Opportunistic Assessment of Dental Pathologies in Cervical Computed Tomography Angiography: A Proof of Concept Study

Computed tomography angiography (CTA) of the head and neck routinely encompasses dentoalveolar structures within the field of view, yet dental findings are rarely reported. Opportunistic detection of dental pathologies could provide valuable information for patient management. This feasability study evaluated the diagnostic potential of CTA for identifying common dental pathologies compared with panoramic radiography (orthopantomogram, OPG).

Fifty-seven patients (39% female, mean age: 63 years), who underwent both OPG and head-and-neck CTA within 100 days were retrospectively included. Three experienced dental radiological examiners independently assessed each tooth for periapical radiolucencies, periodontal bone lesions, carious lesions, root residues, retained teeth, and dental implants in cervical CTA and vascular kernel. Cohen's κ and Fleiss' κ were calculated to determine intra- and inter-rater-intramodality agreement between OPG and CTA findings.

CTA demonstrated good intermodality agreement with OPG regarding the detection of periapical lesions and periodontal bone defects, root canal-filled, retained teeth, and root residues (κ = 0.60-0.98). Carious lesions demonstrated moderate concordance. OPG identified more periodontal bone defects (mean number of detections per rater: CTA: 141.3; OPG: 173) and carious lesions (CTA: 48; OPG: 77; both p < 0.001).

This systematic comparison of CTA and OPG demonstrated the feasability of CTA for opportunistic screening of dental status. While CTA can not replace dedicated dental imaging and clinical assessment, integrating dental evaluation into CTA interpretation may support early detection of oral infection sources and streamline interdisciplinary patient management in neurovascular imaging workflows.