Evaluation of Cone-Beam Computed Tomography Scans to Develop a Staging Method of External Carotid Artery Calcification.

Background: The objective of this study was to develop a practical staging method for reporting external carotid artery calcifications (ECACs) using cone-beam computed tomography (CBCT) imaging, specifically to standardize reporting for oral and maxillofacial radiologists. Methods: This retrospective study evaluated 489 CBCT scans for the presence of ECACs. Two calibrated evaluators assessed the scans in all three orthogonal planes, using the axial plane to develop the staging system. Calcifications were graded on a scale from 0 to 5. Results: ECACs were found in 170 out of 489 scans (34.7%). There was a statistically significant increase in ECAC distribution with age progression. The prevalence of ECACs was similar between genders. Grade 1 calcifications were most common in the 51-60 age group, Grade 2 in the 61-70 and 71-80 groups, and Grades 3 and 4 in the 81-90 group. No Grade 5 calcifications were observed in any age group. The inter-rater reliability showed an excellent correlation in the identification and grading of ECACs. Conclusions: The proposed grading system enables oral and maxillofacial radiologists to quantitatively report ECACs, facilitating timely referrals to physicians for further evaluation and early intervention, thereby potentially reducing the risk of cardiovascular events.