超声在诊断及鉴别根尖肉芽肿和根侧囊肿中的应用。

Utility of Ultrasonography for Diagnosing and Differentiating Periapical Granuloma from Radicular Cyst.

机构信息

Department of Endodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, No. 639, Zhizaoju Road, Shanghai 200011, China (J.W., J.H., W.Z., P.Z., S.R., M.M., Z.H., S.G.).

Department of Ultrasound, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (X.G., A.D.).

出版信息

Acad Radiol. 2023 Oct;30(10):2329-2339. doi: 10.1016/j.acra.2023.05.039. Epub 2023 Jun 30.

DOI:10.1016/j.acra.2023.05.039

PMID:37394410

Abstract

RATIONALE AND OBJECTIVES

This study aimed to investigate the reliability and accuracy of high-resolution ultrasonography (US) for diagnosing periapical lesions and differentiating radicular cysts from granulomas.

MATERIALS AND METHODS

This study included 109 teeth with periapical lesions of endodontic origin from 109 patients scheduled for apical microsurgery. Ultrasonic outcomes were analyzed and categorized after thorough clinical and radiographic examinations using US. B-mode US images reflected the echotexture, echogenicity, and lesion margin, while color Doppler US assessed the presence and features of blood flow of interested areas. Pathological tissue samples were obtained during apical microsurgery and subjected to histopathological examination. Fleiss' κ was used to measure interobserver reliability. Statistical analyses were performed to assess the diagnostic validity and the overall agreement between US and histological findings. The reliability of US compared to histopathological examinations was assessed based on Cohen's κ.

RESULTS

The percent accuracy of US for diagnosing cysts, granulomas, and cysts with infection based on histopathological findings was 89.9%, 89.0%, and 97.2%, respectively. The sensitivity of US diagnoses was 95.1% for cysts, 84.1% for granulomas, and 80.0% for cysts with infection. The specificity of US diagnoses was 86.8% for cysts, 95.7% for granulomas, and 98.1% for cysts with infection. The reliability for US compared to histopathological examinations was good (κ = 0.779).

CONCLUSION

The echotexture characteristics of lesions in US images correlated with their histopathological features. US can provide accurate information on the nature of periapical lesions based on the echotexture of their contents and the presence of vascularity. It can help improve clinical diagnosis and avoid overtreatment of patients with apical periodontitis.

摘要

目的

本研究旨在探讨高分辨率超声（US）诊断根尖周病变并区分根囊肿和肉芽肿的可靠性和准确性。

材料和方法

本研究纳入了 109 例因根尖周病变需行根尖显微手术的患者的 109 颗患牙。在彻底的临床和影像学检查后，使用 US 对超声结果进行分析和分类。B 型 US 图像反映回声纹理、回声强度和病变边缘，而彩色多普勒 US 评估感兴趣区域的血流存在和特征。在根尖显微手术中获得病理组织样本，并进行组织病理学检查。使用 Fleiss' κ 测量观察者间的可靠性。统计分析用于评估 US 与组织学发现之间的诊断有效性和总体一致性。根据 Cohen's κ 评估 US 与组织病理学检查的可靠性。

结果

US 基于组织病理学结果诊断囊肿、肉芽肿和感染性囊肿的准确率分别为 89.9%、89.0%和 97.2%。US 诊断的敏感度分别为囊肿 95.1%、肉芽肿 84.1%和感染性囊肿 80.0%。US 诊断的特异性分别为囊肿 86.8%、肉芽肿 95.7%和感染性囊肿 98.1%。US 与组织病理学检查的可靠性良好（κ=0.779）。