Imaging Sci Dent.  2018 Jun;48(2):121-125. 10.5624/isd.2018.48.2.121.

Is the diagnosis of calcified laryngeal cartilages on panoramic radiographs possible?

Affiliations
  • 1Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Hacettepe University, Ankara, Turkey. lbartvinli@yahoo.com

Abstract

PURPOSE
Detecting laryngeal cartilages (triticeous and thyroid cartilages) on panoramic radiographs is important because they may be confused with carotid artery calcifications in the bifurcation region, which are a risk factor for stroke. This study assessed the efficiency of panoramic radiography in the diagnosis of calcified laryngeal cartilages using cone-beam computed tomography (CBCT) as the reference standard.
MATERIALS AND METHODS
A total of 312 regions (142 bilateral, 10 left, 18 right) in 170 patients (140 males, 30 females) were examined. Panoramic radiographs were examined by an oral and maxillofacial radiologist with 11 years of experience. CBCT scans were reviewed by 2 other oral and maxillofacial radiologists. The kappa coefficient (κ) was calculated to determine the level of intra-observer agreement and to determine the level of agreement between the 2 methods. Diagnostic indicators (sensitivity, specificity, accuracy, and false positive and false negative rates) were also calculated. P values < .05 were considered to indicate statistical significance.
RESULTS
Eighty-two images were re-examined to determine the intra-observer agreement level, and the kappa coefficient was calculated as 0.709 (P < .05). Statistically significant and acceptable agreement was found between the panoramic and CBCT images (κ=0.684 and P < .05). The sensitivity, specificity, diagnostic accuracy rate, the false positive rate, and the false negative rate of the panoramic radiographs were 85.4%, 83.5%, 84.6%, 16.5%, and 14.6%, respectively.
CONCLUSION
In most cases, calcified laryngeal cartilages could be diagnosed on panoramic radiographs. However, due to variation in the calcifications, diagnosis may be difficult.

Keyword

Laryngeal Cartilages; Diagnostic Imaging, Panoramic Radiography, Cone-Beam Computed Tomography

MeSH Terms

Carotid Arteries
Cone-Beam Computed Tomography
Diagnosis*
Humans
Laryngeal Cartilages*
Male
Radiography, Panoramic
Risk Factors
Sensitivity and Specificity
Stroke
Thyroid Gland

Figure

  • Fig. 1 A panoramic radiograph reveals small, ill-defined opacities below the greater horn of the hyoid on the right side, while calcification is demonstrated in the carotid region on cone-beam computed tomographic images.

  • Fig. 2 A panoramic radiograph reveals small, ill-defined opacities below the greater horn of the hyoid on the right side, while calcified laryngeal cartilages are demonstrated on cone-beam computed tomographic images.

  • Fig. 3 Axial maximum intensity projection of the patient in Figure 1 shows the location of the opacity. This image demonstrates calcification in the carotid region.

  • Fig. 4 Axial maximum intensity projection of the patient in Figure 2 shows the location of the opacity. This image demonstrates calcified laryngeal cartilages. Calcified laryngeal cartilages can be differentiated from calcification in the carotid region because they are medial to the greater horn of the hyoid bone.


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