Oral Radiology最新文献

Objectives: To evaluate whether quantitative parameters derived from dual-energy computed tomography (DECT), combined with conventional imaging features, can effectively distinguish between ameloblastomas and odontogenic keratocysts (OKCs) with solid components.

Materials and methods: This retrospective analysis evaluated patients with pathologically confirmed ameloblastomas or OKCs who underwent multiphase contrast-enhanced dual-energy CT examinations between January 2020 and July 2024. Quantitative DECT parameters and conventional radiological characteristics were compared. Multivariate analysis identified predictors, and the receiver operating characteristic (ROC) curve assessed performance.

Results: A total of 28 ameloblastomas and 20 OKCs with solid components were evaluated. Ameloblastomas exhibited significantly higher RHO values in the unenhanced, arterial, and venous phases than those in OKCs (p < 0.001 to 0.002), elevated venous-phase Zeff, IC, NIC, and λ_HU (p < 0.001), larger lesion dimensions, greater expansion (p < 0.008), and pronounced bone resorption (p < 0.001). Conversely, OKCs demonstrated significantly higher FAT and DEI values in the unenhanced and venous phases (p < 0.001 to 0.043). Multivariate logistic regression analysis identified that λ_HU (95% confidence interval 1.195-1.807, p < 0.001), NIC (95% CI 1.069-1.262, p < 0.001) in the venous phase, and maximum dimension (95% CI 1.05-1.252, p = 0.002) are independent predictors. A combined model incorporating these parameters demonstrated superior diagnostic performance to differentiate ameloblastomas from OKCs (AUC: 0.963; sensitivity: 85.71%; specificity: 100%).

Conclusions: The combination of DECT quantitative parameters with conventional imaging features significantly improves differentiating ameloblastomas from OKCs with solid components, offering a potential imaging-based diagnostic tool for clinical decision-making.

Objectives: The aim of this study was to evaluate the interproximal surfaces of posterior teeth using panoramic and bitewing radiographs, and to compare the diagnostic accuracy of dental interns with that of an artificial intelligence application.

Methods: Interproximal surfaces were evaluated on 11 panoramic radiographs and 22 bitewing radiographs obtained from 11 patients. The evaluation focused on the presence and depth of caries on interproximal surfaces without restorative fillings, and on the detection of secondary caries and overhanging dental restorations on restored surfaces. Panoramic and bitewing radiographs were evaluated by 20 fourth- and 20 fifth-year dental interns, and CranioCatch.

Results: Bitewing radiographs were significantly more effective than panoramic radiographs in detecting interproximal caries, caries depth, secondary caries, and overhanging restorations (p < 0.001). In the detection of secondary caries on bitewing radiographs, the artificial intelligence application performed worse than both dental intern groups, and this difference was statistically significant (p = 0.033). In determining caries depth on panoramic and bitewing radiographs, the artificial intelligence application yielded numerically higher diagnostic accuracy values compared to the dental intern groups, but these differences were not statistically significant.

Conclusion: Our study concluded that the diagnostic accuracy of the artificial intelligence application in evaluating the interproximal surfaces of posterior teeth was comparable to dental interns.

Artificial intelligence (AI) is rapidly transforming diagnostic imaging, raising important questions about its role as a collaborative tool or a potential replacement for human expertise. This rapid communication reviews current evidence on AI applications in diagnostic imaging, focusing on clinical, ethical, and legal challenges. Although AI models show promise in detecting abnormalities and optimizing workflows, many remain limited by narrow training datasets and lack external validation. Ethical issues such as algorithm transparency, bias, and accountability are discussed, alongside the financial and practical implications of integrating AI tools into clinical practice, highlighting the need for clear guidelines and regulatory oversight. Radiologists continue to play a crucial role in interpreting images and validating AI outputs to avoid diagnostic errors, while the potential risks of overreliance on AI, including erosion of diagnostic skills among clinicians, are also emphasized. This communication advocates for responsible AI implementation that supports, rather than replaces, the expertise and judgment of healthcare professionals.

Objectives: This study investigated the association between the apical surface area measurement (ASAM) of impacted mandibular third molars (IMTM) and chronological age at varying impaction levels, as well as ASAM differences among levels.

Methods: A total of 446 IMTM (227 right, 219 left) from 257 Malaysian patients aged 15.0 to 25.9 years were included and grouped into 0.9-year intervals. All CBCT images were analysed using Mimics and 3-matic software (Materialise NV, Belgium, version 21.0) to calculate the apical surface area. Impaction level was categorised according to the Pell and Gregory classification system. Spearman's correlation and Welch's ANOVA were conducted to assess the relationship between ASAM and age and to compare ASAM across the four levels (A, B, modified B/C, and C). Differences between left and right IMTM were assessed using an independent t-test, and analysed with SPSS (version 26).

Result: ASAM showed an inverse correlation with age (ρ = -0.89, ρ² = 0.79), with a median of 4.86 mm² (IQR: 2.35-11.92). The steepest decline was observed between 17-18 years, followed by a plateau from 21 years onwards. Left and right IMTM were not statistically different (p = 0.53) and subsequently pooled. ASAM increased with impaction depth; however, only level C exhibited significantly larger ASAM than levels A and B (p < 0.001), with an effect size of ω² = 0.13, indicating a notable delay in maturation.

Conclusions: This study demonstrates the relationship between ASAM in IMTM and age, with potential applicability in dental age estimation. However, caution is advised for level C impactions, as the estimated age may be biased.

Objectives: The purpose of this study was to evaluate the impact of X-ray beam angulation and image receptor positioning on the quantification of alveolar bone mineral density (BMD) using intraoral radiographic technique.

Methods: Intraoral radiographs were acquired from four dry mandibular bone specimens, specifically in the region between the first premolar and first molar. An imaging phosphor plate system and a DentalSCOPE alignment device were used. Standard orthoradial projections were compared with images taken at 7° mesial and distal angulations, as well as 5° upward and downward angulations. In addition, radiographs were obtained with the receptor shifted anteriorly from the standard position by 2 mm, 4 mm, 6 mm, and 8 mm. BMD was measured in the alveolar septum between the mandibular second premolar and first molar using a DentalSCOPE image processing program. Statistical analyses were conducted to assess the impacts of projection angle and receptor positioning.

Results: BMD values obtained from mesiodistal and vertical oblique projections were significantly higher than those from the orthoradial view. However, no statistically significant differences were found between mesial and distal or between upward and downward projections. Variations in receptor positioning up to 8 mm anteriorly did not result in significant changes in BMD values.

Conclusions: Oblique radiographic projections tend to overestimate alveolar bone BMD compared to orthoradial projections. Orthoradial imaging provides reliable and reproducible quantitative BMD assessments when using computer-assisted analysis, highlighting its suitability for clinical and research applications.

Objectives: To evaluate the influence of the number of periapical radiographs with different vertical angles of the X-ray beam and the impact of digital enhancement filters on the diagnosis of horizontal root fracture (HRF).

Methods: Twenty-four single-rooted teeth, 12 with HRF and 12 without HRF, composed the sample. For the first evaluation, periapical radiographs of the teeth were acquired individually with the VistaScan^® system, using three vertical angulations of the X-ray beam (orthoradial, plus 15°, and minus 15°), which were arranged in different image files containing one, two, or three radiographs with different angulations of the same tooth. For the second evaluation, six image enhancement filters from the DBSWIN^® software were applied to the orthoradial radiographs. For all evaluations, five examiners verified the presence of HRF using a 5-point scale. Weighted kappa was used to calculate intra- and inter-examiner reproducibility. Diagnostic values were compared between the conditions by one-way ANOVA (α = 0.05).

Results: The area under the receiver operator curve, sensitivity, and negative predictive values were lower when HRF was diagnosed with only one radiograph (p < 0.05) compared to two or three radiographs, which did not differ among themselves (p > 0.05). There were no differences between the images evaluated in different filter conditions (p > 0.05). Intra- and inter-examiner agreement ranged from moderate to almost perfect and fair to substantial, respectively.

Conclusions: Evaluation of two radiographs with different vertical angulations improves the diagnosis of HRF and is recommended. The use of VistaScan^® system image enhancement filters does not influence this diagnosis.

Objectives: Bone destruction adjacent to salivary gland tumors has been regarded as an indirect sign of malignancy. This scoping review explores possible bone changes due to head and neck pleomorphic adenoma and identifies risk factors for bone destruction.

Methods: Articles on bone alterations in head and neck pleomorphic adenoma were searched online using PubMed, Scopus and Scholar, according to PRISMA-ScR guidelines. Only histopathologically confirmed pleomorphic adenomas were included. Extracted data were age, gender, location and size of tumor, duration of symptoms, type of bone erosion and recurrency status.

Results: The search resulted in 145 pleomorphic adenomas with adjacent bone alterations. The majority caused expansile bone changes, such as cortex erosion (61.4%) and scalloping (31.0%). Extensive bone destruction was reported in 11 cases (full thickness erosion in 3.4% and bone marrow invasion in 4.1%). Significant risk factors for aggressive bone destruction were tumor size and duration of symptoms (OR = 1.08; 95% CI 1.02-1.14 and OR = 1.03; 95% CI 1.00-1.05).

Conclusions: Although mostly bone erosion or scalloping is observed, larger or longstanding pleomorphic adenomas have the capacity of developing more extensive bone destruction, without malignant transformation. However, bone destruction is very rare in pleomorphic adenoma and more likely indicates the presence of malignancy.

Objective: To assess the influence of enhancement filters on the diagnosis of proximal caries lesions in radiographs obtained with a handheld X-ray unit.

Methods: Radiographs of 40 human teeth exhibiting white spots or enamel discolorations were obtained with an Eagle X-ray handheld unit (Alliage, São Paulo, Brazil) configured at 2.5 mA, 60 kVp, and 0.45 s of exposure time. Two digital imaging systems (VistaScan and Digora Toto) were used for radiographic acquisition. A total of 12 enhancement filters--six available in each system--were applied to the radiographs. A total of five dentomaxillofacial radiologists blinded to the filtering condition independently evaluated the radiographs for the presence of caries lesions using a 5-point scale. The area under the receiver operating characteristic curve, sensitivity, and specificity were determined based on the examiners' responses and were compared across the filters tested using one-way analysis of variance, with a significance level of 5%. The weighted Kappa index was used to assess both intra- and inter-examiner agreements in the diagnosis of proximal caries lesions.

Results: Applying the enhancement filters tested did not influence the diagnostic metrics of proximal caries lesions in radiographs obtained using a handheld X-ray unit (p > 0.05). While the intra-examiner agreements were substantial, the inter-examiner agreements ranged from fair to moderate.

Conclusions: The enhancement filters available in the VistaScan and Digora Toto digital systems did not impact the diagnostic accuracy of proximal caries lesions in radiographs obtained using a handheld X-ray unit. Therefore, clinicians can apply these filters based on personal preference without compromising diagnostic reliability.

Pseudoankylosis of the temporomandibular joint (TMJ) is a rare condition causing restricted mandibular movement without true osseous fusion. This case report presents an 85-year-old woman with TMJ pseudoankylosis secondary to chronic inflammation, a unique etiology for pterygomandibular fusion. The patient exhibited limited mouth opening, swelling, and tenderness in the left facial region. Imaging revealed an enlarged left condyle and hypertrophic lateral pterygoid plate in close approximation, consistent with pterygomandibular impingement. Conservative management was chosen due to the patient's age and comorbidities. This case contributes to the limited literature on pterygomandibular fusion and expands our understanding of TMJ pseudoankylosis in geriatric patients with chronic inflammation.

Objective: Lack of Hounsfield Unit (HU) accuracy leads to misrepresentation of tissue densities and causes image artifacts in dental cone beam computed tomography (CBCT) images. This work investigates the improvement in HU accuracy in dental CBCT by suppressing scatter with a novel two-dimensional anti-scatter grid (2D ASG) approach.

Methods: A 2D ASG prototype was developed and integrated into an experimental CBCT system, emulating dental CBCT geometry. CBCT scans were acquired using a multidetector CT (MDCT), a clinical dental CBCT, and the proposed 2D ASG-based experimental CBCT system. Subsequently, HU accuracy, nonuniformity, and contrast-to-noise ratio (CNR) were evaluated in image quality phantoms benchmarked against MDCT images. The effect of scatter suppression on the implant-induced HU degradation was also studied.

Results: 2D ASG reduced scatter content up to a factor of 6.6 in CBCT scans and HU nonuniformity in soft tissue-like regions was reduced from 23 to 4 HU. HU errors in high-density structures were within 65 HU of values measured in the gold standard MDCT images. Robust scatter suppression also reduced streak artifacts caused by implants. CNR increased up to 47% in images acquired with the 2D ASG.

Conclusion: HU accuracy in dental CBCT may reach the accuracy of MDCT with the proposed 2D ASG. Moreover, artifacts are reduced, and contrast visualization can be improved. Hence, this approach may enable a more accurate assessment of tissue densities in CBCT images, and improved image quality may positively impact the diagnostic capabilities of dental CBCT systems.