1.01–3.36) after adjusting for potential confounders.

Conclusion:

CACs detected on panoramic radiographs were positively associated with PAD in middle-aged and older Korean adults.     

The prevalence of carotid artery calcification on the panoramic radiographs of patients with renal disease

OBJECTIVES: To determine the prevalence of carotid calcification on dental panoramic radiographs in end-stage renal disease (ESRD) patients on haemodialysis and renal transplant recipients. METHODS: Panoramic radiographs of 69 adult patients with renal disease (34 with haemodialysis and 35 with renal transplantations) (age range 17-74 years; mean age 39.45 years) and 50 controls (age-match, free of systemic disease) were examined on panoramic radiographs for any unusual radiopacity adjacent to or just below the intervertebral space between C3 and C4. Patients with such calcifications were referred to ultrasound examination. Using Chi-squared tests, calcification prevalence rates were statistically compared. RESULTS: The statistical difference between renal disease patients and control group was significant (chi2 = 17.91, P < 0.001). On comparison of haemodialysis patients and renal transplant recipients with controls, statistical difference (P=0.007) was found to be significant. CONCLUSION: Carotid artery calcification was higher in haemodialysis patients and renal transplant recipients. These patients with such calcifications should be referred for further evaluation and treatment of carotid arteries, coronary arteries and vascular risk factors.     

The association between carotid calcium on dental panoramic radiographs and coronary calcium score on chest computerized tomography

Objectives:Coronary artery calcium measured by CT predicts future coronary events. Similarly, carotid artery calcium on dental panoramic radiographs has been associated with increased cardiovascular events. Pre-procedural assessment of candidates for valve replacement in our institution includes panoramic radiographs and chest tomography. We aimed to assess the association of carotid calcium on panoramic radiographs with coronary artery calcium on chest tomography.Methods:Paired pre-procedural panoramic radiographs and chest tomography scans were done in 177 consecutive patients between October 2016 and October 2017. Carotid calcium was quantified using NIH’s ImageJ. Coronary artery calcium was quantified by the Agatston score using Philips Intellispace portal, v. 8.0.1.20640.Results:Carotid calcium maximal intensity, area and perimeter were higher among patients with high coronary artery calcium. Non-zero carotid calcium was found in half of patients with high coronary artery calcium, doubling prevalence of low coronary artery calcium.Conclusion:Carotid calcium identified in panoramic radiographs was associated with high coronary artery calcium. Awareness of carotid calcium recognized by dental practitioners in low-cost, low radiation and commonly done panoramic radiographs may be useful to identify patients at risk of coronary disease with potential future cardiovascular events.     

A comparative study of the radiological diagnosis of postoperative maxillary cyst

OBJECTIVES: To compare the diagnostic accuracy for the postoperative maxillary cyst (POMC) of panoramic in combination with Waters' radiography with computed tomography (CT) and of oral and maxillofacial radiologists with non-specialists. STUDY DESIGN: Nineteen cases of POMC and 19 of postoperative changes were assessed using panoramic in combination with Waters' radiographs and CT by five oral and maxillofacial radiologists and five non-specialists on a five-point scale. The areas under the ROC curves were analysed using the Wilcoxon rank sum test to determine any differences in diagnostic accuracy between the two methods and between the two groups. RESULTS: The diagnostic accuracy of CT was higher than that of combined panoramic and Waters' radiographs for the oral and maxillofacial radiologists (P < 0.05), but not for the non-specialists (P > 0.05). The diagnostic accuracy of the oral and maxillofacial radiologists for each method was higher than that of the non-specialists group (P < 0.05). CONCLUSIONS: CT improves the evaluation of POMC. Radiological training and experience leads to more accurate diagnoses.     

双源CT双能量去骨技术在颈动脉狭窄病变中的应用价值

目的:探讨双源CT双能量去骨技术在颈动脉钙化性狭窄病变中的应用价值。方法:回顾性分析18例颈动脉钙化性狭窄患者的病例资料,根据北美症状性颈动脉内膜切除试验(NASCET)标准评价血管的狭窄程度,分析颈动脉双能量去骨技术去除钙化斑块后的图像与DSA图像在量化分析颈动脉狭窄程度上的相关性。以DSA图像为对照,评价双能量去骨技术诊断钙化性颈动脉狭窄的敏感性、特异性、准确性、阳性和阴性预测值。结果:64段有明显致密钙化斑块的颈动脉血管,双能量去骨技术检出54个血管节段狭窄,DSA检出50个血管节段狭窄,两者对于颈动脉钙化性狭窄病变的检出差异无统计学意义(P>0.05),两者对于狭窄程度的分级相关性好(R2=0.913)。以DSA为对照,双能量去骨技术检出颈动脉狭窄的敏感度为98.0%,特异度为100.0%,符合率为90.6%,阳性预测值为90.7%,阴性预测值为90.0%。结论:采用双能量去骨技术去除钙化斑块可以很好地评价颈动脉钙化性狭窄病变。     

Digital panoramic radiography: a reliable method to diagnose carotid artery atheromas?

OBJECTIVES: The aim of the present study is to evaluate the panoramic radiographs of 4106 patients for carotid artery atheromas (CAAs) and to correlate our findings with the literature. MATERIALS AND METHODS: The digital panoramic radiographs of 4106 dental patients (2428 female, 1678 male) were evaluated. Radiographs of patients 40 years of age or older were randomly chosen from a computer database. CAA findings were defined as radiopaque masses adjacent to the cervical vertebrae at or below the intervertebral space between C3 and C4 on the panoramic radiograph. The patients who had CAA findings were contacted by telephone, and some of them agreed to further evaluation. Evaluation included carotid ultrasound, ECG, echocardiography and treadmill exercise testing at the Department of Cardiology. RESULTS: Of 4106 patients, 88 patients (2.1%; 70 female, 18 male) had one or more radiopaque mass detected on digital images. All 88 patients with CAA findings were contacted by telephone and 23 agreed to further evaluation at the university hospital. Of these 23 patients, 8 (34.7%) had CAAs on carotid ultrasound and 15 (65.3%) had normal carotid arteries. From these eight patients with CAAs on Doppler ultrasound, 7 (30.4%) had plaques that were not haemodynamically significant and only one (4.3%) had significant plaque. The patient with severe carotid artery stenosis consequently underwent endarterectomy operation. There were no statistically significant differences between male and female in CAAs (P>0.05). CONCLUSION: Digital panoramic images may have some diagnostic value for detecting CAAs and this early diagnosis could potentially increase the length and quality of life for people with CAAs.     

Carotid artery calcification seen on panoramic dental radiographs in the Asian population in Japan

OBJECTIVES: To determine the frequency of carotid artery calcification (CAC) seen on panoramic dental radiographs, the relationship between the condition and a history of cerebral infarction (CI), and the history of the risk factors of CI in patients in Japan. METHODS: A total of 2374 individuals whose panoramic radiographs were obtained at their first consultation were reviewed. Result: CAC was found in 95 subjects (4.0%) and was found at a higher frequency in patients with a history of CI than in those without a history of CI. The modifiable risk factors (a history of hypertension, diabetes and hypercholesterolaemia) and CAC showed significant relationship in the chi(2) test for pairwise comparison. When age and gender were added and all of these risk factors were considered simultaneously in the multiple logistic regression analysis, age and history of hypercholesterolaemia remained statistically significant. CONCLUSIONS: CAC may be seen on panoramic dental radiographs and is related to the patients' general history of CI, and the risk factors of CI in the Asian population in Japan.     

颈部转移淋巴结的CT、B超检查与病理对照研究(Ⅱ.包膜外侵犯的诊断)

目的：评价ＣＴ、Ｂ超检查颈部转移淋巴结包膜外侵犯的价值和诊断标准，以及颈动脉受侵的影像学诊断。材料与方法：对６０例颈淋巴结清扫术的患者做术前前瞻性ＣＴ、Ｂ超检查，术后与病理对照，并进行双盲法分析。结果：以淋巴结边缘不规则强化、脂肪间隙部分或全部消失为转移淋巴结包膜外侵犯的ＣＴ诊断指标，敏感性８１．０３％，特异性９３．０２％；以淋巴结边缘不规则，强回声包膜呈锯齿状中断为转移淋巴结包膜外侵犯的Ｂ超诊断指标，敏感性９５．３５％，特异性６３．６４％。１１例转移淋巴结粘连侵犯颈动脉者，ＣＴ准确评价９例，Ｂ超准确诊断１０例。结论：淋巴结边缘不规则强化，周围脂肪间隙部分或全部消失为ＣＴ评价颈部转移淋巴结包膜外侵犯的准确指标。ＣＴ结合Ｂ超能准确评价颈部转移淋巴结与颈动脉的关系。     

Angiographic correlation of CT calcification in the carotid siphon

BACKGROUND AND PURPOSE: Calcification in the coronary arteries has been correlated with significant vessel stenosis. The predictive value of calcification within the carotid siphon has not been characterized; however, stenosis in the carotid siphon is potentially important in determining management of patients with ipsilateral carotid bifurcation stenosis. The purpose of this study was to determine optimal parameters for assessing carotid siphon calcification on head CT scans and to compare the CT findings with angiographic results. METHODS: We performed a retrospective review of patients referred for diagnostic carotid arteriography. Those patients who also had undergone a head CT study at our institution were selected. The CT scans and angiograms of 64 patients (128 vessels) were reviewed. Carotid siphon calcification on CT scans was characterized on brain and bone windows as mild, moderate, or severe. Comparison was then made with angiographic findings. RESULTS: The sensitivity and specificity of CT for depicting greater than 50% angiographic stenosis in the carotid siphon were 86% and 98%, respectively, for bone windows and 100% and 0%, respectively, for brain windows. The positive predictive value (PPV) for a stenosis of greater than 50% as evidenced by severe calcification was 86% on bone windows and 11% on brain windows. The PPV for mild and moderate calcification on bone windows was 2.5% and 0%, respectively. CONCLUSION: Severe CT calcification in the carotid siphon as characterized on bone windows correlates with a carotid siphon stenosis of greater than 50% as determined angiographically. Therefore, the identification of severe calcification offers a potential noninvasive method for identifying stenosis of the carotid siphon. This information may be essential in determining management and prognosis for patients with carotid bifurcation stenosis.     

Multi-detector row CT angiography in the assessment of carotid artery disease in symptomatic patients: comparison with rotational angiography and digital subtraction angiography

BACKGROUND AND PURPOSE: Compared with the single-detector technique, multi-detector row CT angiography permits larger anatomic coverage that includes both the epiaortic and entire carotid circulations. We evaluated the accuracy of multi-detector row CT angiography by using multiplanar reformation (MPR) for measuring carotid artery diameters compared with that of rotational angiography. We also evaluated the diagnostic performance of CT angiography compared with digital subtraction angiography (DSA). METHODS: In 35 patients, CT angiograms of 70 carotid arteries were compared with DSA images, and CT angiograms of 33 carotid arteries were compared with rotational angiograms. CT angiographic interpretation was performed first interactively at a workstation. Diameter measurements of normal and stenosed carotid arteries were performed on cross-sectional and oblique sagittal MPRs. Degree of stenosis was calculated per North American Symptomatic Carotid Endarterectomy Trial criteria independently by two observers for each technique. RESULTS: Degree of stenosis was slightly underestimated with CT angiography, with mean differences (+/- SD) per observer of 6.9 +/- 17.6% and 10.7 +/- 16.1% for cross-sectional and 2.8 +/- 19.2% and 9.1 +/- 16.8% for oblique sagittal MPRs compared with rotational angiography. CT angiography was somewhat inaccurate for measuring the absolute minimal diameter of high-grade stenoses. On symptomatic sides (n = 35), interactive CT angiographic interpretation combined with MPR measurements for lesions with a visual estimate of 50% or greater stenosis achieved a sensitivity of 95% (20/21) and specificity of 93% (13/14) in the detection of carotid stenosis (>/= 50%) verified with DSA. CONCLUSION: Regardless of slight underestimation of carotid stenosis with CT angiography compared with rotational angiography, diagnostic performance of CT angiography with interactive interpretation proved to be good. Also, the method is highly sensitive for detection of carotid artery stenosis, indicating the suitability of CT angiography as a screening method for symptomatic patients. For hemodynamically significant stenoses revealed by CT angiographic screening, conventional angiography still seems to be necessary.     

Coronary artery calcification detected with ultrafast CT as an indication of coronary artery disease.

To assess the relationship of coronary artery calcification to angiographically detectable disease, the authors evaluated 100 patients less than 60 years of age who underwent clinically indicated coronary angiography and ultrafast computed tomography (CT). The ultrafast CT technique consisted of 3-mm-thick contiguous sections and a 100-msec acquisition time. All patients with clinically significant disease at angiography (defined as at least one stenosis with a diameter narrowing of at least 50%) had some coronary artery calcification present at ultrafast CT (100% sensitivity in this population). The absence of calcification at ultrafast CT had a 100% negative predictive value for clinically significant coronary artery disease. Specificity and positive predictive value were 47% and 62%, respectively. Sensitivity and specificity of ultrafast CT in the detection of patients with angiographically detectable disease were 94% and 72%, respectively. Ultrafast CT of the heart is an anatomically based, noninvasive test with high sensitivity for the detection of coronary artery calcification. Ultrafast CT may be beneficial in the screening of selected populations for the presence of atherosclerotic coronary disease.     

Carotid stenosis: a comparison between MR and spiral CT angiography

We performed a preliminary study comparing three-dimensional time-of-flight (3 D TOF) magnetic resonance angiography (MRA) and spiral CT angiography (SCTA) in the detection and assessment of internal carotid artery stenosis. Digital subtraction angiography (DSA) was the reference examination. We examined 20 patients with signs of cerebrovascular insufficiency, who underwent MRA, SCTA and DSA within a 3 day period. Both internal carotid arteries were assessed by three blinded readers for degree of stenosis at two different levels (bulb and remaining section) giving a total of 80 assessments. Interobserver variability, sensitivity, specificity, diagnostic accuracy, concordance, overestimation and underestimation were assessed. Interobserver variability was not statistically significant. MRA showed higher sensitivity, specificity, diagnostic accuracy and concordance than SCTA (92.0 % vs 80.8 %, 98.2 % vs 96.4 %, 96.3 % vs 91.3 % and 96.0 % vs 88.0 %, respectively). MRA gave rise to a 5.0 % overestimation rate, whereas SCTA occasioned a 7.5 % underestimation rate. These differences are not statistically significant. These results suggest that MRA is a more useful, noninvasive modality for assessment of the internal carotid artery with a more than 70 % stenosis. Received: 8 August 1997 Accepted: 10 October 1997     

Carotid artery calcification in the black population: a retrospective study on panoramic radiographs

OBJECTIVES: To determine the prevalence of carotid artery calcification on panoramic radiographs in the Black population. METHODS: Panoramic radiographs of 700 adult male and female Black dental outpatients from the Medical Center of Louisiana Charity Hospital were examined for any unusual radiopacity adjacent to or just below the intervertebral space between C3 and C4. RESULTS: Three (0.43%) of the 700 patients, with ages ranging from 46 - 77-years-old, had one or more unusual radiopacities in the region of interest. All three were female. CONCLUSION: It is uncommon to find radiopacities adjacent to or just below the intervertebral space between C3 and C4 in the general Black population.     

The relationship between coronary artery calcification detected by non-gated multi-detector CT in patients with suspected ischemic heart disease and myocardial ischemia detected by thallium exercise stress testing

OBJECTIVE: To examine whether we could predict myocardial ischemia when coronary artery calcification is detected by non-gated multidetector CT in patients with suspected ischemic heart disease. METHODS: Eighty-three patients suspected of having ischemic heart disease (55 men, 28 women; age range 36-83 years; mean age 68 years) underwent multidetector CT and T1-201 single photon emission computed tomography. Prediction of myocardial ischemia by coronary arterial calcification detected on CT was evaluated by comparing the coronary artery territories that showed calcification with the area of myocardial ischemia determined by SPECT. The sensitivity, specificity, positive predictive value, and negative predictive value of multidetector CT for predicting myocardial ischemia were calculated. Coronary angiography was also examined and compared with multidetector CT. Risk factors, including hypertension, smoking, hyperlipidemia, diabetes, and family history, were compared for evidence of coronary artery calcification detected by multidetector CT and myocardial ischemia detected by thallium nuclear scans. RESULTS: For analysis by patients, the sensitivity, specificity, positive predictive value, and negative predictive value of coronary artery calcification for myocardial ischemia detection were 65, 63, 56, and 71%, respectively. Similarly, for analysis by coronary arterial territories, those values were 56, 77, 41 and 86%, respectively. Coronary stenosis on CAG was also related to the ischemia determined by SPECT and calcification on multidetector CT. Ischemia was better influenced by risk factors than was coronary arterial calcification. CONCLUSIONS: For analysis by coronary arterial territories, the specificity and negative predictive value of coronary arterial calcification seen by multidetector CT are relatively high.     

Endoscopic ultrasound and Computed Tomography in the diagnosis, locoregional staging and assessment of vascular infiltration of pancreatic carcinoma

PURPOSE: The aim of this study was to evaluate the diagnostic accuracy of colour-Doppler Endoscopic Ultrasonography (EUS), in the detection, loco-regional staging and assessment of vascular infiltration in pancreatic carcinoma, and to compare the results with those obtained by Computed Tomography (CT). MATERIALS AND METHODS: A series of 57 patients with diagnosed or suspected pancreatic carcinoma was retrospectively analysed. All patients underwent EUS and thin-slice (< 5 mm) spiral dynamic CT. The final diagnosis (carcinoma in 37 patients and benign lesion in 20) was obtained by laparotomy in 21 patients, fine-needle aspiration cytology (FNAC) in 17, and follow-up in 19. RESULTS: The specificity and sensitivity for the diagnosis of malignancy were respectively 45% and 92% for EUS and 45% and 89% for CT, with an accuracy of 75% for EUS (p <0.05) and 74% for CT (p = 0.07). The specificity and sensitivity for the diagnosis of loco-regional nodal metastases were both 100% for EUS. The specificity and sensitivity for the diagnosis of vascular infiltration were 100% and 94% for EUS and 100% and 44% for CT, giving a diagnostic accuracy of 97% for EUS vs 74% for CT (p <0.001). CONCLUSIONS: EUS proved to be more sensitive and specific than CT in the loco-regional staging of pancreatic carcinoma. Its diagnostic accuracy is especially high in assessing vascular infiltration and loco-regional nodal metastases. CT still remains the examination of choice for staging pancreatic carcinoma and for assessing its resectability as it affords a panoramic view and ability to rule out distant metastases. Candidates to resection should all be examined by EUS, as, due to its high accuracy in loco-regional staging and assessing vascular infiltration, it might allow a large proportion of patients to be spared the operation.     

Intracranial carotid calcification on CT images as an indicator of atheromatous plaque: analysis of high-resolution CTA images using a 64-multidetector scanner

PURPOSE: Intracranial arterial wall calcifications are frequently observed on routine head computed tomography (CT) images. The purpose of this study was to evaluate whether calcification of the intracranial carotid artery on CT images could predict atheromatous plaque and luminal stenosis. MATERIALS AND METHODS: A total of 259 patients were examined using three-dimensional CT angiography using high-resolution 64 detector scanners. We examined patients from the petrous portion to the top of the internal carotid arteries. We evaluated the existence of calcification and atheromatous plaque based on our criteria retrospectively. The thickness of calcification was measured in each vessel, and the shape of calcification was classified into three types. RESULTS: There was low correlation between the thickness of the calcification and luminal stenosis, but the shape of the calcification corresponded well to the stenosis. The population of patients with >50% stenosis of the intracranial carotid artery differed statistically significantly for each calcification shape. There was a high negative predictive value (97.7%) in the correlation between the existence of calcification and atheromatous plaque on the multidetector CT images. CONCLUSION: Calcification of the intracranial carotid artery on CT images shows a high negative predictive value for the existence of atheromatous plaque in the same artery. The thickness of the calcification did not correlate well with luminal stenosis, but its shape seemed to predict luminal stenosis.     

320层容积CT无心率(律)控制的冠状动脉血管成像在冠心病高危人群中的初步应用

目的 探讨在无心率(律)控制条件下,320层容积CT冠状动脉血管成像(VCTA)诊断冠心病高危人群冠状动脉狭窄的准确性.方法 对30例有冠心病高危因素的患者,以冠状动脉导管造影(ICA)为金标准,评价VCTA诊断冠状动脉节段狭窄率≥50%的敏感度、特异度、阳性预测值(PPV)、阴性预测值(NPV)及Youden指数;同时采用卡方检验分析心率快慢及钙化程度对2种检查方法诊断一致率的影响.结果 30例患者平均心率(73.7±15.4)次/min(bpm),420个可分析节段的平均Agatston钙化积分中位数为45.6分(OR=181).心率＜70和≥70 bpm分别显示242和169段,诊断一致率差异无统计学意义(P＞0.05);Agatston钙化积分≥100分的图像质量和诊断一致率低于Agatston钙化积分＜100分的节段,但VCTA与ICA结果仍具有良好吻合性(P＞0.05).结论 在无心率(律)控制情况下,VCTA对冠心病高危人群的冠状动脉狭窄诊断具有很高的准确性.     

Comparing the accuracy of panoramic and intraoral radiography in the diagnosis of proximal caries

OBJECTIVES: The purpose of this study was to compare the diagnostic accuracy of panoramic and intraoral radiographic surveys in the diagnosis of proximal caries according to the different dental regions (maxillary and mandibular incisor, canine, premolar and molar). METHODS: In this study, full mouth series and panoramic radiographs of 79 patients were used. The radiographs were evaluated for proximal caries by three observers. The diagnostic accuracy of radiographic surveys for each dental region was assessed by means of receiver operating characteristic (ROC) curve analysis. RESULTS: Full mouth series was the most efficient method in the diagnosis of caries for incisor and canine teeth. However, full mouth series and combination of panoramic plus bitewings had similar diagnostic accuracy for premolar and molar teeth. CONCLUSIONS: Panoramic survey alone was not sufficient for the diagnosis of proximal caries for the entire dentition. The combination of panoramic plus bitewing plus anterior periapical survey exhibited a diagnostic accuracy for proximal caries that was comparable with full mouth series.     

Intracranial aneurysms: CT angiography and MR angiography for detection prospective blinded comparison in a large patient cohort

PURPOSE: To compare computed tomographic (CT) angiography and magnetic resonance (MR) angiography with intraarterial digital subtraction angiography (DSA) in the detection of intracranial aneurysms. MATERIALS AND METHODS: One hundred forty-two patients underwent intraarterial DSA to detect aneurysms. CT angiography, three-dimensional time-of-flight MR angiography, and intraarterial DSA were performed contemporaneously. Film hard-copy images and maximum intensity projection reconstructions of the CT angiograms and MR angiograms were reviewed at different times. RESULTS: The accuracy per patient for the best observer was 0.87 at CT angiography and 0.85 at MR angiography. The accuracy per aneurysm for the best observer was 0.73 at CT angiography and 0.67 at MR angiography. Differences between readers and modalities were not significant. Interobserver agreement was good: kappa value of 0.73 for CT angiography and of 0.74 for MR angiography. The sensitivity for detection of aneurysms smaller than 5 mm was 0.57 for CT angiography and 0.35 for MR angiography compared with 0.94 and 0.86, respectively, for detection of aneurysms 5 mm or larger. The accuracy of both CT angiography and MR angiography was lower for detection of internal carotid artery aneurysms compared with that at other sites. With low observer confidence, the likelihood of correct interpretation was significantly poorer. CONCLUSION: CT angiography and MR angiography have limited sensitivity in the detection of small aneurysms but good interobserver agreement. There is no significant difference in diagnostic performance between the noninvasive modalities.