Elkersh Noha M, Hassan Mohamed G, Zakaria Osama
Department of Oral medicine, Periodontology, Oral diagnosis and Oral Radiology, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
Department of Orthodontics, Faculty of Dentistry, Assiut University, Assiut, Egypt.
Clin Oral Investig. 2025 Jul 3;29(7):371. doi: 10.1007/s00784-025-06425-y.
The aim of this work was to present a novel, non-invasive, and cost-effective technique to effectively distinguish between radicular cysts and periapical granulomas. This approach involves the application of pseudo-color enhancement to cone-beam CT imaging data, which has the potential to provide clinicians with valuable preliminary diagnostic information prior to more invasive investigative procedures.
The study involved a total of 57 cases, including both radicular cysts and periapical granulomas, with cone-beam CT scans obtained for each case. The DICOM data were imported into an open-access software (R2Gate), and a pseudo-color enhancement tool was then applied to visualize the color distribution patterns within each case. A scoring system was subsequently developed based on the observed color distribution characteristics. Two blind investigators independently assessed and classified each case according to their diagnostic findings. The statistical analysis involved the use of the independent t-test to compare the two groups with normal distributions, and the categorical data were represented as numbers and percentages. The significance level for the statistical findings was set at 5%.
The reliability of the intra-examiner reliability was evaluated and showed high agreement (0.965). With regard to the inter-examiner reliability, it revealed high agreement (0.930). A statistically significant difference (p = 0.002) was revealed between the two groups (cysts and granulomas) according to the scoring system. The results showed that all cystic lesions were categorized in score 2 while 29 of cases diagnosed granulomas histopathologically (out of 49) followed score 1.
Within the settings of this study, it was possible to distinguish between radicular cysts and periapical granulomas with the pseudo-color enhancement of cone-beam CT images.
To date, no studies have evaluated the validity of using pseudo-color enhancement, available in open-access cone-beam CT software, for differentiating between radicular cysts and periapical granulomas. This novel technique holds promise as a non-invasive and affordable approach to distinguish these two common periapical lesions.
本研究旨在提出一种新颖、无创且经济高效的技术，以有效区分根端囊肿和根尖肉芽肿。该方法涉及对锥束CT成像数据应用伪彩色增强技术，这有可能在进行更具侵入性的检查程序之前，为临床医生提供有价值的初步诊断信息。
本研究共纳入57例病例，包括根端囊肿和根尖肉芽肿，对每个病例均进行了锥束CT扫描。将DICOM数据导入开源软件（R2Gate），然后应用伪彩色增强工具来可视化每个病例中的颜色分布模式。随后根据观察到的颜色分布特征制定了评分系统。两名盲法研究者根据诊断结果对每个病例进行独立评估和分类。统计分析采用独立t检验比较两组正态分布数据，分类数据以数字和百分比表示。统计结果的显著性水平设定为5%。
评估了检查者内信度，显示出高度一致性（0.965）。关于检查者间信度，也显示出高度一致性（0.930）。根据评分系统，两组（囊肿和肉芽肿）之间存在统计学显著差异（p = 0.002）。结果显示，所有囊性病变均归类为2分，而49例经组织病理学诊断为肉芽肿的病例中有29例符合1分。
在本研究的条件下，通过锥束CT图像的伪彩色增强可以区分根端囊肿和根尖肉芽肿。
迄今为止，尚无研究评估开源锥束CT软件中可用的伪彩色增强技术在区分根端囊肿和根尖肉芽肿方面的有效性。这种新技术有望成为一种无创且经济实惠的方法来区分这两种常见的根尖病变。
