Sittinger Mia A, Sandner Christoph, Zhou Kun, Mente Johannes, Lauer Arne, Özen Ali C, Vollherbst Dominik F, Breckwoldt Michael O, Bendszus Martin, Heiland Sabine, Hilgenfeld Tim
Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.
Department of Conservative Dentistry, Heidelberg University Hospital, Heidelberg, Germany.
Sci Rep. 2025 Sep 12;15(1):32432. doi: 10.1038/s41598-025-16272-2.
Clinical evaluation of the human dental pulp is limited to imprecise, subjective methods, necessitating the development of an accurate and objective diagnostic parameter. Diffusion-weighted imaging (DWI) could address this gap; however, no in vivo data are available. To illustrate the feasibility of DWI imaging of the human pulp and to investigate physiological patterns. A turbo gradient spin echo (TGSE) BLADE diffusion MRI sequence was optimized for dental pulp imaging in three volunteers, defining an optimal b-value range and assessing intraindividual fluctuations at 3 T. Apparent diffusion coefficient (ADC) values were calculated in 18 participants using the 2-point and 7-point methods in 329 healthy teeth, analyzing data according to tooth and jaw type. Statistical analysis was performed using Kruskal-Wallis, Wilcoxon signed-rank-test, and one-way ANOVA. Mean pulp ADCs (± SD) for the 2-/7-point methods were 1.219 ± 0.340 / 1.242 ± 0.297 × 10 m/s (p ≤ 0.0001), with intraindividual variations of 0.159 × 10 m/s. Minor but significant differences were observed between tooth types for maxillary premolars vs. maxillary incisors/canines, mandibular canines, and maxillary incisors vs. molars (ADC difference range: 0.209-0.272 × 10 m/s; p-values: 0.0017-0.0473). In vivo assessment of the dental pulp by DWI is feasible and reliable using the TGSE BLADE sequence. Reference ADC values were established, with no substantial differences between jaw and tooth types, indicating that the ADC is a stable intraindividual parameter here. These findings may substantially improve the diagnostic evaluation of pulp diseases to minimize over- and undertreatment.
对人类牙髓的临床评估仅限于不精确的主观方法，因此需要开发一种准确客观的诊断参数。扩散加权成像（DWI）可以填补这一空白；然而，目前尚无体内数据。为了说明人类牙髓DWI成像的可行性并研究其生理模式。在三名志愿者中，对涡轮梯度自旋回波（TGSE）刀锋式扩散MRI序列进行了优化，以用于牙髓成像，确定了最佳b值范围并评估了3T时个体内的波动情况。在18名参与者中，使用两点法和七点法在329颗健康牙齿中计算了表观扩散系数（ADC）值，并根据牙齿和颌骨类型分析数据。使用Kruskal-Wallis检验、Wilcoxon符号秩检验和单因素方差分析进行统计分析。两点法/七点法的平均牙髓ADC值（±标准差）为1.219±0.340/1.242±0.297×10⁻³mm²/s（p≤0.0001），个体内差异为0.159×10⁻³mm²/s。在上颌前磨牙与上颌切牙/尖牙、下颌尖牙以及上颌切牙与磨牙之间观察到牙齿类型之间存在微小但显著的差异（ADC差异范围：0.209 - 0.272×10⁻³mm²/s；p值：0.0017 - 0.0473）。使用TGSE刀锋式序列通过DWI对牙髓进行体内评估是可行且可靠的。建立了参考ADC值，颌骨和牙齿类型之间没有实质性差异，表明ADC在此处是一个稳定的个体内参数。这些发现可能会显著改善牙髓疾病的诊断评估，以尽量减少过度治疗和治疗不足的情况。
