title: Ultrasound screening for asymptomatic carotid stenosis in subjects with calcifications in the area of the carotid arteries on panoramic radiographs: a cross-sectional study.
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.
  
  
  BACKGROUND
  The study was registered at http://www.clinicaltrials.gov; NCT00514644.
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden. elias.johansson@medicin.umu.se
authors.forename: Elias P
authors.initials: EP
authors.lastname: Johansson
authors.forename: Jan
authors.initials: J
authors.lastname: Ahlqvist
authors.forename: Maria
authors.initials: M
authors.lastname: Garoff
authors.forename: Kjell
authors.initials: K
authors.lastname: Karp
authors.forename: Eva Levring
authors.initials: EL
authors.lastname: Jäghagen
authors.forename: Per
authors.initials: P
authors.lastname: Wester
mesh_terms: D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging*; D009202:Cardiomyopathies / Q000000981:diagnostic imaging*; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D011446:Prospective Studies; D011862:Radiography, Panoramic / Q000379:methods; D014463:Ultrasonography