Quantitative analysis of mandibular cortical morphology using artificial intelligence-based computer assisted diagnosis for panoramic radiography on underlying diseases and dental status in women over 20 years of age.

Background/purpose: Recently, an artificial intelligence-based computer-assisted diagnosis (AI-CAD) for panoramic radiography was developed to scan the inferior margin of the mandible and automatically evaluate mandibular cortical morphology. The aim of this study was to analyze quantitatively the mandibular cortical morphology using the AI-CAD, especially focusing on underlying diseases and dental status in women over 20 years of age. Materials and methods: 419 patients in women over 20 years of age who underwent panoramic radiography were included in this study. The mandibular cortical morphology was analyzed with an AI-CAD that evaluated the degree of deformation of the mandibular inferior cortex (MIC) and mandibular cortical index (MCI) automatically. Those were analyzed in relation to underlying diseases, such as diabetes, hypertension, dyslipidemia, rheumatism and osteoporosis, and dental status, such as the number of teeth present in the maxilla and mandible. Results: The degree of deformation of MIC in women under 51 years of age (21-50 years; n = 229, 16.0 ± 12.7) was significantly lower than those of over 50 years of age (51-90 years; n = 190, 45.1 ± 23.0), and the MCI was a significant difference for the different age group. Regarding the degree of deformation of MIC and MCI in women over 50 years of age, osteoporosis and number of total teeth present in the maxilla and mandible were significant differences. Conclusion: The results of this study indicated that the mandibular cortical morphology using the AI-CAD is significantly related to osteoporosis and dental status in women over 50 years of age.

A pilot study of half-value layer measurements using a semiconductor dosimeter for intraoral radiography.

Purpose: This pilot study was conducted to evaluate half-value layer (HVL) measurements obtained using a semiconductor dosimeter for intraoral radiography. Materials and Methods: This study included 8 aluminum plates, 4 of which were low-purity (less than 99.9%) and 4 high-purity (greater than 99.9%). Intraoral radiography was performed using an intraoral X-ray unit in accordance with the dental protocol at the authors' affiliated hospital: tube voltage, 60 kVp and 70 kVp; tube current, 7 mA; and exposure time, 0.10 s. The accuracy of HVL measurements for intraoral radiography was assessed using a semiconductor dosimeter. A simple regression analysis was performed to compare the aluminum plate thickness and HVL in relation to the tube voltage (60 kVp and 70 kVp) and aluminum purity (low and high). Results: For the low-purity aluminum plates, the HVL at 60 kVp (Y) and 70 kVp (Y) was significantly correlated with the thickness of the aluminum plate (X), with Y = 1.708 + 0.415X (r=0.999, P<0.05) and Y = 1.980 + 0.484X (r=0.999, P<0.05), respectively. Similarly, for the high-purity aluminum plates, the HVL at 60 kVp (Y) and 70 kVp (Y) was significantly correlated with the plate thickness (X), with Y = 1.696 + 0.454X (r=0.999, P<0.05) and Y = 1.968 + 0.515X (r=0.998, P<0.05), respectively. Conclusion: This pilot study examined the relationship between aluminum plate thickness and HVL measurements using a semiconductor dosimeter for intraoral radiography. Semiconductor dosimeters may prove useful in HVL measurement for purposes such as quality assurance in dental X-ray imaging.

Accuracy of non-contact semiconductor X-ray analyzer for quality assurance in intraoral radiography: a comparison with ionization chamber dosimeter.

OBJECTIVES: The aim of the present study was to evaluate the accuracy of a non-contact semiconductor X-ray analyzer for quality assurance in intraoral radiography, especially a comparison with an ionization chamber dosimeter. METHODS: Intraoral radiography was performed with intraoral X-ray unit using the dental protocol at our hospital: tube voltage, 70 kV; tube current, 7 mA. Accuracy of dose and half-value layer (HVL) measurements was analyzed with a non-contact semiconductor X-ray analyzer and an ionization chamber dosimeter. Stability of the semiconductor sensor, effect of scattered radiation, and comparison of measured HVL between the ionization chamber and the semiconductor sensor were analyzed in this study. RESULTS: The values with the semiconductor sensor were tube voltage: 70.3 ± 0.2 kVp (degree of variability: 0.28%), dose: 454.1 ± 12.3 µGy (degree of variability: 2.7%), and HVL: 1.91 ± 0.02 mmAl (degree of variability: 1.0%). With collimator, the dose with the semiconductor sensor and the ionization chamber decreased by 2.3 µ Gy and 5.2 µ Gy, respectively. The measured HVL of the semiconductor dosimeter was more than that of ionization chamber, and the semiconductor dosimeter was less than ionization chamber in variation of between without and with collimator. CONCLUSION: This study indicated the accuracy of a non-contact semiconductor X-ray analyzer for quality assurance in intraoral radiography, especially a comparison with an ionization chamber dosimeter. The semiconductor sensor can be useful for quality assurance in intraoral radiography.

A computer program to assess the bone scan index for Tc-99m hydroxymethylene diphosphonate: evaluation of jaw pathologies of patients with bone metastases using SPECT/CT

PURPOSE: This study aimed to evaluate the jaw pathologies of patients with bone metastases using a computer program to assess the bone scan index (BSI) for Tc-99m hydroxymethylene diphosphonate (HMDP) with single-photon emission computed tomography/computed tomography (SPECT/CT). METHODS: Ninety-seven patients with jaw pathologies (24 with bone metastases and 73 without) were evaluated. High-risk hot spots and BSI in the patients were evaluated using the VSBONE BSI (ver.1.1) analysis software for Tc-99m HMDP that scanned SPECT/CT and automatically defined the data. The two groups were compared using the Pearson chi-square test and Mann-Whitney U test for high-risk hot spots and BSI, respectively. A P value of <0.05 was considered statistically significant. RESULTS: High-risk hot spot occurrence was significantly correlated to bone metastases [sensitivity, 21/24 (87.5%); specificity, 40/73 (54.8%); accuracy, 61/97 (62.9%); P < 0.001]. The number of high-risk hot spots was higher in patients with bone metastases (5.96 ± 10.30) than in those without (0.90 ± 1.50; P < 0.001). Furthermore, the BSI for patients with bone metastases (1.44 ± 2.18%) was significantly higher than for those without (0.22 ± 0.44%; P < 0.001). CONCLUSION: A computer program that assessed BSI for Tc-99m HMDP may be useful in the evaluation of patients with bone metastases using SPECT/CT.

Characteristic multimodal imaging of palatal follicular lymphoma: a case report on effectiveness of CT, diffusion-weighted MR imaging and intraoral ultrasonography.

Oral lymphomas are relatively uncommon. Follicular lymphoma is the second most common subtype of non-Hodgkin lymphoma. We report characteristic multimodal imaging of palatal follicular lymphoma, especially CT, diffusion-weighted MR imaging (DWI) and intraoral ultrasonography. A 67-year-old woman presented with swelling on the right side of the palate within 2 months. On clinical examination, an approximately 35 × 20 mm mass lesion with elastic soft was found to overlay the right side of the palate. Contrast-enhanced CT image showed a mass with homogeneous enhancement on the right side of the palate, and bone tissue algorithm CT showed focal erosion of the right posterior maxilla. Regarding MR imaging, on T1-weighted image, the mass showed low signal intensity and homogeneous enhancement, and T2-weighted and STIR images revealed intermediate and high signal intensity, respectively. Furthermore, DWI and apparent diffusion coefficient (ADC) map showed high and low signal intensity, respectively. ADC value of the mass was 0.60 × 10-3 mm2s-1. On intraoral ultrasonography, the mass showed clear boundary, hypoechoic echogenicity, homogeneous internal architecture, vascular signals using color Doppler imaging and heterogeneous hard using strain elastography. A partial biopsy of the palatal region was performed. Histopathological diagnosis was follicular lymphoma. This case suggests that multimodal imaging, especially CT, DWI with ADC map and intraoral ultrasonography with color Doppler imaging and strain elastography, could be effective for evaluating palatal lesions.

Volumetric analysis of mandibular lesions with SPECT/CT: a pilot clinical study of maximum standardized uptake value.

Purpose: This study was designed to investigate mandibular lesions using volumetric analysis with bone single-photon emission computed tomography/computed tomography (SPECT/CT). Material and methods: Eight patients with mandibular lesions underwent SPECT/CT scan acquisition 4 hours after injection of Tc-99m hydroxymethylene diphosphonate (HMDP). Regarding volumetric analysis, maximum standar-dized uptake value (SUV) was obtained using software and a workstation (Q.Volumetrix MI and GEniE-Xeleris 4 DR, respectively). The localization and size of the volume of interest (VOI) can be drawn over the lesion, mesial, distal, and opposite side as normal using the CT, SPECT, and SPECT/CT transaxials, coronals, and sagittals as the anatomical reference. Q.Volumetrix MI can analyse SUV of lesions by organ segmentation using optional pan and zoom imaging. Then, the dosimetry software provided multiple quantitative data for a given VOI. Statistical analyses for the maximum SUV were performed by Mann-Whitney U test. A p-value lower than 0.05 was considered as statistically significant. Results: Maximum SUVs for medication-related osteonecrosis of the jaw (n = 4, 25.4 ± 4.9), chronic osteomyelitis (n = 3, 14.6 ± 3.1), and squamous cell carcinoma (n = 1, 31.7) were significantly higher than those of the opposite side as normal mandible (3.8 ± 0.7, 4.6 ± 1.8, and 7.4, respectively; p = 0.000). Conclusions: Volumetric analysis with SPECT/CT could be useful for the evaluation of mandibular lesions, such as detecting and surgical planning.

AI-based computer-aided diagnosis for panoramic radiographs: Quantitative analysis of mandibular cortical morphology in relation to age and gender.

OBJECTIVE: This study aimed to investigate AI-based computer-aided diagnosis (AI-CAD) for panoramic radiographs, especially quantitative evaluation of mandibular cortical morphology in relation to age and gender. METHODS: 321 patients with jaw lesions who underwent panoramic radiography were prospectively included. The mandibular cortical morphology was analyzed with an AI-CAD that evaluated the degree of deformation of mandibular inferior cortex and mandibular cortical index (MCI) automatically. Those were analyzed in relation to age and gender, such as younger (≦ 20 years), middle (21-60 years) and older group (≧ 61 years) in men and women. RESULTS: The degree of deformation in older men (33.0 ± 18.5) was higher than those of middle (25.0 ± 15.3, p = 0.030) and younger (32.5 ± 16.9, p = 0.993), and those in older women (46.2 ± 22.5) was higher than those of middle (19.4 ± 16.5, p < 0.001) and younger (22.4 ± 14.5, p < 0.001). The MCI of women was a significant difference for aging (p < 0.001), although those of men was not significant difference for aging (p = 0.189). CONCLUSION: The AI-CAD could be a useful tool for the quantitative analysis of mandibular cortical morphology.

Medication-related osteonecrosis of the jaw in a patient with multiple myeloma: an unusual case with tumor in the surgical specimen.

Multiple myeloma is characterized by a neoplastic proliferation of plasma cells primarily in the bone marrow. Neoplastic plasma cells stimulated osteoclasts, and destroy bone tissue, causing bone pain, pathological fractures, paralysis due to spinal cord compression, and hypercalcemia. Bisphosphonates are used as supportive therapy in the management of multiple myeloma. Medication-related osteonecrosis of the jaw (MRONJ) is a well-known complication of treatment with bisphosphonates, denosumab, and other drugs, such as anti-angiogenic agents and novel anti-cancer drugs. We report MRONJ in a patient with multiple myeloma, especially an unusual case with tumor in the surgical specimen. A 73-year-old woman presented with pain on the left side of the mandible within 3 months. On clinical examination, an exposed bone without purulent drainage presented on the left side of the mandible. Before 2 years, she received chemotherapy of zoledronate for multiple myeloma at another hospital. Panoramic imaging showed radiopacities of bone in the left side of the mandibular molar area. Multidetector computed tomography (MDCT) with axial, multiplanar reformation (MPR) and three-dimensional (3D) images showed the sequestrum without periosteal reaction. She was diagnosed as MRONJ, and underwent surgery. Finally, the surgical specimen was diagnosed as multiple myeloma in the sequestrum. This case suggests that the evaluation of the surgical specimen of MRONJ could be essential for detection of primary tumor.

Analysis of medication-related osteonecrosis of the jaw with bone SPECT/CT: relationship between patient characteristics and maximum standardized uptake value.

OBJECTIVE: To analyze medication-related osteonecrosis of the jaw (MRONJ) with bone single photon emission computed tomography (SPECT)/CT, especially relationship between patient characteristics and maximum standardized uptake value (SUV). METHODS: 48 patients with MRONJ who underwent bone SPECT/CT were prospectively included. MRONJ patients were included 34 osteoporosis and 14 bone metastases from 6 lung cancer, 6 breast cancer and 2 rectal cancer. The maximum SUV of the MRONJ patient characteristics were analyzed such as gender, location, underlying disease, medication and staging of MRONJ by Mann-Whitney U test. P-values lower than 0.05 indicate significant differences. RESULTS: Regarding underlying disease, maximum SUV of patients with osteoporosis (18.69 ± 8.57) were significantly higher than those with bone metastases (12.28 ± 4.32, p = 0.005). Furthermore, maximum SUV of MRONJ was a significant difference for medication (denosumab: 13.62 ± 5.70 and minodronate: 22.98 ± 11.73, p = 0.009) and staging of MRONJ (Stage 2: 15.59 ± 8.06 and Stage 3: 21.51 ± 7.15, p = 0.014). CONCLUSION: Maximum SUV assessed by SPECT/CT was significantly increased in MRONJ patients with osteoporosis and Stage 3. Bone SPECT/CT could be an effective tool for the analysis of MRONJ.