Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.
Dres. Mueller-Stahl Private Dental Practice, Poing, Germany.
Int Endod J. 2022 Mar;55(3):252-262. doi: 10.1111/iej.13662. Epub 2021 Nov 27.
This prospective in vivo study aimed to optimize the assessment of pulpal contrast-enhancement (PCE) on dental magnetic resonance imaging (dMRI) and investigate physiological PCE patterns.
In 70 study participants, 1585 healthy teeth were examined using 3-Tesla dMRI before and after contrast agent administration. For all teeth, the quotient of post- and pre-contrast pulp signal intensity (Q-PSI) was calculated to quantify PCE. First, pulp chambers were analysed in 10 participants to compare the coefficient of variation of mean versus maximum Q-PSI values (Q-PSI versus Q-PSI ). Second, dynamic PCE was evaluated in 10 subjects to optimize the time interval between contrast agent application and image acquisition. Finally, 50 participants (age groups: 20-29, 30-39, 40-49, 50-59 and 60-69 years) were examined to analyse age, gender, tooth types and maxilla versus mandible as independent factors of PCE. Statistical analysis was performed using Wilcoxon signed rank test and linear mixed models.
PCE assessment based on Q-PSI was associated with a significantly smaller coefficient of variation compared with Q-PSI , with median values of 0.17 versus 0.21 (p = .002). Analysis of dynamic PCE revealed an optimal timing interval for image acquisition 4 min after contrast media application. No significant differences in PCE were observed by comparing age groups, female versus male participants and maxillary versus mandibular teeth (p > .05). Differences between tooth types were small (median Q-PSI values of 2.52/2.32/2.30/2.20 for molars/premolars/canines/incisors) but significant (p < .05), except for the comparison of canines versus premolars (p = .80).
PCE in dMRI was a stable intra-individual marker with only minor differences between different tooth types, thus forming an important basis for intra-individual controls when assessing teeth with suspected endodontic pathosis. Furthermore, it was demonstrated that PCE is independent of age, gender and jaw type. These findings indicate that dMRI-based PCE analysis could be a valuable diagnostic tool for the identification of various pulp diseases in future patient studies.
本前瞻性体内研究旨在优化牙髓对比增强（PCE）在磁共振成像（dMRI）上的评估，并研究生理 PCE 模式。
在 70 名研究参与者中，使用 3-Tesla dMRI 在对比剂给药前后对 1585 颗健康牙齿进行检查。对于所有牙齿，计算对比后和对比前牙髓信号强度的商（Q-PSI）以量化 PCE。首先，在 10 名参与者中分析牙髓腔，以比较平均与最大 Q-PSI 值的变异系数（Q-PSI 与 Q-PSI ）。其次，在 10 名受试者中评估动态 PCE，以优化对比剂应用与图像采集之间的时间间隔。最后，检查 50 名参与者（年龄组：20-29、30-39、40-49、50-59 和 60-69 岁），以分析年龄、性别、牙齿类型以及上颌与下颌作为 PCE 的独立因素。使用 Wilcoxon 符号秩检验和线性混合模型进行统计分析。
基于 Q-PSI 的 PCE 评估与 Q-PSI 相比，变异系数显著较小，中位数分别为 0.17 和 0.21（p=0.002）。动态 PCE 分析显示，在对比剂应用后 4 分钟进行图像采集的最佳时间间隔。在年龄组、女性与男性参与者以及上颌与下颌牙齿之间，PCE 无显著差异（p>.05）。不同牙齿类型之间的差异较小（磨牙/前磨牙/尖牙/切牙的中位数 Q-PSI 值分别为 2.52/2.32/2.30/2.20），但具有统计学意义（p<.05），除了尖牙与前磨牙之间的比较（p=0.80）。
dMRI 中的 PCE 是一种稳定的个体内标志物，不同牙齿类型之间仅有微小差异，因此在评估疑似牙髓病的牙齿时，为个体内对照提供了重要基础。此外，研究表明 PCE 与年龄、性别和颌型无关。这些发现表明，基于 dMRI 的 PCE 分析可能成为未来患者研究中识别各种牙髓疾病的有价值的诊断工具。
