title: Correlating carotid artery stenosis detected by panoramic radiography with clinically relevant carotid artery stenosis determined by duplex ultrasound.
abstract: OBJECTIVE
  We sought to assess the utility of panoramic radiography as an adjunct screening tool for detecting significant asymptomatic carotid artery stenosis. The specific aim was to correlate calcifications seen in the region of the carotid bifurcation with clinically relevant carotid artery stenosis as determined by duplex ultrasound (DUS).
  
  
  METHODS
  Routine dental panoramic films of patients 55 and older (n = 778) at the University of Rochester Eastman Dental Center were retrospectively reviewed for calcifications around the carotid bifurcation. Patients with such calcifications were referred for DUS, and raw data were interpreted by a vascular surgeon blinded to the radiographic findings. Groups were compared by using the chi(2) test.
  
  
  RESULTS
  Twenty-seven patients (3.5%) had suggestive radiographic calcifications on one or both sides, 20 of whom consented to DUS. Clinically significant carotid stenoses (>50% lumenal narrowing) were present in 50% of the sides with calcification compared with 21% of the sides without (P =.08, chi(2)). Three patients (15% of those screened with DUS) had stenoses greater than 80% and underwent 4 carotid endarterectomies as a direct result of screening.
  
  
  CONCLUSIONS
  Data suggest that clinically significant stenosis may exist if calcifications are observed on panoramic radiographs. Incidental examination of this area carries a minimal cost and appears beneficial as a screening tool for carotid disease, although definitive testing must follow.
authors.affiliation: Prosthodontics, University of Rochester Eastman Dental Center, New York, USA. dov_almog@urmc.rochester.edu
authors.forename: Dov M
authors.initials: DM
authors.lastname: Almog
authors.forename: Tuvia
authors.initials: T
authors.lastname: Horev
authors.forename: Karl A
authors.initials: KA
authors.lastname: Illig
authors.forename: Richard M
authors.initials: RM
authors.lastname: Green
authors.forename: Laurie C
authors.initials: LC
authors.lastname: Carter
mesh_terms: D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging*; D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D011862:Radiography, Panoramic / Q000191:economics; D012189:Retrospective Studies; D018616:Ultrasonography, Doppler, Duplex / Q000191:economics