title: Reliability of panoramic radiograph for carotid atheroma detection: a study in patients who fulfill the criteria for carotid endarterectomy.
abstract: OBJECTIVE
  To evaluate the reliability of panoramic radiograph (PR) for carotid artery atheroma detection, by comparing its results with the carotid-vertebral digital subtraction angiography (DSA) findings, as well as with the detected calcium deposition in the carotid plaques, which were surgically resected, using direct radiographs.
  
  
  METHODS
  Forty consecutive patients suffering from carotid artery atherosclerotic occlusive disease confirmed by preoperative DSA, fulfilling the criteria for carotid endarterectomy, were operated on. Preoperatively, all of the patients had undergone PR, while postoperatively all of the surgically resected carotid plaques were radiographed using radiographic films and submitted to histologic examination. Compared with the DSA and the radiographic film findings, the PR results were classified as: 1) true-positive; 2) true-negative; 3) false-positive; or 4) false-negative.
  
  
  RESULTS
  Panoramic radiograph has low sensitivity and specificity compared with the DSA findings and the direct radiographs results. However, a positive predictive value (PPV) of 100% per patient as well as for luminal stenosis >80% was documented.
  
  
  CONCLUSIONS
  Even in the subgroup of patients who fulfill the criteria for carotid endarterectomy, PR has a low sensitivity and specificity; therefore, it cannot be considered to be a useful screening tool for atheroma detection in the general dental population. However, the 100% PPV per patient and for luminal stenosis >80%, indicates that positive calcification PR findings at the C(3)-C(4) region are highly suggestive for carotid artery atherosclerotic occlusive disease. Therefore, especially asymptomatic patients should be referred for further examination.
authors.affiliation: Oral Diagnosis and Radiology Department, School of Dentistry, University of Athens, Athens, Greece. sdamask@dent.uoa.gr
authors.forename: Spyros
authors.initials: S
authors.lastname: Damaskos
authors.forename: John
authors.initials: J
authors.lastname: Griniatsos
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Tsekouras
authors.forename: Sotirios
authors.initials: S
authors.lastname: Georgopoulos
authors.forename: Chris
authors.initials: C
authors.lastname: Klonaris
authors.forename: Elias
authors.initials: E
authors.lastname: Bastounis
authors.forename: Kostas
authors.initials: K
authors.lastname: Tsiklakis
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D050197:Atherosclerosis / Q000000981:diagnostic imaging* / Q000601:surgery; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000601:surgery; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011862:Radiography, Panoramic; D012680:Sensitivity and Specificity