Ultrasound screening for asymptomatic carotid stenosis in subjects with calcifications in the area of the carotid arteries on panoramic radiographs: a cross-sectional study

Elias P Johansson, Jan Ahlqvist, Maria Garoff, Kjell Karp, Eva Levring Jäghagen, Per Wester, Elias P Johansson, Jan Ahlqvist, Maria Garoff, Kjell Karp, Eva Levring Jäghagen, Per Wester

Abstract

Background: Directed ultrasonic screening for carotid stenosis is cost-effective in populations with > 5% prevalence of the diagnosis. Occasionally, calcifications in the area of the carotid arteries are incidentally detected on odontological panoramic radiographs. We aimed to determine if directed screening for carotid stenosis with ultrasound is indicated in individuals with such calcifications.

Methods: This was a cross-sectional study. Carotid ultrasound examinations were performed on consecutive persons, with findings of calcifications in the area of the carotid arteries on panoramic radiography that were otherwise eligible for asymptomatic carotid endarterectomy.

Results: Calcification in the area of the carotid arteries was seen in 176 of 1182 persons undergoing panoramic radiography. Of these, 117 fulfilled the inclusion criterion and were examined with carotid ultrasound. Eight persons (6.8%; 95% CI 2.2-11.5%) had a carotid stenosis--not significant over the 5% pre-specified threshold (p = 0.232, Binomial test). However, there was a significant sex difference (p = 0.008), as all stenoses were found in men. Among men, 12.5% (95%CI 4.2-20.8%) had carotid stenosis--significantly over the 5% pre-specified threshold (p = 0.014, Binomial test).

Conclusions: The incidental finding of calcification in the area of the carotid arteries on panoramic radiographs should be followed up with carotid screening in men that are otherwise eligible for asymptomatic carotid endarterectomy.

Trial registration: The study was registered at http://www.clinicaltrials.gov; NCT00514644.

Figures

Figure 1
Figure 1
Panoramic image. Showing bilateral calcification in the area of the carotid arteries (arrows). (M = mandible, CS = cervical spine, HB = hyoid bone).
Figure 2
Figure 2
Anterio-posterior projection of the neck. Showing calcifications in the area of the carotid arteries (arrows) adjacent to the cervical spine.
Figure 3
Figure 3
Trial profile.
Figure 4
Figure 4
Reasons for reference persons to be excluded from the study.

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