Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, Minnesota.
The Center for Magnetic Resonance Research, Minneapolis, Minnesota.
J Endod. 2023 Jun;49(6):703-709. doi: 10.1016/j.joen.2023.03.011. Epub 2023 Mar 25.
Vertical root fracture (VRF) in root-canal-treated teeth frequently results in tooth loss, partly because VRFs are difficult to diagnose and when detected the fracture is often beyond the point of preservation with surgical intervention. Nonionizing magnetic resonance imaging (MRI) has demonstrated the ability to detect small VRFs, but it is unknown how its diagnostic capabilities compare with the current imaging standard for VRF detection, cone-beam computed tomography (CBCT). This investigation aimed to compare the sensitivity and specificity between MRI and CBCT for detecting VRF, using micro-computed tomography (microCT) as a reference.
A total of 120 extracted human tooth roots were root canal treated using common techniques, and VRFs were mechanically induced in a proportion. Samples were imaged using MRI, CBCT, and microCT. Axial MRI and CBCT images were examined by 3 board-certified endodontists, who evaluated VRF status (yes/no) and gave a confidence assessment for that decision, from which a receiver operating characteristic curve was generated. Intra- and inter-rater reliability were calculated, sensitivity and specificity, and area under the curve.
Intra-rater reliability was 0.29-0.48 for MRI and 0.30-0.44 for CBCT. Inter-rater reliability for MRI was 0.37 and for CBCT 0.49. Sensitivity was 0.66 (95% confidence interval [CI], 0.53-0.78) and 0.58 (95% CI, 0.45-0.70), and specificity 0.72 (95% CI, 0.58-0.83) and 0.87 (95% CI, 0.75-0.95) for MRI and CBCT, respectively. Area under the curve was 0.74 (95% CI, 0.65-0.83) for MRI and 0.75 (95% CI, 0.66-0.84) for CBCT.
There was no significant difference in sensitivity or specificity between MRI and CBCT in detecting VRF, despite the early-stage development of MRI.
根管治疗后的牙齿发生垂直根裂（VRF）常导致牙齿丧失，部分原因是 VRF 难以诊断，而且当发现时，通常已经超出了手术干预的保留范围。非电离磁共振成像（MRI）已证明其检测小 VRF 的能力，但尚不清楚其诊断能力与 VRF 检测的当前成像标准——锥形束计算机断层扫描（CBCT）相比如何。本研究旨在通过微计算机断层扫描（microCT）作为参考，比较 MRI 和 CBCT 检测 VRF 的敏感性和特异性。
共 120 个人工根管治疗后的人类牙根被机械诱导产生 VRF。使用 MRI、CBCT 和 microCT 对样本进行成像。3 名持有董事会认证的牙髓病专家对轴向 MRI 和 CBCT 图像进行检查，评估 VRF 状态（有/无），并对该决策的置信度进行评估，从而生成受试者工作特征曲线。计算了内部和外部评估者的可靠性、敏感性和特异性以及曲线下面积。
MRI 的内部评估者可靠性为 0.29-0.48，CBCT 为 0.30-0.44。MRI 的外部评估者可靠性为 0.37，CBCT 为 0.49。MRI 的敏感性为 0.66（95%置信区间[CI]，0.53-0.78）和 0.58（95% CI，0.45-0.70），特异性为 0.72（95% CI，0.58-0.83）和 0.87（95% CI，0.75-0.95），MRI 和 CBCT 分别。MRI 的曲线下面积为 0.74（95% CI，0.65-0.83），CBCT 为 0.75（95% CI，0.66-0.84）。
尽管 MRI 处于早期发展阶段，但在检测 VRF 方面，MRI 和 CBCT 的敏感性或特异性没有差异。
