Association between extra- and intracranial calcifications of the internal carotid artery: a CBCT imaging study

Can convolutional neural networks identify external carotid artery calcifications?

OBJECTIVE

We developed and evaluated the accuracy and reliability of a convolutional neural network (CNN) in detecting external carotid artery calcifications (ECACs) in cone beam computed tomography scans.

STUDY DESIGN

Using TensorFlow, we developed a program to identify calcification in 427 cone beam computed tomography scans evaluated to determine the presence of ECACs. We compared the results to the findings of a human evaluator. Using an 80:20 training-to-validation ratio, we calculated the k-fold cross-validation accuracy of the initial dataset and extrapolated the F1 score and Matthews Correlation Coefficient.

RESULTS

We calculated a k-fold cross-validation accuracy of 76%, with a recall and precision of 66% and 79%, respectively, and a combined F1 score of 0.72. We extrapolated a Matthews correlation coefficient of 0.53, showing a strong balance between confusion matrix categories.

CONCLUSION

Our CNN model can reliably identify ECACs in cone beam computed tomography scans.

Risk factors associated with hemorrhagic cerebrovascular accident: A cross-sectional study in patients from a hospital in Peru

In Peru, cardiovascular accidents (CVA) cause around 15% of premature death, with an increase in CVA due to the prevalence of risk factors for CVA in the Peruvian population. Hemorrhagic CVA presents higher mortality compared to ischemic. This research aimed to identify the risk factors associated with hemorrhagic CVA. We carried out a retrospective cross-sectional study using the medical records of patients with a diagnosis of CVA treated at the Regional Hospital of Ica during the years 2018 and 2019. Independent variables included age, sex, type 2 diabetes, dyslipidemia, hypertension, smoking, obesity, and intracranial carotid artery calcification. To identify factors associated with an increased probability for hemorrhagic CVA compared to ischemic CVA, a generalized linear model with logit link and binomial family, obtaining the odds ratio (OR) and its 95% confidence interval (CI). we evaluated the data from 132 patients. Of them, 46 (34.85%) had hemorrhagic CVA. Only systolic blood pressure (OR: 1.04; 95% CI: 1.02-1.06) and hypertension (OR: 0.29; 95% CI: 0.10-0.89) were significantly associated with hemorrhagic CVA compared to ischemic CVA. Hypertension is associated with hemorrhagic CVA compared to ischemic CVA. These results are consistent with the literature.

Evaluation of the Prevalence of Atherosclerosis Within the Course of Internal Carotid Artery in Cone Beam Computed Tomography Images

The aim of the present study was to retrospectively evaluate the gender-related and age-related prevalence and severity of calcifications within the segments of the internal carotid artery in cone beam computed tomography (CBCT). By using a documented visual scale, out of 400 CBCT examinations a total of 304 CBCT scans of adult patients over 40 years old were evaluated as to the prevalence and severity of intracranial calcifications within the segments of the internal carotid artery. Calcifications were found in 117 CBCT scans. These calcifications were detected along the extracranial (C1: 53%), petrous (C2: 22.2%), Lacerum (C3:27%), cavernous (C4: 94%), and ophthalmic-clinoid (C5/C6: 65%) segments. The Friedman test showed significant differences in the severity of calcifications among the internal carotid artery segments. The McNemar test showed no significant differences between calcifications on the right or left side segments. The Chi square test showed no significant differences in the prevalence of calcifications between men and women; it also showed that the prevalence of calcifications increased with increase in age (P < 0.05). In this study, the frequency and severity of calcifications decreased throughout the C4, C5/C6, and C1 segments in a descending order; moreover, an increased incidence of calcifications by increase in age was documented irrespective of gender.

Evaluation of the Incidental Prevalence of Soft Tissue Calcifications in the Neck Region with Cone Beam Computed Tomography

Objective: The aim of this study was to retrospectively evaluate the incidental prevalence of heterotopic soft tissue calcifications in the neck region, on Cone Beam Computed Tomography (CBCT) images, and their relationship with age and sex. Methods: A total of 6620 CBCT images were examined. CBCT images of 503 patients aged between 20 and 86 years were included in the study. Patients were grouped into five age groups: 20-30 (N = 132), 31-40 (N = 68), 41-50 (N = 92), 51-60 (N = 104), and 61 and above (N = 107). The images were assessed according to the presence of lymph node calcification, carotid artery calcification, thyroid cartilage, and triticeous cartilage calcification in the neck region. Descriptive statistics, crosstabs, and chi-square tests were used for data analysis. The significance level was set to 0.05 Results: At least one calcification was detected in 372 (73.9%) patients. The difference between the prevalence of each calcification according to age groups was statistically significant. A significant relationship was found between the presence of carotid artery calcification and the sex variable (p< .05). The presence of other calcifications did not show statistically significant differences associated with sex (p> .05). Conclusion: The results of this study showed a significant amount of soft tissue calcification in the neck region. The most common calcifications were thyroid cartilage calcifications, and the least common calcification was lymph node calcification.

Assessment of posterior tilting of the hyoid bone in relation to carotid atherosclerosis: a CBCT study

Aim: The present study aimed to investigate whether the presence and areal and volumetric measurements of the unilateral extra-cranial carotid artery calcifications (ECACs) are associated with posterior tilting of the hyoid bone. Material and Method: A total of 658 cone-beam computed tomography (CBCT) scans were screened for the presence of ECACs. The calcifications were categorized as unilateral (right or left) or bilateral. Study group was consisted of cases with unilateral ECACs. A control group without ECACs matching with study group by age and gender was created. Volumetric and areal measurements in the ECAC group were done by using Mimics Medical software. Posterior tilting of the hyoid bone in relation to mid-sagittal plane and the dimension of posterior inclination through the greater horns were measured on i-Cat Vision software. Results: In total, 71 (10.8%) ECACs (30 bilateral and 41 unilateral) were detected. Study group consisted of 41 (6.2%) unilateral ECAC cases [25 (61%) females and 16 (39%) males]. Gender and age distributions were similar between ECAC and control groups. No significant difference between two groups was found considering the prevalence of posterior tilting of the hyoid bone (63.4% vs. 43.9%, p=0.240). Similarly, there was no significant difference in the mean dimension of posterior inclination between groups (2.48±2.12 mm. vs. 2.24±1.47 mm, p=0.646). The volume and areal measurements of calcifications were not correlated with the dimension of posterior inclination of the hyoid bone. Conclusion: Posterior tilting of the hyoid bone may be a frequent finding in cases of unilateral ECAC. However, the present findings suggest that no significant relationship exists between the presence of unilateral ECACs and posterior tilting of the hyoid bone.

Comparison of Intracranial and Extracranial Carotid Artery Calcifications between Obstructive Sleep Apnea Patients and Healthy Individuals: A Combined Cone-Beam Computed Tomography and Polysomnographic Study

Purpose

This study aimed to compare the presence and grades of intra- and extracranial carotid artery calcifications between obstructive sleep apnea (OSA) and non-OSA patients.

Methods

CBCT records of 190 patients (95 OSA patients and 95 non-OSA patients) were retrospectively collected and analyzed. Patient demographic data, including age and gender for both study groups and body mass index (BMI), and apnea-hypopnea index (AHI) for OSA patients were recorded. The presence of intra- and extracranial carotid artery calcifications and the number of calcifications were noted according to the grading scale.

Results

There was a significant difference in carotid artery calcifications between OSA patients and healthy individuals. A total of 56.8% of the OSA patients showed at least one carotid artery calcification, whereas 13.8% of healthy individuals showed at least one carotid artery calcification (p < 0.05). For intracranial calcifications, OSA patients showed a significantly higher prevalence than healthy individuals (p < 0.05). The results showed that as the apnea-hypopnea index increases in OSA patients, the incidence of carotid artery calcification increases simultaneously. AHI > 30 patients showed the highest percentage of calcifications.

Conclusion

In conclusion, OSA patients showed a higher prevalence of calcified carotid artery calcifications than healthy individuals. The results can be interpreted as the higher AHI, the more carotid artery calcification occurs. As these lesions can be a precursor of future strokes, 3D MDCT/CBCT images should evaluate meticulously not only extracranial but also intracranially, especially in OSA patients.

Craniocervical Junction Visualization and Radiation Dose Consideration Utilizing Cone Beam Computed Tomography for Upper Cervical Chiropractic Clinical Application a Literature Review

Objectives

To highlight the detail obtained on a Cone Beam Computed Tomography (CBCT) scan of the craniocervical junction and its usefulness to Chiropractors who specialize in the upper cervical spine. A review of the dose considerations to patients vs radiography in a chiropractic clinical setting and to review the effective radiation dose to the patient.

Methods

A review of studies discussing cervical biomechanics, neurovascular structures, and abnormal radiographic findings, was discussed in relation to chiropractic clinical relevance. Further studies were evaluated demonstrating radiation dose to the patient from radiographs compared to CBCT.

Results

Incidental and abnormal findings of the craniocervical junction were shown to have superior visualization with CBCT compared to radiography. The radiation dose to the patient for similar imaging protocols to the craniocervical junction and cervical spine was equal or less utilizing CBCT when compared to radiographs.

Conclusions

The use of CBCT for visualization of the craniocervical junction and cervical spine in the chiropractic clinical setting allows for adjunctive visualization of the osseous structures which is germane to clinical protocol. Further with CBCT the effective dose to the patient is equal or less than similar imaging protocols utilizing radiographs to evaluate the craniocervical junction.

Association between internal carotid artery calcifications detected as incidental findings and clinical characteristics associated with atherosclerosis: A dental volumetric tomography study

PURPOSE

To evaluate the presence of calcifications in the internal carotid artery (ICA) in cone-beam computed tomography (CBCT), and to verify the association of these findings with sex, age, dental condition, and risk factors associated with vascular disorders.

METHODS

The CBCT scans used in this study were obtained from the database of a private dental clinic requested for the planning of rehabilitation with dental implants. The selection criteria were patients aged 40 years and above. Out of a pool of 1176 CBCT examinations, a total of 284 scans of adult patients were evaluated by two blinded observers. Data were collected from patients' medical records.

RESULTS

ICA calcifications were present in 63.0% of the examinations. Most calcifications were in the intracranial pathway (166). Despite being present in a smaller number 57 (C1), extracranial calcifications were more severe. Spearman's ρ coefficients (rS) indicated that the number of missing teeth was directly associated with the presence of calcifications (p = 0.042) and severity (p = 0.020). The age variable also had a direct relationship with the presence of calcifications (p ≤ 0.0001), increasing its frequency and severity over the years. In addition, hypertension (p = 0.036) and use of antihypertensive drugs (p = 0.015) were directly associated.

CONCLUSIONS

There is a high occurrence of ICA calcifications in CBCT as incidental findings in adult patients, and it is directly associated with age, number of missing teeth and hypertension.

Association between Periodontitis and Carotid Artery Calcification: A Systematic Review and Meta-Analysis

Recent studies have supported the relationship between periodontitis and carotid artery calcification (CAC), but still uncertain. This systematic review is aimed at evaluating the association between periodontitis and CAC. The search was conducted in four electronic databases: PubMed, EMBASE, Web of Science, and The Cochrane Library, supplemented by checking references of included articles and related review articles. Eligibility assessment and data extraction were conducted independently. The quality assessment and publication bias analysis were performed. The association between periodontitis and CAC was presented in odd ratio (OR) with 95% confidence interval (CI). Additional outcomes included the percentage of alveolar bone loss in CAC versus non-CAC. Twelve studies were included, and 10 were performed quantity analysis. Periodontitis with secure definition (OR = 2.02, 95%CI = 1.18 - 3.45) and insecure definition (OR = 10.78, 95%CI = 4.41 - 26.34) was associated with CAC. And a higher average percentage of alveolar bone loss (weighted mean difference = 10.84%; 95%CI = 6.40 - 15.48) was also observed in CAC patients compared to non-CAC patients. No significant publication bias was found. The results of this systematic review and meta-analysis revealed a significant relationship between periodontitis and CAC.

Dual Energy Computed Tomography of Internal Carotid Artery: A Modified Dual-Energy Algorithm for Calcified Plaque Removal, Compared With Digital Subtraction Angiography

Background: Atherosclerotic disease of the internal carotid artery (ICA) is a common reason for ischemic stroke. Computed tomography angiography (CTA) is a common tool for evaluation of internal carotid artery (ICA) stenosis. However, blooming artifacts caused by calcified plaques might lead to overestimation of the stenosis grade. Furthermore, the intracranial ICA is more vulnerable to calcification than other ICA segments. The proposed technique, dual-energy computed tomography (DECT) with a modified three-material decomposition algorithm may facilitate the removal of calcified plaques and thus increase diagnostic accuracy.

Objectives: The objective of the study is to assess the accuracy of the modified three-material decomposition algorithm for grading intracranial ICA stenosis after calcified plaque removal, with digital subtraction angiography (DSA) used as a reference standard.

Materials and Methods: In total, 41 patients underwent DECT angiography and DSA. The three-material decomposition DECT algorithm for calcium removal was applied. We evaluated 64 instances of calcified stenosis using conventional CTA, the previous non-modified calcium removal DECT technique, the modified DECT algorithm, and DSA. The correlation coefficient (r²) between the results generated by the modified algorithm and DSA was also calculated.

Results: The virtual non-calcium images (VNCa) produced by the previous non-modified calcium removal algorithm were named VNCa 1, and those produced by the modified algorithm were named VNCa 2. The assigned degree of stenosis of VNCa 1 (mean stenosis: 39.33 ± 19.76%) differed significantly from that of conventional CTA images (mean stenosis: 59.03 ± 25.96%; P = 0.001), DSA (13.19 ± 17.12%, P < 0.001). VNCa 1 also significantly differed from VNCa 2 (mean stenosis: 15.35 ± 18.70%, P < 0.001). In addition, there was a significant difference between the degree of stenosis of VNCa 2 and conventional CTA images (P < 0.001). No significant differences were observed between VNCa 2 and DSA (P = 0.076). The correlation coefficient (r²) between the stenosis degree of the VNCa 2 and DSA images was 0.991.

Conclusions: The proposed DECT with a modified three-material decomposition algorithm for calcium removal has high sensitivity for the detection of relevant stenoses, and its results were more strongly correlated with DSA than with those of conventional CTA or the previous non-modified algorithm. Further, it overcomes CTA's previous problem of overestimating the degree of stenosis because of blooming artifacts caused by calcified plaques. It is useful to account for calcified plaques while evaluating carotid stenosis.

Incidental Findings in Cone Beam Computed Tomography for Dental Implants in 1002 Patients

PURPOSE

The purpose of this study is to analyze the frequency and elevate the awareness of the prevalence of nondental pathology in cone beam computed tomography (CBCT) scans taken for implant placement treatment planning and postplacement evaluation. The data from the CBCT should be read by an oral and maxillofacial radiologist for proper diagnosis of dental and nondental pathology and referred to the medical specialist for proper management when necessary.

MATERIALS AND METHODS

This retrospective study analyzed 1002 consecutive CBCT scans taken at a single private practice noting the prevalence of nondental pathology in CBCT images for all dental implant procedures. All scans were taken from November 2007 to March 2020. One board certified oral and maxillofacial radiologist systemically read all scans and reported all findings in the maxilla and mandible, condyles and TMJ, paranasal sinuses, nasal fossa, pharyngeal airway, skull base and temporal bone, neck soft tissues, and cervical spine. The incidental findings, variation of normal anatomy, or pathology reported in these structures were categorized based on anatomic location and significance and the incidence was investigated.

RESULTS

Pathologies ranged from innocuous sinusitis, to more serious atherosclerotic calcification of the carotid arteries, narrowed airways, and neoplastic lesions. Fifty-one different findings were noted, of which 36 were pathologies that required referral or follow-up.

CONCLUSIONS

Incidental findings can be detected in CBCT scans for dental implants. The clinician must be familiar with the radiographic diagnosis of head and neck pathology, and/or must refer these images to an appropriate specialist for the radiographic interpretation of the full volume.

Association between intracranial carotid artery calcifications and periodontitis. Cone-beam computed tomography (CBCT) study

BACKGROUND

Intracranial carotid artery calcifications (ICACs) are one type of calcification that may be detected as incidental findings in cone-beam computed tomography (CBCT). This retrospective study aimed to examine the prevalence of ICACs on CBCT images and their associations among age, gender, chronic periodontitis, and patient-reported cardiovascular diseases (CVDs).

METHODS

A total of 303 CBCT scans were reviewed and a total of 208 patients met the inclusion criteria. The presence or absence of ICACs was evaluated in the ophthalmic and cavernous segments of each scan. Patient demographic data, including age, gender, and medical history, specifically focused on CVDs were recorded. The presence or absence of periodontitis was recorded from each subject with full mouth radiographs and clinical measurements. Odds ratios (ORs) were calculated as part of the logistic regression analysis.

RESULTS

Overall, ICACs were found in 93 subjects (45%). The bilateral ICACs were found in 43 subjects (21% of the total subjects, 46% of the subjects with ICACs). There were statistically significant associations between presence of ICACs and periodontitis (OR = 4.55), hypertension (OR = 3.02), hyperlipidemia (OR = 2.87), increasing age (OR = 2.24), and the male gender (OR = 1.85). Smoking status was not significantly correlated with ICACs.

CONCLUSION

This study revealed that nearly half (45%) of the subjects displayed ICACs on the CBCT images. ICACs are significantly related to the status of chronic periodontitis, age, gender, and CVDs. A more careful review of CBCT scans is highly recommended to detect these calcifications and refer patients for further medical evaluation.

Assessment of relationship between extracranial and intracranial carotid calcifications-a retrospective cone beam computed tomography study

OBJECTIVES

Cone beam CT scans in current day dental practice are highly collimated yet involve areas along the course of the extracranial carotid artery. Detecting an extracranial carotid calcification on small volume scans leaves the dentist with two questions: whether the patient is likely to have intracranial carotid calcifications and whether the patient warrants further medical attention. This study aimed to assess the presence of intracranial carotid artery calcifications (ICAC) in the presence of extracranial carotid artery calcifications (ECAC).

METHODS

450 CBCT scans were retrospectively evaluated for ECAC and ICAC. Erby et al's classification was modified to classify calcifications as mild, moderate, and severe. The presence of ICAC when ECAC were present was evaluated in all three orthogonal planes. The risk of ICAC in the presence of ECAC was calculated as odds ratio and the association between the two was calculated using a χ² test.

RESULTS

The odds ratio for bilateral ICAC in the presence of bilateral ECAC was 15.09. The odds ratio for left ICAC/right ICAC in the presence of left/ right ECAC was 0.833 and 2.564, respectively. The number and severity of calcifications increased with age. The χ² test showed that there was a strong association (p < 0.001) between bilateral ECAC with bilateral ICAC.

CONCLUSIONS

The results of this group of patients showed that there is an increased presence of ICAC in the presence of ECAC.

Carotid canal and optic canal at sphenoid sinus

In the present study, we investigated the relationship between sphenoid sinus, carotid canal, and optic canal on paranasal sinus computed tomography (PNSCT). This study was performed retrospectively. PNSCT images of 300 adult subjects (159 male, 141 female). Sphenoid sinus (pneumatisation, dominancy, septation, inter-sinus septa deviation), anterior clinoid process pneumatisation, Onodi cell, carotid and optic canals (width, dehiscence, classification) were measured. In males, type 3 pneumatised sphenoid sinus (in both sides) and in females type 2 pneumatised sphenoid sinus (right side) and type 3 pneumatised sphenoid sinus (left side) were detected more. Anterior clinoid pneumatisation was present 47.2% in males and 39.7% in females. In male group, more septation (i.e. 22.6%, ≥ 3 septa) in sphenoid sinus were detected. Onodi cell was present 26.6 and 19.1% in males and females, respectively. Carotid canal protrudation to the sphenoid sinus wall was present 23.9-32.1% in males and 35.5-36.2% in females. Dehiscence in carotid canal was detected more in females (34%) compared to males (22%). Optic canal protrudation was 33.3 and 30.5% in males and females. Type 4 optic canal was detected more in both gender. Optic canal dehiscence was detected 11.3 and 9.9% in males and females. Carotid and optic canal diameters were higher in males. In pneumatised sphenoid sinuses and in females, type 3 carotid canal (Protrudation to SS wall) (bilaterally) and type 1 optic canal type (No indentation) (ipsilateral side) were detected more. In elderly patients, carotid and optic canal width increased. When carotid canal protrudation was detected, there was no indentation in optic canals In pneumatised SS, carotid canal protrudation was observed with a greater risk in surgery. However, type 1 (non indentation) optic canal was present in highly pneumatised SS with lower risk for the surgery. In women, the risk of carotid canal protruding (about 1/3) is greater than that of males, and carotid canal dehiscence rates are also higher in females. Therefore, physicians should be very careful during the preparatory stages of the sphenoid sinus surgery. Otherwise, it may not be possible to prevent lethal carotid artery bleeds.

Prevalence of Soft Tissue Calcifications in CBCT Images of Mandibular Region

STATEMENT OF THE PROBLEM

Most of the soft tissue calcifications within the head and neck region might not be accompanied by clinical symptoms but may indicate some pathological conditions.

PURPOSE

The aim of this research was to determine the prevalence of soft tissue calcifications in cone beam computed tomography (CBCT) images of mandibular region.

MATERIALS AND METHOD

In this cross sectional study the CBCT images of 602 patients including 294 men and 308 women with mean age 41.38±15.18 years were evaluated regarding the presence, anatomical location; type (single or multiple) and size of soft tissue calcification in mandibular region. All CBCT images were acquired by NewTom VGi scanner. Odds ratio and chi-square tests were used for data analysis and p< 0.05 was considered to be statistically significant.

RESULTS

156 out of 602 patients had at least one soft tissue calcification in their mandibular region (25.9%. of studied population with mean age 51.7±18.03 years). Men showed significantly higher rate of soft tissue calcification than women (30.3% vs. 21.8%). Soft tissue calcification was predominantly seen at posterior region of the mandible (88%) and most of them were single (60.7%). The prevalence of soft tissue calcification increased with age. Most of the detected soft tissue calcifications were smaller than 3mm (90%).

CONCLUSION

Soft tissue calcifications in mandibular area were a relatively common finding especially in posterior region and more likely to happen in men and in older age group.

Treatment and imaging of intracranial atherosclerotic stenosis: current perspectives and future directions

BACKGROUND AND PURPOSE

Intracranial atherosclerosis is a common cause of stroke worldwide. It results in ischemic stroke due to different mechanisms including artery-to-artery embolism, in situ thrombo-occlusion, occlusion of perforating arteries, and hemodynamic failure. In this review, we present an overview of current treatment and imaging modalities in intracranial atherosclerotic stenosis.

METHODS

PubMed was searched for relevant articles in English that evaluated the treatment and imaging of intracranial atherosclerotic stenosis (ICAS).

RESULTS

Aggressive medical management, consisting of dual antiplatelet therapy and intensive risk factor management, is important in patients with ICAS because of a substantial risk of recurrent stroke, approximately 20% in the first year, in patients on aspirin or warfarin alone. Recent trials have suggested that, aggressive medical therapy results in better outcome as compared with intracranial stenting. However, the question remains what the optimal treatment strategy would be in patients with recurrent strokes in the setting of failed aggressive medical therapy. Moreover, controversy exists whether a subgroup of patients with symptomatic ICAS could benefit from intracranial stenting if selection is based on radiological evidence of hemodynamic failure. With regard to imaging, transcranial Doppler ultrasound and magnetic resonance angiography are useful screening tests for exclusion of ICAS, but need confirmation by other imaging modalities when stenosis is suggested. Computed tomography angiography has a high positive and negative predictive value for detection of intracranial luminal stenosis of 50% or higher, but performs worse than digital subtraction angiography with regard to establishing the exact degree of luminal stenosis. Novel imaging techniques including high-resolution CT and MRI better identify plaque characteristics than conventional imaging methods.

CONCLUSIONS

Currently, aggressive medical management remains the standard of care for patients with ICAS. Further research is needed to identify high-risk subgroups and to develop more effective treatments for ICAS patients.

The presence of calcifications along the course of internal carotid artery in Greek and Brazilian populations: a comparative and retrospective cone beam CT data analysis

OBJECTIVES

We aimed to retrospectively compare the prevalence of soft tissue calcifications (STCs) depicted incidentally along the extra- and intracranial course of the internal carotid artery (ICA) on cone beam computed tomography examinations in 2 different populations (Greeks and Brazilians).

METHODS

The cohort consisted of examinations of 232 Greeks and 174 Brazilians, for a total of 406 patients. The scans were evaluated for the presence of STCs along the course of the ICA, with data analyzed in each ethnic group according to gender and age criteria.

RESULTS

In total, 355 STCs were recorded; 78 (22.0% of all STCs) and 58 (16.3%) were extracranials, and 128 (36.1%) and 91 (25.6%) were intracranials for Greeks and Brazilians, respectively. The χ(2) test indicated no statistical differences between Greeks and Brazilians in the occurrence of STCs; however, their prevalence differed between genders in those populations. The presence of lesions, both extra- and intracranially, was found to increase with age (P < .05). The odds ratios were estimated at 2.23 (95% CI, 1.81-2.74) and 3.26 (95% CI, 2.56-4.16) for extracranial and intracranial lesions, respectively, with increasing age.

CONCLUSIONS

We found an equal distribution for both extra- and intracranial STCs among Greeks and Brazilians. The prevalence of lesions differed between genders within both populations. Aging was found to be a risk factor for STCs, as the odds ratio increased significantly.