Nicopoulou-Karayianni K, Bragger U, Patrikiou A, Stassinakis A, Lang N P
Department of Oral and Radiographic Diagnosis, School of Dental Medicine, University of Athens, Greece.
Int Endod J. 2002 Jul;35(7):615-22. doi: 10.1046/j.1365-2591.2002.00526.x.
The aim of the present study was to evaluate the effect of root canal treatment on periapical lesions by conventional and subtracted digital radiographic images of clinical cases.
Eleven patients who exhibited clinical or radiological signs of periapical pathology received root canal treatment. Periapical radiographs were obtained immediately postoperatively and recall radiographs at intervals of 3, 6, 9 and 12 months postoperatively were obtained. Identical exposure geometry was maintained. From the standardized radiographs digitized images were produced. Four experienced practitioners interpreted the radiographs and the digitized images. They assessed 59 pairs of images projected at random using a slide projector. On the left side, there was a reference image with no lesion, and on the right an image either with or without a lesion. Each reader was asked to rate each pair of images on a three-point scale: yes, absolutely sure that gain or loss was present; uncertain, if there was gain or loss; no, absolutely sure that no gain or loss was present. There was no time limit for each decision. Inter- and intra-examiner agreement was analyzed using the kappa-statistic for the diagnosis of periapical bone density changes in the periapical region at the different time points either in conventional pairs of radiographs or using digital subtraction images.
The inter-examiner agreement (P < 0.001) and the intra-examiner agreement (P = 0.02) when digital pictures where evaluated were significantly higher than with conventional radiographs.
A highly significantly better observer agreement was achieved by digital subtraction radiography during the evaluation of the outcome of root canal treatment on periapical lesions.
本研究旨在通过临床病例的传统和减影数字放射图像评估根管治疗对根尖周病变的影响。
11例表现出根尖周病变临床或放射学征象的患者接受了根管治疗。术后立即拍摄根尖周X线片，并在术后3、6、9和12个月间隔拍摄复查X线片。保持相同的曝光条件。从标准化的X线片生成数字化图像。四位经验丰富的医生解读X线片和数字化图像。他们使用幻灯机随机评估59对图像。左侧是无病变的参考图像，右侧是有或无病变的图像。要求每位读者对每对图像进行三点评分：是，绝对确定有增减；不确定，是否有增减；否，绝对确定无增减。每次判断没有时间限制。使用kappa统计量分析不同时间点根尖周区域根尖骨密度变化诊断中传统X线片对或数字减影图像的检查者间和检查者内一致性。
评估数字图像时，检查者间一致性（P<０.００１）和检查者内一致性（P = 0.02）显著高于传统X线片。
在评估根管治疗对根尖周病变的效果时，数字减影放射摄影获得了高度显著更好的观察者一致性。
