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Rofo 2015; 187(04): 269-275
DOI: 10.1055/s-0034-1385808
Head/Neck
© Georg Thieme Verlag KG Stuttgart · New York

Assessment of Apical Periodontitis by MRI: A Feasibility Study

Vergleich von MRT und DVT bei der Diagnose von periapikalen Osteolysen
M. A. Geibel
1   Oral and Maxillofacial Surgery, Ulm University, Ulm
,
E. S. Schreiber
2   Internal Medicine II, Ulm University, Ulm, Germany
,
A. K. Bracher
2   Internal Medicine II, Ulm University, Ulm, Germany
,
E. Hell
3   Dental Imaging, Sirona Dental Systems GmbH, Bensheim, Germany
,
J. Ulrici
3   Dental Imaging, Sirona Dental Systems GmbH, Bensheim, Germany
,
L. K. Sailer
4   MKG, DOC Praxisklinik im Wiley, Neu-Ulm, Germany
,
Y. Ozpeynirci
5   Diagnostic and Interventional Radiology, Ulm University, Ulm, Germany
,
V. Rasche
2   Internal Medicine II, Ulm University, Ulm, Germany
› Author Affiliations
Further Information

Publication History

20 May 2014

05 November 2014

Publication Date:
16 January 2015 (online)

Also available at
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Abstract

Purpose: The purpose of this clinical feasibility study was to evaluate the applicability of magnetic resonance imaging (MRI) for the assessment of apical periodontitis in direct comparison with cone beam CT (CBCT).

Materials and Methods: 19 consecutive patients (average age 43 ± 13 years) with 34 lesions in total (13 molars, 14 premolars and 7 front teeth) were enrolled in this feasibility study. Periapical lesions were defined as periapical radiolucencies (CBCT) or structural changes in the spongy bone signal (MRI), which were connected with the apical part of a root and with at least twice the width of the periodontal ligament space. The location and dimension of the lesions were compared between MRI and CBCT.

Results: While mainly mineralized tissue components such as teeth and bone were visible with CBCT, complimentary information of the soft tissue components was assessable with MRI. The MRI images provided sufficient diagnostic detail for the assessment of the main structures of interest. Heterogeneous contrast was observed within the lesion, with often a clear enhancement close to the apical foramen and the periodontal gap. No difference for lesion visibility was observed between MRI and CBCT. The lesion dimensions corresponded well, but were slightly but significantly overestimated with MRI. A heterogeneous lesion appearance was observed in several patients. Four patients presented with a well circumscribed hyperintense signal in the vicinity of the apical foramen.

Conclusion: The MRI capability of soft tissue characterization may facilitate detailed analysis of periapical lesions. This clinical study confirms the applicability of multi-contrast MRI for the identification of periapical lesions.

Key Points:

• MRI can be applied for the identification of periapical lesions without ionizing radiation exposure

• MRI might facilitate more detailed characterization of periapical lesions

• MRI might provide more accurate lesion dimensions as X-ray-based methods

Citation Format:

• Geibel MA., Schreiber ES, Bracher AK et al. Assessment of Apical Periodontitis by MRI: A Feasibility Study. Fortschr Röntgenstr 2015; 187: 269 – 275

Zusammenfassung

Ziel: Das Ziel dieser klinischen Machbarkeitsstudie war die Untersuchung der Darstellbarkeit periapikaler Osteolysen mittels der Magnetresonanztomografie (MRT) im direkten Vergleich mit der digitalen Volumentomografie (DVT).

Material und Methoden: In die Studie wurden 19 Patienten (Durchschnittsalter 43 ± 13 Jahre) mit 34 periapikalen Osteolysen eingeschlossen. Die Läsionen wurden radiologisch befundet als periapikale Osteolysen (DVT) oder als knöcherne Destruktion in der Spongiosa (MRT), die eine Lagebeziehung zum Apex des Wurzelkanals hatten und mindestens eine Ausdehnung der zweifachen Größe des parodontalen Ligaments zeigten. Zur Auswertung kamen die Lage der Läsion und deren räumliche Ausdehnung im direkten Vergleich der Darstellung mittels MRT und DVT.

Ergebnisse: Bei der Beschreibung der apikalen Läsionen war die Darsellung mittels DVT technikbedingt beschränkt auf die Zähne und rein knöcherne Befunde. Mittels der MRT konnte zusätzlich eine Darstellung des Weichteilgewebes erreicht werden. Die Darstellung im MRT erlaubte eine zufriedenstellende radiologische Diagnostik. Zusäzlich konnten Unterschiede im Aufbau der Mukosa und auch von soliden Einschlüssen differenziert werden. Alle mittels DVT identifzierten periapikalen Läsionen, wurden auch mittels MRT diagnostiziert. Die Daten vom MRT und DVT zeigten eine gute Korrelationen, wobei die Ausdehnung der Läsionen in der MRT Darstellung leicht, aber statistisch signifikant vergrößert resultierte. Bei mehreren Patienten wurden in der T2w Darstellung heterogene Läsionen gefunden und bei vier Patienten zeigte sich ein scharf begrenztes hyperintenses Signal in der Nähe des apikalen Foramens.

Schlussfolgerung: Die Beurteilung des Weichgewebes und eventueller Einschlüsse mittels MRI können helfen die radiologische Diagnose einer apikalen Aufhellung weiter zu differenzieren. Die Studie indiziert den sinnvollen Einsatz der multi-kontrast MRT für die Identifizierung apikaler Osteolysen.

Kernaussagen:

• Die MRT erlaubt die Erkennung periapikaler Läsionen ohne Strahlenexposition.

• Der Mehrwert der MRT erscheint in der Möglichkeit präoperative apikale Osteolysen zu charakterisieren.

• Die MRT hat das Potential die Läsionsdimensionen genauer zu identifizieren.

Key words

head/neck - diagnostic radiology - MR imaging - radiography - apical periodontitis - dental MRI - cone beam computed tomography
 

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