Health  Vol.6 No.15 , August 2014
Evaluation of Positive Predictive Value for Digital Panoramic Radiography in Comparison to Ultrasound in the Diagnosis of Calcified Carotid Atheroma
Abstract: Aim: Detection of calcified carotid atheroma (CCA) has an important role in reducing the incidence of Cerebro Vascular Accident (CVA). The aim of this study was to evaluate efficacy of panoramic digital radiography in detecting atherosclerosis. Methods: It is descriptive-analytical diagnostic study. The people (22 to 62 years old) were referred to a radiology clinic to perform panoramic radiography for diagnosis of CCA. Individuals who were suspected were introduced to the radiology department of dental school to undergo ultrasound evaluation to CCA. For the 41 patients (55 sides), ultrasound was performed. For data analysis, the Chi-square and Fisher's exact test were used. Results: The prevalence of CCA was 2.43%. The PPV of digital panoramic was 45.5%. There was no significant relationship between age (P = 0.14) and sex (P = 0.539) and PPV of digital panoramic. The PPV of digital panoramic was significantly associated with hypertension (P = 0.032). Conclusion: It seems that panoramic can be used to screen patients with a history of hypertension for atherosclerosis.
Cite this paper: Ezoddini-Ardakani, F. , Mirzaei, M. , Nayer, S. , Besharati, S. and Moeini, M. (2014) Evaluation of Positive Predictive Value for Digital Panoramic Radiography in Comparison to Ultrasound in the Diagnosis of Calcified Carotid Atheroma. Health, 6, 1933-1940. doi: 10.4236/health.2014.615226.

[1]   Longo, D., Fauci, A., Kasper, D., Hauser, S., Jameson, J., et al. (2011) Harrison’s Principles of Internal Medicine. 18th Edition, McGraw-Hill Companies Inc., New York, 1077-1084.

[2]   Manzi, F.R., Boscolo, F.N., de Almedia, S.M. and Haiterneto, F. (2003) Panoramic Radiography as an Auxillary in Detecting Patients at Risk for Cerebrovascular Accident (CVA): A Case Report. Journal of Oral Science, 45, 177-180.

[3]   Friedlander, A.H. and Friedlander, I.K. (1996) Panoramic Dental Radiography: An Aid in Detecting Individuals Prone to Stroke. British Dental Journal, 181, 23-26.

[4]   Bayram, B., Uckan, S, Acikgoz, A., Muderrisoglu, H. and Aydinap, A. (2006) Digital Panoramic Radiography: A Reliable Method to Diagnose Carotid Artery Atheromas? Dentomaxillofacial Radiology, 35, 266-270.

[5]   Guimaraes Henriques, J.C., Kreich, E.M., Helena Baldani, M., Luciano, M., Cezar de Melocastilho, J., et al. (2011) Panoramic Radiography in the Diagnosis of Carotid Artery Atheromas and the Associated Risk Factor. Open Dentistry Journal, 5, 79-83.

[6]   Kamikawa, R.S., Rereira, M.F., Fernandes, A. and Meurer, M.I. (2006) Study of the Localization of Radiopacities Similar to Calcified Carotid Atheroma by Means of Panoramic Radiography. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 101, 374-378.

[7]   Drozdzowska, B., Pluskiewics, W. and Tarnawska, B. (2002) Panoramic Based Mandibular Indices in Relation to Mandibular Bone Mineral Density and Skeletal Status Assessed by Dual Energy x-Ray Absorptionometry and Quantitative Ultrasound. Dentomaxillofacial Radiology, 31, 361-367.

[8]   Friedlander, A.H., Garrett, N.R., Chin, E.E. and Baker, J.D. (2005) Ultrasonographic Confirmation of Carotid Artery Atheromas Diagnosed via Panoramic Radiography. Journal of the American Dental Association, 136, 635-640.

[9]   Ertas, E.T., Mavili, E., Sisman, Y., Sahman, H., Eto, Z.M., et al. (2010) Incidental Findings of Carotid Artery Stenosis Detected by Calcifications on Panoramic Radiographs: Report of Three Cases. Oral Radiology, 26, 116-127.

[10]   Tofanghchiha, M., Maryam, A., Mosallaei, S.S. and Moghaddam, M.A. (2009) Comparison of Panoramic Radiography in Detection of Carotid Artery Calcifications with Doppler Sonography Results. JQUMS, 13, 63-68.

[11]   White, S.C. and Pharoah, M.J. (2009) Oral Radiology Principles and Interpretation. 6th Edition, Mosby, St. Louis, 175-190, 221-222.

[12]   Arai, D., Yamaguchi, S., Murakami, M., Nakakuki, T., Fukuda, S., Satoh-Asahara, N., et al. (2011) Characteristics of Carotid Plaque Findings on Ultrasonography and Black Blood Magnetic Resonance Imaging in Comparison with Pathological Findings. Acta Neurochirurgica Supplementum, 112, 15-19.

[13]   Forouzan-Nia, K.H., Nafisi-Moghadam, R., Abdollahi, M.H., Zare, S., Baradaran, S.H., et al. (2006) Carotid Artery Sonography Findings in 291 Patients Undergoing CABG. JSSU, 14, 15-22.

[14]   Pornprasertsuk-Damrongsri, S., Virayavanich, W., Thanakun, S., Siriwonqpairat, P., Amaekchok, P., et al. (2011) Carotid Atheroma Detected by Panoramic Radiography and Ultra-sonography in Patients with Metabolic Syndrome. Oral radiology, 27, 43-49.

[15]   Al-Zoman, H.A., Al-Sadhan, R.I., Al-Lahem, Z.H., Al-Sakakar, A.N. and Al-Fawaz, Y.F. (2012) Prevalence Carotid Calcification Detected on Panoramic Radiographs in a Soudi Population from a Training Institute in Central Saudi Arabia. Saudi Medical Journal, 33, 177-181.

[16]   De Syo, D., Franjic, B.D., Lovricevic, I., Vokelic, M. and Palenkic, H. (2005) Carotid Bifurcation Position and Branching Angle in Patients with Atherosclerotic Carotid Disease. Collegium Antropologicum, 29, 627-632.

[17]   Warburton, L. and Gillard, J. (2006) Functional Imaging of Carotid Atheromatous Plaques. Journal of Neuroimaging, 16, 293-301.

[18]   Friedlander, A.H. and Altman, L. (2001) Carotid Artery Atheromas in Postmenopausal Woman. Their Prevalence on Panoramic Radiographs and Their Relationship to Atherogenic Risk Factors. Journal of the American Dental Association, 132, 1130-1136.

[19]   Friedlander, A.H. and Lande, A. (1981) Panoramic Radiographic Identification of Carotid Arterial Plaques. Oral Surgery, Oral Medicine, Oral Pathology, 52, 102-104.

[20]   Friedlander, A.H. and Maeder, L.A. (2000) The Prevalence of Calcified Carotid Artery Atheromas on the Panoramic Radiographs of Patients with Type 2 Diabetes Mellitus. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics, 89, 420-424.

[21]   Freymiller, E.G., Sung, E.C. and Friedlander, A.H. (2000) Detection of Radiation-Induced Cervical Atheromas by Panoramic Radiography. Oral Oncology, 36, 175-179.

[22]   Friedlander, A.H. and Baker, J.D. (1994) Panoramic Radiography: An Aid in Detecting Patients at Risk of Cerebrovascular Accident. Journal of the American Dental Association, 125, 1598-1603.

[23]   Friedlander, A.H. and Farman, A.G. (2007) Detection of Carotid Atheromas by Panoramic Radiography. Inside Dentistry, 3, 46-51.

[24]   Ohba, T., Takata, Y., Ansai, T., Morimoto, Y., Tanaka, T., Kito, S., et al. (2003) Evaluation of Calcified Carotid Artery Atheromas Detected by Panoramic Radiographs among 80-Year-Old. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics, 96, 647-650.

[25]   Carter, L.C., Haller, A.D., Nadarajah, V., Calamel, A.D. and Aguirre, A. (1997) Use of Panoramic Radiography among an Ambulatory Dental Population to Detect Patients at Risk of Stroke. Journal of the American Dental Association, 128, 977-984.

[26]   Beckstrom, B.W., Horsley, S.H., Scheets, J.P., Khan, Z., Sliveria, A.M., et al. (2007) Correlation between Carotid Area Calcifications and Periodontitis: A Retrospective Study of Digital Panoramic Radiographic Findings in Pretreatment Cancer Patients. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics, 103, 359-366.

[27]   Friedlander, A.H., Eichstaedt, R.M., Friedlander, I.K. and Lambert, P.M. (1998) Detection of Radiation-Induced, Accelerated Atherosclerosis in Patients with Osteoradionecrosis by Panoramic Radiography. Journal of Oral and Maxillofacial Surgery, 56, 455-459.

[28]   Joakimsen, O., Bonaa, K.H., Stensland-Bugge, E. and Jacobsen, B.K. (2000) Population-Based Study of Age at Meno-pause and Ultrasound Assessed Carotid Atherosclerosis: The Tromso Study. Journal of Clinical Epidemiology, 53, 525-530.

[29]   Ravon, N.A., Hollender, L.G., McDonald, V. and Persson, G.R. (2003) Signs of Carotid Calcification from Dental Panoramic Radiographs Are in Agreement with Doppler Sonography Results. Journal of Clinical Periodontology, 30, 1084-1090.

[30]   Sisman, Y., Ertas, E.T., Gokce, C., Menku, A., Ulker, M. and Akgunlu, F. (2007) The Prevalence of Carotid Artery Calcification on the Panoramic Radiographs in Cappadocia Region Population. European Journal of Dentistry, 1, 132-138.

[31]   Johansson, E.P., Ahlqvist, J., Garoff, M., Karp, K., Jäghagen, E.L. and Wester, P. (2011) Ultrasound Screening for Asymptomatic Carotid Stenosis in Subjects with Calcifications in the Area of the Carotid Arteries on Panoramic Radiographs: A Cross-Sectional Study. BMC Cardiovascular Disorders, 11, 44.

[32]   Friedlander, A.H., Tajima, T. and Garrett, N.R. (2011) Panoramic Radiographs of Head and Neck Cancer Patients Are Often Evidence of Carotid Artery Atherosclerotic Lesions: A Sign of High-Risk Comorbid Illness. Journal of Oral and Maxillofacial Surgery, 70, 1096-1101.

[33]   Friedlander, A.H. and Friedlander, I.K. (1998) Identification of Stroke Prone Patients by Panoramic. Australian Dental Journal, 43, 51-54.

[34]   Romano-Sousa, G.M., Krejcj, L., Medeiros, F.M., Graciosa-Filho, R.G., Martins, M.F., Guedes, V.N., et al. (2009) Diagnostic Agreement between Panoramic Radiographs and Color Doppler Images of Carotid Atheroma. Journal of Applied Oral Science, 17, 45-48.

[35]   Christou, P., Leemann, B., Schimmel, M., Kiliaridis, S. and Müller, F. (2010) Carotid Artery Calcification in Ischemic Stroke Patients Detected in Standard Dental Panoramic Radiographs—A Preliminary Study. Advances in Medical Sciences, 55, 26-31.

[36]   Ezoddini Ardakani, F., Afkhami, M., Mohammadi, Z. and Sheikhha, M.H. (2007) Evaluating Calcified Carotid Artery Atheromas in Panoramic Radiographs of Patients with Type 2 Diabetes Mellitus. Oral Radiology, 23, 6-9.