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Assessment of Apical Periodontitis by MRI: a Feasibility Study Vergleich Von MRT Und DVT Bei Der Diagnose Von Periapikalen Osteolysen

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Assessment of Apical Periodontitis by MRI: a Feasibility Study Vergleich Von MRT Und DVT Bei Der Diagnose Von Periapikalen Osteolysen Head/Neck 269 Assessment of Apical Periodontitis by MRI: A Feasibility Study Vergleich von MRT und DVT bei der Diagnose von periapikalen Osteolysen Authors M. A. Geibel1, E. S. Schreiber2, A. K. Bracher2, E. Hell3, J. Ulrici3, L. K. Sailer4, Y. Ozpeynirci5, V. Rasche2 Affiliations 1 Oral and Maxillofacial Surgery, Ulm University, Ulm 2 Internal Medicine II, Ulm University, Ulm, Germany 3 Dental Imaging, Sirona Dental Systems GmbH, Bensheim, Germany 4 MKG, DOC Praxisklinik im Wiley, Neu-Ulm, Germany 5 Diagnostic and Interventional Radiology, Ulm University, Ulm, Germany Key words Zusammenfassung Abstract ●" head/neck ! ! ●" diagnostic radiology Ziel: Das Ziel dieser klinischen Machbarkeits- Purpose: The purpose of this clinical feasibility ●" MR imaging studie war die Untersuchung der Darstellbarkeit study was to evaluate the applicability of magnet- ●" radiography periapikaler Osteolysen mittels der Magnetreso- ic resonance imaging (MRI) for the assessment of ●" apical periodontitis ●" dental MRI nanztomografie (MRT) im direkten Vergleich mit apical periodontitis in direct comparison with ●" cone beam computed der digitalen Volumentomografie (DVT). cone beam CT (CBCT). tomography Material und Methoden: In die Studie wurden 19 Materials and Methods: 19 consecutive patients Patienten (Durchschnittsalter 43 ± 13 Jahre) mit 34 (average age 43 ± 13 years) with 34 lesions in total periapikalen Osteolysen eingeschlossen. Die Läsio- (13 molars, 14 premolars and 7 front teeth) were nen wurden radiologisch befundet als periapikale enrolled in this feasibility study. Periapical lesions Osteolysen (DVT) oder als knöcherne Destruktion were defined as periapical radiolucencies (CBCT) in der Spongiosa (MRT), die eine Lagebeziehung or structural changes in the spongy bone signal zum Apex des Wurzelkanals hatten und mindes- (MRI), which were connected with the apical tens eine Ausdehnung der zweifachen Größe des part of a root and with at least twice the width of parodontalen Ligaments zeigten. Zur Auswertung the periodontal ligament space. The location and kamen die Lage der Läsion und deren räumliche dimension of the lesions were compared between Ausdehnung im direkten Vergleich der Darstellung MRI and CBCT. mittels MRT und DVT. Results: While mainly mineralized tissue compo- Ergebnisse: Bei der Beschreibung der apikalen Lä- nents such as teeth and bone were visible with sionen war die Darsellung mittels DVT technikbe- CBCT, complimentary information of the soft tis- dingt beschränkt auf die Zähne und rein knöcherne sue components was assessable with MRI. The Befunde. Mittels der MRT konnte zusätzlich eine MRI images provided sufficient diagnostic detail received 20.5.2014 Darstellung des Weichteilgewebes erreicht wer- for the assessment of the main structures of inter- accepted 5.11.2014 den. Die Darstellung im MRT erlaubte eine zufrie- est. Heterogeneous contrast was observed within denstellende radiologische Diagnostik. Zusäzlich the lesion, with often a clear enhancement close Bibliography konnten Unterschiede im Aufbau der Mukosa und to the apical foramen and the periodontal gap. This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. DOI http://dx.doi.org/ 10.1055/s-0034-1385808 auch von soliden Einschlüssen differenziert wer- No difference for lesion visibility was observed Published online: 16.1.2015 den. Alle mittels DVT identifzierten periapikalen between MRI and CBCT. The lesion dimensions Fortschr Röntgenstr 2015; 187: Läsionen, wurden auch mittels MRT diagnostiziert. corresponded well, but were slightly but signifi- 269–275 © Georg Thieme Die Daten vom MRT und DVT zeigten eine gute cantly overestimated with MRI. A heterogeneous Verlag KG Stuttgart · New York · Korrelationen, wobei die Ausdehnung der Läsionen lesion appearance was observed in several pa- ISSN 1438-9029 in der MRT Darstellung leicht, aber statistisch sig- tients. Four patients presented with a well cir- Correspondence nifikant vergrößert resultierte. Bei mehreren Pa- cumscribed hyperintense signal in the vicinity of Frau Prof. Margit-Ann Geibel tienten wurden in der T2w Darstellung heterogene the apical foramen. Zahnheilkunde, Universität Ulm Läsionen gefunden und bei vier Patienten zeigte Conclusion: The MRI capability of soft tissue char- Albert-Einstein-Allee 11 sich ein scharf begrenztes hyperintenses Signal in acterization may facilitate detailed analysis of 89081 Ulm der Nähe des apikalen Foramens. periapical lesions. This clinical study confirms Germany Schlussfolgerung: Die Beurteilung des Weichge- the applicability of multi-contrast MRI for the Tel.: ++ 49/07 31/50 06 43 03 Fax: ++ 49/07 31/50 06 43 02 webes und eventueller Einschlüsse mittels MRI identification of periapical lesions. margrit-ann.geibel@ können helfen die radiologische Diagnose einer uniklinik-ulm.de apikalen Aufhellung weiter zu differenzieren. Die Geibel MA et al. Assessment of Apical… Fortschr Röntgenstr 2015; 187: 269–275 270 Head/Neck Studie indiziert den sinnvollen Einsatz der multi-kontrast MRT Key Points: für die Identifizierung apikaler Osteolysen. ▶ MRI can be applied for the identification of periapical lesions Kernaussagen: without ionizing radiation exposure ▶ Die MRT erlaubt die Erkennung periapikaler Läsionen ohne ▶ MRI might facilitate more detailed characterization of periapi- Strahlenexposition. cal lesions ▶ Der Mehrwert der MRT erscheint in der Möglichkeit präopera- ▶ MRI might provide more accurate lesion dimensions as X-ray- tive apikale Osteolysen zu charakterisieren. based methods ▶ Die MRT hat das Potential die Läsionsdimensionen genauer zu Citation Format: identifizieren. ▶ Geibel MA., Schreiber ES, Bracher AK et al. Assessment of Apical Periodontitis by MRI: A Feasibility Study. Fortschr Röntgenstr 2015; 187: 269–275 Introduction and an overall increase in diagnostic fidelity. Estrela et al. [14] re- ! ported that only progressed periapical lesions were identified Apical periodontitis (AP) is mainly caused by bacterial inflamma- correctly by conventional radiography. In contrast, Balasundaram tion. Through an inflamed root canal (pulpitis) or a deep gingival et al. [15] reported an only insignificant impact of CBCT diagnosis sulcus, bacteria can penetrate to the apical foramen and cause lo- for the treatment of a respective lesion. cal infections. Apical periodontitis can be classified as an acute Due to the underlying physical principle, all X-ray (XR)-based ima- type with pain symptomatology and a chronic type without ging techniques have limited capabilities in soft tissue characteri- pain. Several studies have evaluated the type and incidence of zation and are supposed to be limited in the differentiation be- periapical lesions in vivo [1, 2] and in vitro [3, 4] with different tween chronic and acute periapical lesions that may have an diagnostic methods. Nair et al. investigated 256 extracted teeth impact on the treatment strategy. Furthermore, the related ioniz- for identification of the incidence of abscess, granuloma, and ra- ing radiation with its well-known risks [16] limits the application dicular cyst. Their results showed an incidence of granuloma of CBCT for longitudinal monitoring especially in young patients. (50 %) and periapical abscess (35 %) and a surprisingly low inci- Magnetic resonance imaging (MRI) has shown excellent results dence of cysts (15 %), which could be further categorized into a for soft-tissue visualization without any harmful radiation. Al- true apical cyst (acute) and an apical pocket cyst (chronic) build- ready in 1981, the versatile three-dimensional assessment of ing up after healing. In a comparative study between radiograph- morphology and function raised the interest of MRI as a generic ic assessment and histological findings [4], the same group ana- imaging tool in dental applications [17, 18]. lyzed 114 specimens and revealed an insufficient concurrence of However, up to now, only a few reports have been published on diagnosis between the two modalities, clearly indicating the the application of MRI in dentistry mainly due to the limited ac- need for improved in vivo diagnostic tools. Simon et al. [2] inves- cess of dentists to MRI and limitations of MRI arising from metal tigated the use of CBCT for the classification of periapical lesions. artifacts caused by dental fillings. Without being used widely, re- In direct comparison, the CBCT-derived diagnosis compared well ported applications of MRI in dentistry include the assessment of with the biopsy-based diagnosis in the majority of the cases extracranial tumors [18 – 21], the assessment of the morphology (75 %). However, in about 25 % of the cases, CBCT failed to differ- and function of the temporomandibular joint [22 – 27], the plan- entiate between cyst and granuloma, indicating the need for ad- ning of dental implantation procedures [28 – 32], planning and vanced in vivo imaging techniques. evaluating orthodontics and orthognathic surgery [33], the as- In the current clinical routine, X-ray-based imaging is still the sessment of impacted teeth [34] and the mandibular and the tri- gold standard for the diagnosing and progression monitoring of geminal nerve channel [35 – 41], caries diagnosis [42 – 45], as- periapical lesions. Chronic apical periodontitis can be identified sessment of dental pulp [46, 47], or for imaging of the mandible in the X-ray image by the related root resorption, hypercemento- and mandibular for other purposes [48 – 50]. With the introduc- sis and osteitis. Acute lesions, however, are
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