title: What are the potential implications of identifying intracranial internal carotid artery atherosclerotic lesions on cone-beam computed tomography? A systematic review and illustrative case studies.
abstract: OBJECTIVE
  A systematic literature review was performed to examine the clinical implications of intracranial internal carotid artery calcific atherosclerotic lesions (IICACALs) detected at cone-beam computed tomographic (CBCT) examinations.
  
  
  METHODS
  The PubMed database was queried in 2 separate searches using the linked search terms non-contrast enhanced cone beam computed tomography and calcified intracranial vascular lesions and non-contrast enhanced computed tomography and calcified intracranial vascular lesions. Reviewed were all English-language articles using CBCT or CT imaging that enrolled neurologically asymptomatic and symptomatic patients. Excluded were studies describing patients with hemorrhagic stroke. Illustrative cases describing incidentally detected IICACALs on CBCT scans are provided.
  
  
  RESULTS
  Three articles described identification of IICACALs on CBCT scans of almost 1,500 dental patients. Two of these fully addressed the subject, with 1 noting that IICACALs were benign and another urging patient referral for further workup. Five non-contrast-enhanced CT studies were evaluated in detail; all confirmed IICACALs as a substantive risk marker of advanced stenotic disease in the cerebral circulation, central brain atrophy, concomitant advanced atherosclerotic disease in the cardiovascular circulation, and an indicator of future ischemic events. Five CBCT examinations showing IICACALs in the cavernous and ophthalmic segments are presented.
  
  
  CONCLUSIONS
  Few studies have denoted the importance of identifying IICACALs on CBCT scans. However, all non-contrast-enhanced CT studies emphasized the clinical significance of these lesions in relation to cerebral and cardiovascular disease. Therefore, IICACALs seen on CBCT and CT scans present the same risk and should prompt referral for further evaluation.
authors.affiliation: Director of the Graduate Medical Association and Associate Chief of Staff/Education, Veterans Affairs Greater Los Angeles Healthcare System; Director, Quality Assurance Hospital Dental Service, Ronald Reagan UCLA Medical Center; Professor-in-Residence, Section of Oral and Maxillofacial Surgery, School of Dentistry, University of California-Los Angeles, Los Angeles, CA.
authors.forename: Arthur H
authors.initials: AH
authors.lastname: Friedlander
authors.affiliation: Professor, Department of Clinical Neurology; Associate Director, Stroke Program, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA.
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.affiliation: Third-Year Dental Student, School of Dentistry, University of California-Los Angeles, Los Angeles, CA.
authors.forename: Huy Q
authors.initials: HQ
authors.lastname: Tran
authors.affiliation: Assistant Professor and Residency Program Director, Section of Oral and Maxillofacial Radiology, Division of Diagnostic and Surgical Sciences, School of Dentistry, University of California-Los Angeles, Los Angeles, CA. Electronic address: smallya@dentistry.ucla.edu.
authors.forename: Sanjay M
authors.initials: SM
authors.lastname: Mallya
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000000981:diagnostic imaging* / Q000473:pathology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging* / Q000473:pathology; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged