Summary of: Evaluation of carotid calcification detected using panoramic radiography and carotid Doppler sonography in patients with and without coronary artery disease

Key Points

• Panoramic radiographs do not seem to be a good screening tool for detection of carotid stenosis and are not cost effective for this purpose.

• There is poor clinical correlation between calcifications in panoramic radiographs and carotid ultrasound unless the patient has an advanced coronary problem.

Abstract

Objectives Carotid artery calcification is responsible for an estimated 5% of ischaemic strokes. Carotid doppler sonography (DS) is a frequently used non-invasive method for assessing carotid artery stenosis and calcification. This study assessed the utility of panoramic radiography to detect any carotid artery calcification in patients with and without coronary artery disease, as well as the level of agreement between panoramic radiographs and DS findings.

Methods Ninety subjects who underwent coronary angiography for any reason in Namazi Hospital, Shiraz University of Medical Science during an 11 month period received a DS assessment and panoramic radiograph. The radiopacities adjacent to the cervical vertebrae at or below the intervertebral space between C3-C4 were diagnosed as carotid artery calcifications. Carotid calcifications were scored as present or absent and pattern of calcification was noted by a maxillofacial radiologist who was blind to the angiogram and sonogram results. The final sample population was 84 subjects, providing data on 168 carotid arteries.

Results The panoramic radiograph had a sensitivity of 66.6% and a positive predictive value of 45% for detecting carotid artery calcifications in patients whose angiograms confimed the coronary artery disease. It had 50% sensitivity in patients with normal angiogram. The level of agreement between panoramic radiographs and DS results was weak.

Conclusion Because of low sensitivity and positive predictive value, the panoramic radiograph can not be considered an accurate or reliable method for detecting carotid artery calcification.

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