Jiang Dongmei, Hong Junhuan, Yan Yalan, Huang Hao, You Peiying, Huang Weilin, Zhao Xiance, She Dejun, Cao Dairong
Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, P.R. China.
Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, P.R. China.
Dentomaxillofac Radiol. 2025 Feb 1;54(2):163-172. doi: 10.1093/dmfr/twae060.
To evaluate the reliability of 3T MRI nerve-bone fusion in assessing the lingual nerve (LN) and its anatomical relationship to the lingual cortical plate prior to the impacted mandibular third molar (IMTM) extraction.
The MRI nerve and bone sequences used in this study were 3D T2-weighted fast field echo (3D-T2-FFE) and fast field echo resembling a CT using restricted echo-spacing (FRACTURE), respectively. Both sequences were performed in 25 subjects, and the resulting 3D-T2-FFE/FRACTURE fusion images were assessed by 2 independent observers. Semi-quantitative analyses included assessments of overall image quality, image artefacts, nerve continuity, and the detectability of 5 intermediate points (IPs). Quantitative analyses included measurements of the lingual cortical plate thickness (LCPT), vertical distance (V1* and V2*), and the closest horizontal distance (CHD) between the LN and the lingual cortical plate. Reliability was evaluated using weighted Cohen's kappa coefficient (κ), intraclass correlation coefficient (ICC), and Bland-Altman plots. Differences in LCPT between 3D-T2-FFE/FRACTURE fusion images and cone-beam computed tomography (CBCT) were compared using independent samples t-tests or Mann-Whitney U tests.
The fusion images demonstrated that the LN continuity score was 3.00 (1.00) (good), with 88% (44/50) of LNs displayed continuously at the IMTM level. Intra-reader agreement for nerve continuity was moderate (κ = 0.527), as was inter-reader agreement (κ = 0.428). The intra-reader and inter-reader agreement for LCPT measurements at the neck, mid-root, and apex of the IMTM were all moderate (ICC > 0.60). Intra-reader agreements for V1*, V2*, and CHD were moderate to excellent (ICC = 0.904, 0.967, and 0.723, respectively), and inter-reader agreements for V1*, V2*, and CHD were also moderate to excellent (ICC = 0.948, 0.941 and 0.623, respectively). The reliability of LCPT measurements between 3D-T2-FFE/FRACTURE fusion and CBCT was moderate (ICC = 0.609-0.796).
The 3D-T2-FFE/FRACTURE fusion technique demonstrated potential feasibility for the identification of the LN and its relationship to the lingual cortical plate, as well as for the measurement of LCPT. This study has generated a dataset that is capable of simultaneously defining the LN and LCPT.
评估3T磁共振成像（MRI）神经-骨融合技术在评估下颌阻生第三磨牙（IMTM）拔除术前舌神经（LN）及其与舌皮质板的解剖关系中的可靠性。
本研究中使用的MRI神经和骨序列分别为三维T2加权快速场回波（3D-T2-FFE）和使用受限回波间距的类似CT的快速场回波（FRACTURE）。对25名受试者进行了这两种序列的扫描，并由2名独立观察者对所得的3D-T2-FFE/FRACTURE融合图像进行评估。半定量分析包括对整体图像质量、图像伪影、神经连续性以及5个中间点（IPs）的可检测性的评估。定量分析包括测量舌皮质板厚度（LCPT）、垂直距离（V1和V2）以及LN与舌皮质板之间的最近水平距离（CHD）。使用加权Cohen卡方系数（κ）、组内相关系数（ICC）和Bland-Altman图评估可靠性。使用独立样本t检验或Mann-Whitney U检验比较3D-T2-FFE/FRACTURE融合图像与锥形束计算机断层扫描（CBCT）之间LCPT的差异。
融合图像显示LN连续性评分为3.00（1.00）（良好），在IMTM水平处88%（44/50）的LN连续显示。读者内神经连续性一致性为中等（κ = 0.527），读者间一致性也为中等（κ = 0.428）。在IMTM颈部、牙根中部和根尖处LCPT测量的读者内和读者间一致性均为中等（ICC > 0.60）。V1*、V2和CHD的读者内一致性为中等至优秀（ICC分别为0.904、0.967和0.723），V1、V2*和CHD的读者间一致性也为中等至优秀（ICC分别为0.948、0.941和0.623）。3D-T2-FFE/FRACTURE融合与CBCT之间LCPT测量的可靠性为中等（ICC = 0.609 - 0.796）。
3D-T2-FFE/FRACTURE融合技术在识别LN及其与舌皮质板的关系以及测量LCPT方面显示出潜在的可行性。本研究生成了一个能够同时定义LN和LCPT的数据集。
