锥形束计算机断层扫描和数字化根尖片对根尖周炎患牙所选解剖学及治疗相关诊断参数的比较
Comparison of Selected Anatomical and Treatment-related Diagnostic Parameters Estimated by Cone-Beam Computed Tomography and Digital Periapical Radiography in Teeth with Apical Periodontitis.
作者信息
Gudac Jelena, Hellén-Halme Kristina, Venskutonis Tadas, Puisys Algirdas, Machiulskiene Vita
机构信息
Clinic of Dental and Oral Pathology, Lithuanian University of Health Sciences, KaunasLithuania.
Department of Oral and Maxillofacial Radiology, Faculty of Odontology, Malmo University, MalmoSweden.
出版信息
J Oral Maxillofac Res. 2020 Jun 30;11(2):e4. doi: 10.5037/jomr.2020.11204. eCollection 2020 Apr-Jun.
OBJECTIVES
To compare selected anatomical and treatment-related diagnostic parameters estimated by cone-beam computed tomography and by digital periapical radiography in teeth with apical periodontitis, and to evaluate reliability of different examiners in interpretation of images obtained by both methods.
MATERIAL AND METHODS
Teeth with apical periodontitis were evaluated independently by 2 endodontists and 1 radiologist based on 128 cone-beam computed tomography (CBCT) and 162 digital periapical radiography (DPR) images. Anatomical (size, relation with root, location of periapical radiolucency) and treatment-related (canal obturation length, homogeneity, coronal seal) parameters were assessed. Fleiss kappa reflected inter-observer agreement while intra-examiner agreement was estimated by Cohen's kappa. McNemar and McNemar-Bowker tests served for evaluation of differences between CBCT- and DPR-based estimates.
RESULTS
Cohen's kappa ranged from 0.62 to 1 for all examiners. Fleiss kappa values were nearly perfect for majority of parameters. Diagnostic discrepancy between methods was found for size of radiolucency that in 15 - 17% cases was larger, and in 25 - 28% smaller in DPR than in CBCT images. DPR revealed 20% of root canals scored as non-obturated while in CBCT - obturation present. Canal obturation was rated as homogenous by CBCT, while absent or non-homogenous by DPR, in 17 - 23%, and 11 - 14% of cases, respectively. Radiologist detected more root perforations in CBCT than in DPR images.
CONCLUSIONS
Good intra- and inter-examiner agreement for anatomical and treatment-related diagnostic parameters was achieved using cone-beam computed tomography and digital periapical radiography methods and demonstrated similar diagnostic capability, although variation regarding root perforations and canal obturation quality was observed.
目的
比较锥形束计算机断层扫描（CBCT）和数字化根尖片对根尖周炎患牙所评估的特定解剖学及治疗相关诊断参数，并评估不同检查者对两种方法所获图像解读的可靠性。
材料与方法
两名牙髓病医生和一名放射科医生基于128张锥形束计算机断层扫描（CBCT）图像和162张数字化根尖片（DPR）图像，对根尖周炎患牙进行独立评估。评估解剖学参数（大小、与牙根的关系、根尖透射影的位置）和治疗相关参数（根管充填长度、均匀性、冠部封闭）。Fleiss卡方反映观察者间一致性，而检查者内一致性通过Cohen卡方进行评估。McNemar检验和McNemar-Bowker检验用于评估基于CBCT和DPR的评估之间的差异。
结果
所有检查者的Cohen卡方值范围为0.62至1。大多数参数的Fleiss卡方值近乎完美。两种方法在透射影大小方面存在诊断差异，在15%-17%的病例中，DPR图像中的透射影比CBCT图像中的大，而在25%-28%的病例中则较小。DPR显示20%的根管被判定为未充填，而CBCT显示存在充填。在17%-23%的病例中，CBCT将根管充填评定为均匀，而DPR评定为不存在或不均匀，分别为11%-14%。放射科医生在CBCT图像中检测到的牙根穿孔比在DPR图像中更多。
结论
使用锥形束计算机断层扫描和数字化根尖片方法，在解剖学及治疗相关诊断参数方面，检查者内和检查者间一致性良好，且显示出相似的诊断能力，尽管在牙根穿孔和根管充填质量方面存在差异。
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