Panoramic Radiography for Carotid Artery Assessment

Panoramic radiography is a widely used dental imaging modality that incidentally captures the cervical region, enabling visualisation of radiopaque deposits adjacent to the C3–C4 vertebrae. These deposits often represent carotid artery calcifications (CAC), a hallmark of underlying atherosclerosis and an indicator of elevated cardiovascular risk. The technique offers broad availability and low cost, making it a practical first-line screening tool in dental clinics. However, image quality, anatomical superimposition and observer expertise influence diagnostic accuracy. Advances in image-processing algorithms and artificial intelligence are now augmenting manual interpretation, improving sensitivity and specificity, and supporting integration of dental radiographs into multidisciplinary vascular risk management pathways.

Research from Nature Portfolio

Recent studies have harnessed deep learning to automate the identification and delineation of carotid calcifications on panoramic radiographs. A cascaded neural network combining classification and segmentation modules achieved discrimination between normal and calcified cases with an area under the ROC curve exceeding 0.99, sensitivity above 0.98 and specificity above 0.98. Segmentation performance metrics, including Dice similarity coefficients approaching 0.72 and Jaccard indices around 0.60, demonstrated lesion delineation comparable to cross-sectional imaging. This automated approach promises to standardise screening in dental settings, reduce inter-observer variability and facilitate early referral for vascular evaluation.

Panoramic Radiography for Carotid Artery Assessment publication trend

The graph below shows the total number of articles in panoramic radiography for carotid artery assessment across all publications each year (not limited to Nature Index journals).

Technical terms

Panoramic radiography: A two-dimensional dental imaging technique capturing the maxilla, mandible and adjacent cervical anatomy in a single panoramic view.

Carotid artery calcification (CAC): Deposition of calcium within the walls of the carotid arteries, indicative of atherosclerotic plaque.

Atherosclerosis: Progressive arterial disease marked by lipid accumulation, inflammatory response and calcification, leading to vessel narrowing and ischaemic complications.

Area under the receiver operating characteristic curve (AUC): A metric that quantifies a diagnostic test’s overall ability to distinguish between diseased and non-diseased states across all classification thresholds.

Dice similarity coefficient: A statistical measure of spatial overlap between two segmented regions, with values from 0 (no overlap) to 1 (perfect concordance).

References

1. CACSNet for automatic robust classification and segmentation of carotid artery calcification on panoramic radiographs using a cascaded deep learning network. Scientific Reports (2024).
2. Carotid calcifications in panoramic radiographs are associated with future stroke or ischemic heart diseases: a long-term follow-up study. Clinical Oral Investigations (2018).
3. Prevalence of suggestive images of carotid artery calcifications on panoramic radiographs and its relationship with predisposing factors. Ciência & Saúde Coletiva (2016).
4. Incidental findings detected with panoramic radiography: prevalence calculated on a sample of 2017 cases treated at a major Italian trauma and cancer centre. Oral Radiology (2020).