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Kotan S, Koç A, Öner Talmaç AG. The current overview of the devices of temporary anchorage placed on the palatal bone: CBCT study. Odontology 2024:10.1007/s10266-024-00931-3. [PMID: 38564121 DOI: 10.1007/s10266-024-00931-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024]
Abstract
Temporary anchorage devices (TADs) are frequently applied to different anatomic areas with different protocols to increase skeletal effects and anchorage in orthodontic treatment planning. It has been reported in many literatures that primary stability for orthodontic TADs is significant for long-term survival rate. For this reason, different areas of the palatal region, which has many indications, have been widely used in the studies. In this evaluation where bone quality and thickness are important, density, bone thickness, and fractal dimension (FD) on cone beam computed tomography (CBCT) will provide more predictable clinical results. The aim of this study was to evaluate bone thickness, density, and FD in the palatal region of the first, and second premolars, and first molars. There was a remarkable difference (p < 0.05) between the parameters of FD, thickness and density of bone in the identified areas in the palatal region. In terms of thickness and FD, the 1st premolar region had significantly higher values than the other regions (p < 0.05). In terms of density, the values in the right 1st molar and right 1st premolar regions were significantly higher (p < 0.05). The 1st premolar region is an ideal site for placement of palatal TADs. CBCT-assisted preliminary evaluation of FD value, bone density, and thickness may increase clinical success when selecting the location of TADs to be applied to the palatal bone.
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Affiliation(s)
- Seda Kotan
- Department of Orthodontics, Faculty of Dentistry, Iğdır University, Iğdır, 76000, Turkey.
| | - Alaettin Koç
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Van Yüzüncü Yıl University, Van, Turkey
| | - Ayşe Gül Öner Talmaç
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Van Yüzüncü Yıl University, Van, Turkey
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Çolak S, Altan A, Bayrak S, Akbulut N. Evaluation of bony changes observed in mandibular osteotomy lines and mandibular condyles following bilateral sagittal ramus osteotomy by fractal analysis. Oral Maxillofac Surg 2023; 27:519-526. [PMID: 35831722 DOI: 10.1007/s10006-022-01101-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/10/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study aimed to evaluate the surgically impacted trabecular changes in mandibular osteotomy lines and mandibular condyles after bilateral sagittal split ramus osteotomy using the fractal analysis method. MATERIALS AND METHOD The study population consisted of 30 patients (9 male, 21 female) diagnosed with mandibular prognathism and operated with bilateral sagittal split ramus osteotomy under general anesthesia. Fractal analyses observed the alterations on the trabecular structure of osteotomy lines, and mandibular condyles on panoramic radiographs obtained preoperatively, postoperatively, 1st week, 6th month, and 12th month. The box-counting method was used to evaluate the changes in trabecular structure by fractal analysis. P-values of less than 0.05 were considered significant. RESULTS The fractal dimension values in both osteotomy lines and mandibular condyles were significantly decreased on postoperative 1st week regarding preoperative values. However, fractal dimension values commenced increasing in the following postoperative period. The fractal dimension values of the horizontal and vertical osteotomy lines reached their preoperative values on postoperative 6th and 12th month, respectively. The decreased fractal dimension values observed in the early postoperative period in the right and left condyles reached their preoperative values at the 6th postoperative month. CONCLUSION Fractal analyses performed postoperatively can provide information about trabecular changes and bone healing of structures such as osteotomy lines directly affected by bilateral sagittal split ramus osteotomy and indirectly affected mandibular condyles. The results support that fractal analysis can be used together with clinical data in the evaluation of bone healing process.
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Affiliation(s)
- Sefa Çolak
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tokat Gaziosmanpasa University, Kaleardi Mahallesi, Muhittin Fisunoglu Caddesi, Omcalik Sokak, Ali Sevki Erek Yerleskesi Dis Hekimligi Fakültesi, Merkez, Tokat, 60030, Turkey.
| | - Ahmet Altan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Konya Necmettin Erbakan University, Beysehir Caddesi, Baglarbası Sk, Meram, Konya, 42090, Turkey
| | - Seval Bayrak
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Bolu Abant Izzet Baysal University, Abant Izzet Baysal Universitesi Dis Hekimligi Fakultesi, Golkoy Kampusu, Bolu, Turkey
| | - Nihat Akbulut
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tokat Gaziosmanpasa University, Kaleardi Mahallesi, Muhittin Fisunoglu Caddesi, Omcalik Sokak, Ali Sevki Erek Yerleskesi Dis Hekimligi Fakültesi, Merkez, Tokat, 60030, Turkey
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Prado HV, Debossan SAT, Loayza KS, Abreu LG, Brasileiro CB, Borges-Oliveira AC. Radiomorphometric indices and fractal dimension of the mandible in individuals with osteogenesis imperfecta: a matched cross-sectional study. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:102-111. [PMID: 36966060 DOI: 10.1016/j.oooo.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/25/2023] [Accepted: 02/04/2023] [Indexed: 02/14/2023]
Abstract
OBJECTIVE The objective was to analyze radiomorphometric indices (RMIs) of mandibular cortical bone and fractal dimension (FD) of trabecular bone of individuals with osteogenesis imperfecta (OI) and compare the findings to those of individuals without OI. METHODS Digital panoramic radiographs of 20 individuals with OI (case group) and 40 individuals without OI (control group) were examined. The RMIs of mandibular cortical index (MCI) and mandibular cortical thickness (MCT) were analyzed. FD of mandibular trabecular bone was calculated bilaterally in 3 regions. The chi-squared test and paired t test were used to compare the significance of differences between the groups. The effect size and minimal clinically important difference (MCID) were also determined. Significance was established at P < .05. RESULTS Categories C2 and C3 of the MCI were more frequent in individuals with OI (P < .001). The Mean MCT was 2.08 ± 0.79 in the OI case group and 2.91 ± 0.60 in the control group (P < .001). Mean FD in the condylar region was significantly lower in the OI case group (P = .002). The effect size for these 2 measures was large, and the difference between groups was greater than the MCID. CONCLUSION Radiographs of individuals with OI exhibited more porosity and diminished thickness of the mandibular cortical bone and lower FD values in the condylar trabecular bone.
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Affiliation(s)
- Heloisa Vieira Prado
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil.
| | - Suélen Alves Teixeira Debossan
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Katherine Silvana Loayza
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Lucas Guimarães Abreu
- Department of Pediatric Dentistry, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Cláudia Borges Brasileiro
- Department of Oral Pathology and Surgery, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Ana Cristina Borges-Oliveira
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Pantoja LLQ, Lustosa M, Yamaguti PM, Rosa LS, Leite AF, Figueiredo PTS, Castro LC, Acevedo AC. Pamidronate Therapy Increases Trabecular Bone Complexity of Mandibular Condyles in Individuals with Osteogenesis Imperfecta. Calcif Tissue Int 2022; 110:303-312. [PMID: 34677656 DOI: 10.1007/s00223-021-00915-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/08/2021] [Indexed: 11/30/2022]
Abstract
Patients with Osteogenesis Imperfecta (OI) present extra-skeletal manifestations, including important orodental and craniofacial features as dentinogenesis imperfecta, dental agenesis, failure of maxilla growth and hypotonia of masticatory muscles. These features may compromise vital functions speech and mastication. Studies have demonstrated that cyclic pamidronate infusion, the standard therapy for patients with moderate to severe OI, influences the histomorphometric pattern of different body bones. The present study aimed to investigate the condyle trabecular bone pattern in OI patients. We used fractal dimension (FD) analysis on dental panoramic radiographic images to characterize the mandibular condyle trabecular bone in adolescents diagnosed with OI and treated with pamidronate. Imaging exam of 33 adolescents of both sexes, aged between 12 and 17 years, were analyzed and compared with 99 age- and sex-matched healthy adolescents. FD in patients was significantly lower (1.23 ± 0.15) than in healthy controls (1.29 ± 0.11; p < 0.01). Type of OI, age at treatment onset, and the duration of therapy were variables that showed a statistically significant effect on the FD results. This study demonstrated that the bone architecture of mandibular condyles may be altered in pediatric patients with moderate and severe forms of OI. Also, pamidronate treatment seems to have a positive effect on condyle trabecular bone in these patients. This is supported by our finding that FD values were positively influenced by the length of cyclic pamidronate treatment at the time of imaging, as well as by the age of the individual at treatment onset.
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Affiliation(s)
| | - Mariana Lustosa
- Oral Care Center for Inherited Diseases, University of Brasília, Brasília, DF, Brazil
| | - Paulo Márcio Yamaguti
- Oral Care Center for Inherited Diseases, University of Brasília, Brasília, DF, Brazil
| | - Lídia S Rosa
- Laboratory of Oral Histopathology, Faculty of Healthy Science, University of Brasília, Brasília, DF, Brazil
| | - André Ferreira Leite
- Oral Care Center for Inherited Diseases, University of Brasília, Brasília, DF, Brazil
- Department of Radiology, Faculty of Healthy Science, University of Brasília, Brasília, DF, Brazil
| | - Paulo Tadeu S Figueiredo
- Oral Care Center for Inherited Diseases, University of Brasília, Brasília, DF, Brazil
- Department of Radiology, Faculty of Healthy Science, University of Brasília, Brasília, DF, Brazil
| | - Luiz Claudio Castro
- Pediatric Endocrinology Department, University Hospital of University of Brasília, Brasília, DF, Brazil
| | - Ana Carolina Acevedo
- Oral Care Center for Inherited Diseases, University of Brasília, Brasília, DF, Brazil.
- Laboratory of Oral Histopathology, Faculty of Healthy Science, University of Brasília, Brasília, DF, Brazil.
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Tosun S, Karataslioglu E, Tulgar MM, Derindag G. Fractal analysis and periapical index evaluation of multivisit nonsurgical endodontic retreatment: A retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:245-251. [PMID: 34556458 DOI: 10.1016/j.oooo.2021.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/20/2021] [Accepted: 08/21/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This retrospective study compared changes in periapical trabecular patterns using fractal analysis and the periapical index (PAI) on the periapical radiographs of patients who underwent multivisit nonsurgical endodontic retreatment of persistent periapical disease. STUDY DESIGN In total, 50 participants were included in the study. For each patient, baseline periapical radiographs were acquired just before retreatment and postoperative radiographs were acquired 1 year later. The region of interest, located in the abnormal tissue around the root apex, was selected from each of the paired radiographs and the fractal dimension (FD) was calculated. Periapical status was classified using the PAI as "healed" (PAI <3) or "unhealed" (PAI ≥3). RESULTS According to the PAI scores, retreatment after 1 year had a healing rate of 70%. In healed cases, the FD values increased significantly (P < .001), whereas FD decreased significantly in unhealed cases (P = .021). Change in FD was significantly different between healed and unhealed cases (P < .001). However, change in FD did not have a significant correlation with PAI in either healed or unhealed cases (P > .05). There was no significant effect of sex on the change in FD values in either healed or unhealed cases (P ≥ .690). CONCLUSIONS The significant differences in FD suggest that this parameter may be useful in detecting increased trabeculation and estimating retreatment prognosis.
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Affiliation(s)
- Samet Tosun
- Assistant Professor, Department of Endodontics, Faculty of Dentistry, Pamukkale University, Denizli, Turkey.
| | - Emrah Karataslioglu
- Associate Professor, Department of Endodontics, Faculty of Dentistry, Katip Çelebi University, İzmir, Turkey
| | - Mustafa Mert Tulgar
- Research Assistant, Department of Endodontics, Faculty of Dentistry, Katip Çelebi University, İzmir, Turkey
| | - Gözde Derindag
- Assistant Professor, Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Pamukkale University, Denizli, Turkey
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Türkmenoğlu A, Yüksel HT, Karahan AY. Evaluation of mandibular condyle trabecular structure in patients with rheumatoid arthritis using fractal analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:229-237. [PMID: 34526250 DOI: 10.1016/j.oooo.2021.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/07/2021] [Accepted: 08/14/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The aim of this study was to compare the fractal dimension (FD) of trabecular structure of the mandibular condyles in patients with rheumatoid arthritis (RA) to patients without RA. Correlations between condylar FD and bone mineral density T-scores in the femoral neck and lumbar spine were also examined. STUDY DESIGN The RA study group patients were divided into 3 categories (33 normal, 33 osteopenic, and 34 osteoporotic) according to T-scores. The control group without RA was sex- and age-matched with the study group. FD was calculated from panoramic radiographs and compared between the study and control groups. The relationships between FD values and femoral neck and L1-L4 lumbar spine T-scores were investigated for study and control groups. Significance was established at P < .05. RESULTS The mean FD values of the entire study group and of each category in the study group were significantly lower than those of the control group (P < .001). There were no significant differences in FD values among the 3 RA categories (P > .05). No significant correlations appeared between FD and femoral neck or lumbar spine T-scores (P ≥ .063). CONCLUSIONS Fractal analysis of the condyles on panoramic radiographs can distinguish RA from healthy condyles, even if the patients with RA have normal bone mineral density T-scores.
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Affiliation(s)
- Ayşegül Türkmenoğlu
- Lecturer, Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Usak University, Uşak, Turkey.
| | - Halil Tolga Yüksel
- Assistant Professor, Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Usak University, Uşak, Turkey
| | - Ali Yavuz Karahan
- Associate Professor, Department of Physical Medicine and Rehabilitation, Training and Research Hospital, Faculty of Medicine, Usak University, Uşak, Turkey
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Tosun S, Karataslioglu E, Tulgar MM, Derindag G. Retrospective fractal analyses of one-year follow-up data obtained after single-visit nonsurgical endodontic retreatment on periapical radiographs. Clin Oral Investig 2021; 25:6465-6472. [PMID: 34302217 DOI: 10.1007/s00784-021-04079-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/12/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of retrospective study was to evaluate the changes to the periapical bone sites after non-surgical endodontic retreatment by using fractal analysis on periapical radiographs. MATERIALS AND METHODS Thirty patients whose teeth had periapical lesions and underwent primary endodontic treatment were selected for nonsurgical single-visit endodontic retreatment. Two radiographs were taken, the first immediately after retreatment and the second at the 1-year follow-up. An identical region of interest close to the infected root apex was selected from each radiograph. FD was measured using the box-counting method. Periapical status was evaluated using the periapical index (PAI). Treatment outcomes were categorized into healed (PAI < 3), or not healed (PAI ≥ 3) based on radiographic criteria. RESULTS The mean FD value significantly increased at the 1-year follow-up compared to baseline. No significant sex biases were apparent. According to the PAI, retreatment after 1 year resulted in a 63.3% healed. CONCLUSION The extent of periapical trabecular bone evident radiographically increased, as revealed by FD data, 1 year after endodontic retreatment. Clinical relevance The use of fractal analysis as a quantitative method to evaluate changes in periapical trabecular bone (such as healing and inflammation) after endodontic retreatment can be an important marker in determining the prognosis of endodontic retreatment.
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Affiliation(s)
- Samet Tosun
- Department of Endodontics, Faculty of Dentistry, Pamukkale University, 20160, Pamukkale, Denizli, Turkey.
| | - Emrah Karataslioglu
- Department of Endodontics, Faculty of Dentistry, Katip Çelebi University, 35300, İzmir, Turkey
| | - Mustafa Mert Tulgar
- Department of Endodontics, Faculty of Dentistry, Katip Çelebi University, 35300, İzmir, Turkey
| | - Gözde Derindag
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Pamukkale University, 20160, Denizli, Turkey
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Akan B, Ünlü Kurşun B. Structural changes in the trabecular bone of the mandibular condyle of growing patients with sagittal jaw discrepancy treated with the twin-block appliance. Orthod Craniofac Res 2021; 25:142-149. [PMID: 34236758 DOI: 10.1111/ocr.12516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 06/30/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the structural changes in the trabecular bone of the mandibular condyles in patients treated with the Twin-block functional orthopaedic appliance that act by promoting condylar growth and to compare the fractal dimension (FD) of condylar trabecular bone structure prior to treatment (T0) and after orthopaedic functional treatment (T1). SETTING AND SAMPLE POPULATION This retrospective study included panoramic images of 112 individuals with a mean age of 11.04 ± 1.30 years in the study group (32 girls and 24 boys) and 11.6 ± .80 years in the control group (29 girls and 27 boys). MATERIALS AND METHODS The standardized region of interest was selected as the right and left condylar areas close to the articulation surfaces from the twin-block (TB) group, which included patients who completed functional orthopaedic treatment and the control group, which included untreated individuals. FD values in the condylar region were analysed from the panoramic radiographs of both groups using a box-counting method with ImageJ software (version 1.52a, US National Institutes of Health). RESULTS There was a significant decrease in the FD values of the right (-.038) and left (-.022) condylar region at T0 and T1 in the TB group. Between-group FD comparisons demonstrated that the TB group showed changes in the condylar region (right, P = .004; left, P = .022) compared to the control group. CONCLUSION Functional orthopaedic forces caused a decrease in the trabecular structure of the condylar area examined.
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Affiliation(s)
- Burçin Akan
- Department of Orthodontics, Faculty of Dentistry, Izmir Katip Celebi University, Izmir, Turkey
| | - Begüm Ünlü Kurşun
- Department of Prosthetic Dentistry, Faculty of Dentistry, Izmir Katip Celebi University, Izmir, Turkey
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Watanabe H, Hayano K, Ohira G, Imanishi S, Hanaoka T, Hirata A, Kano M, Matsubara H. Quantification of Structural Heterogeneity Using Fractal Analysis of Contrast-Enhanced CT Image to Predict Survival in Gastric Cancer Patients. Dig Dis Sci 2021; 66:2069-2074. [PMID: 32691383 DOI: 10.1007/s10620-020-06479-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 07/04/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Malignant tumor essentially implies structural heterogeneity. Fractal analysis of medical imaging has a potential to quantify this structural heterogeneity in the tumor AIMS: The purpose of this study is to quantify this structural abnormality in the tumor applying fractal analysis to contrast-enhanced computed tomography (CE-CT) image and to evaluate its biomarker value for predicting survival of surgically treated gastric cancer patients. METHODS A total of 108 gastric cancer patients (77 men and 31 women; mean age: 69.1 years), who received curative surgery without any neoadjuvant therapy, were retrospectively investigated. Portal-phase CE-CT images were analyzed with use of a plug-in tool for ImageJ (NIH, Bethesda, USA), and the fractal dimension (FD) in the tumor was calculated using a differential box-counting method to quantify structural heterogeneity in the tumor. Tumor FD was compared with clinicopathologic features and disease-specific survival (DSS). RESULTS High FD value of the tumor significantly associated with high T stage and high pathological stage (P = 0.009, 0.007, respectively). In Kaplan-Meier analysis, patients with higher FD tumors (FD > 0.9746) showed a significantly worse DSS (P = 0.009, log rank). Multivariate analysis demonstrated that tumor FD, T stage, and N stage were independent prognostic factors for DSS. In subset analysis of lymph-node positive gastric cancers, only tumor FD was an independent prognostic factor for DSS. CONCLUSION CT fractal analysis can be a useful biomarker for gastric cancer patients, reflecting survival and clinicopathologic features.
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Affiliation(s)
- Hiroki Watanabe
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Koichi Hayano
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.
| | - Gaku Ohira
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Shunsuke Imanishi
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Toshiharu Hanaoka
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Atsushi Hirata
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Masayuki Kano
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan
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Kaba YN, Öner Nİ, Amuk M, Bilge S, Soylu E, Demirbaş AE. Evaluation of trabecular bone healing using fractal dimension analysis after augmentation of alveolar crests with autogenous bone grafts: a preliminary study. Oral Radiol 2021; 38:139-146. [PMID: 34003449 DOI: 10.1007/s11282-021-00536-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate bone remodeling after alveolar crest augmentation with autogenous bone grafts. METHODS 50 patients who were applied augmentation due to alveolar deficiency were included in this study. Fractal dimensions were measured on the radiographs in the preoperative, postoperative, follow-up periods. The ROI was selected specific to each patient, but repeated in a standardized manner on subsequent radiographs. RESULTS A total of 50 patients were included in the study; There were 31 females and 19 males. Implants were placed in all patients without any complications. The mean fractal dimensions on the graft recipient side were statistically higher in the postoperative 5th month compared to the postoperative 1st week (p = 0.002). The mean fractal dimensions on the donor side were statistically higher in the preoperative and postoperative 5th month compared to the postoperative 1st week (p < 0.001). CONCLUSION Any clinical imaging method cannot fully reflect the histological microstructures of the bone. Evaluating the fractal analysis together with the clinical results can demonstrate adequate bone healing and quality prior to implant placement. Fractal analysis is a non-invasive, reproducible, method but further, prospective, randomized, controlled clinical studies are needed to estimate bone quality prior to implant placement.
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Affiliation(s)
- Yusuf Nuri Kaba
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Melikgazi, Turkey
| | - Neşe İspekter Öner
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Melikgazi, Turkey. .,Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Turkey.
| | - Mehmet Amuk
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Melikgazi, Turkey
| | - Suheyb Bilge
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Melikgazi, Turkey
| | - Emrah Soylu
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Melikgazi, Turkey
| | - Ahmet Emin Demirbaş
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Melikgazi, Turkey
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Madlum DV, Gaêta-Araujo H, Brasil DM, Lima CAS, Oliveira ML, Haiter-Neto F. Influence of the file format and transmission app on the radiographic diagnosis of caries lesions. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:448-455. [PMID: 33386287 DOI: 10.1016/j.oooo.2020.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/17/2020] [Accepted: 11/29/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This in vitro study aimed to evaluate the influence of the radiographic image file format and the transmission application (app) on the diagnosis of proximal caries lesions. STUDY DESIGN Twenty bitewing radiographs of 40 posterior human teeth placed in phantoms were acquired using the Digora Toto digital sensor. All images were exported as TIFF (Tagged Image File Format), BMP (Windows Bitmap), PNG (Portable Network Graphics), and JPEG (Joint Photographic Experts Group) and transmitted online via WhatsApp and Messenger. Five examiners evaluated the radiographs with no online transmission and as transmitted through the 2 apps for the presence of proximal caries lesions using a 5-point scale. The reference standard for caries lesions was established using micro-computed tomography. Two-way analysis of variance compared values of sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (α = .05). The kappa test was used to assess intra- and interexaminer agreement. RESULTS Sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve values showed no significant differences in the diagnosis of proximal caries lesions between the different image file formats (P ≥ .773) and transmission apps (P ≥ .608). Intraexaminer agreement was substantial (κ = 0.742) and interexaminer agreement was moderate (κ = 0.475). CONCLUSION The digital file format and transmission app did not influence the radiographic diagnosis of proximal caries lesions.
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Affiliation(s)
- Daniela Verardi Madlum
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.
| | - Hugo Gaêta-Araujo
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Danieli Moura Brasil
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Carlos Augusto Souza Lima
- Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Division of Oral Radiology, Campinas, Brazil
| | - Matheus L Oliveira
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Francisco Haiter-Neto
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
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12
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Hayek E, Aoun G, Geha H, Nasseh I. Image-based Bone Density Classification Using Fractal Dimensions and Histological Analysis of Implant Recipient Site. Acta Inform Med 2020; 28:272-277. [PMID: 33627929 PMCID: PMC7879433 DOI: 10.5455/aim.2020.28.272-277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Success of dental implants is affected by the quality and density of the alveolar bone. These parameters are essential for implant stability and influence its load-bearing capacity. Their assessment is usually based on preoperative radiographs used as a tool prior to implant procedures. Objective: The aim of the study was to compare the bone density of surgically harvested bone specimens at implant recipient sites in the maxillary and mandibular posterior region using histological analysis to the radiographic bone density using fractal dimension for reliability and determining an image based classification of bone density prior surgery. Methods: Fifty implants were placed in the posterior region of male patients, (twenty five implants in the maxilla and twenty five in the mandible). The edentulous regions were presurgically assessed using Photo Stimulable Phosphor Plate (PSP) intra-oral radiographs and the fractal dimension box counting of region of interest was calculated at the implant recipient site. During surgery, bone core specimens were trephined, and bone densities and minerals parameters were evaluated based on histological analysis using SEM (Scanning Electron Microscopy), and atomic absorption spectrometry. Results: Fractal dimensions (FD) values for the same region of interest (ROI) selected on the radiographs of bone blocks and edentulous sites were different but showed a proportional variation in molar and premolar region of the maxilla and mandible. Bone density results, calculated by the ratio of bone mass (BM) to the bone volume (BV) of the bone core specimen (D=M/V), increased in the mandibular bone blocks, and decreased in the maxilla specimens. Moreover, fractal dimension values of preoperative radiographs at implant recipient sites and bone density of trephined showed a statistically similar distribution. However, no significant difference was shown in the percentage of minerals contents and mass of calcium phosphate of each bone specimen between maxilla and mandible based on scanning electron microscopy analysis. Four types of bone densities were classified according to the distribution of FD values based on preoperative radiographs and on the densities of bone cores calculations. Conclusion: Radiographic estimation of bone quality calculated with fractal dimension could be a useful, non-invasive tool when using preoperative intra-oral radiographs to predict bone density at implant recipient sites with caution and limits concerning the kind of digital radiographs and size of region of interest, especially when these results were based with bone specimens harvested from implant site as an absolute reference.
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Affiliation(s)
- Elie Hayek
- Department of Oral Medicine and Maxillofacial Radiology, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| | - Georges Aoun
- Department of Oral Medicine and Maxillofacial Radiology, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| | - Hassem Geha
- Department of Comprehensive Dentistry, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Ibrahim Nasseh
- Department of Oral Medicine and Maxillofacial Radiology, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
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13
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Kato CN, Barra SG, Tavares NP, Amaral TM, Brasileiro CB, Mesquita RA, Abreu LG. Use of fractal analysis in dental images: a systematic review. Dentomaxillofac Radiol 2019; 49:20180457. [PMID: 31429597 DOI: 10.1259/dmfr.20180457] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES This study reviewed the use of fractal analysis (FA) in dental images. METHODS A search was performed using PubMed, MEDLINE, LILACS, Web of Science and SCOPUS databases. The inclusion criteria were human studies in the English language, with no date restriction. RESULTS 78 articles were found in which FA was applied to panoramic radiographs (34), periapical radiographs (21), bitewing radiographs (4), cephalometric radiograph (1), cone beam CT (15), micro-CT (3), sialography (2), and ultrasound (2). Low bone mineral density (21) and systemic or local diseases (22) around the bone of dental implants were the main subjects of the study of FA. Various sizes and sites of the regions of interest were used to evaluate the bone structure. Different ways were used to treat the image and to calculate FA. FA of 43 articles showed significant differences in the comparison of groups, mainly between healthy and sick patients. CONCLUSIONS FA in Dentistry has been widely applied to the study of images. Panoramic and periapical radiographs were those most frequently used. The Image J software and the box-counting method were extensively adopted in the studies reviewed herein. Further studies are encouraged to improve clarification of the parameters that directly influence FA.
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Affiliation(s)
- Camila Nao Kato
- Department of Oral Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Sâmila G Barra
- Department of Oral Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Núbia Pk Tavares
- Department of Oral Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Tânia Mp Amaral
- Department of Oral Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Cláudia B Brasileiro
- Department of Oral Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo A Mesquita
- Department of Oral Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Lucas G Abreu
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Toghyani S, Nasseh I, Aoun G, Noujeim M. Effect of Image Resolution and Compression on Fractal Analysis of the Periapical Bone. Acta Inform Med 2019; 27:167-170. [PMID: 31762572 PMCID: PMC6853732 DOI: 10.5455/aim.2019.27.167-170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction: Fractal dimension (FD) on periapical radiographs is used as a simple descriptor of the complex architecture of the trabecular bone surrounding the dentition. It is used on periapical and panoramic radiographs as a descriptor of the complex architecture of trabecular bone surrounding teeth. Aim: The aim of this study was to evaluate the effect of image resolution and different compression levels on fractal dimension of alveolar bone with images obtained using storage phosphor plate (SPP) system. Methods: Periapical images of premolar and molar teeth on both sides of three dry human mandibles were obtained with Digora Optime (Soredex Corp., Helsinki, Finland) SPP system. The SPPs were exposed equally and scanned immediately after exposure with standard, high and very high resolutions. All the images then were compressed and saved by degrees of 0%, 25%, 50%, 75% and 90%. FD was calculated using public domain software (ImageJ with FracLac plug-in) on two non-overlapping regions of interest (ROIs) on premolar and molar periapical bone areas of each radiograph using differential box-counting method. The ROIs on corresponding images were of the same size and position. FDs were compared using two-way ANOVA and Tukey–Kramer multiple comparison tests (p=0.05). Results: There was no significant difference in FD calculations in different levels of compression for all the resolutions. Images obtained with high resolution scans showed significantly lower variation in FD values compared to very high and standard resolutions for all compressions (p<0.0001). Conclusion: The high resolution demonstrated the lowest variation in FD values in all levels of compression which makes it the most reliable and consistent resolution for measuring the FD values. The level of compression does not make a significant difference in FD values for all the scan resolutions. Scanning resolution of SPPs should be carefully chosen when evaluating the change in FD of alveolar bone for various bone disorders.
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Affiliation(s)
- Shiva Toghyani
- Oral and Maxillofacial Radiology, Department of Diagnosis and Oral Health, University of Louisville, School of Dentistry, USA
| | - Ibrahim Nasseh
- Department of Dento-Maxillo-Facial Radiology, Oral and Maxillofacial Radiology Postgraduate Program, Lebanese University, Faculty of Dental Medicine, Lebanon
| | - Georges Aoun
- Department of Oral Medicine and Dento-Maxillo-Facial Radiology, Lebanese University, Faculty of Dental Medicine, Lebanon
| | - Marcel Noujeim
- Department of Oral and Maxillofacial Radiology, University of Texas Health Science Center San Antonio, Texas, USA
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15
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de Molon RS, de Paula WN, Spin-Neto R, Verzola MHA, Tosoni GM, Lia RCC, Scaf G, Marcantonio E. Correlation of fractal dimension with histomorphometry in maxillary sinus lifting using autogenous bone graft. Braz Dent J 2016; 26:11-8. [PMID: 25672378 DOI: 10.1590/0103-6440201300290] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 12/11/2014] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to determine the pattern of bone remodeling after maxillary sinus lifting in humans by means of fractal dimension (FD) and histomorphometric analysis. Therefore, the correlation between FD and the histomorphometric findings was evaluated. Sixteen patients with posterior edentulous maxilla were enrolled in this study. Maxillary sinus lifting was performed using autogenous bone grafted from the mandibular retromolar area. Three direct digital panoramic radiographs were obtained: before surgery (Group 1), immediately postoperatively (Group 2) and after 6 months of healing (Group 3) for FD analysis. Biopsies were taken after 6 months, processed and submitted to histological and histomorphometric analysis. Data were analyzed by Shapiro-Wilk test and ANOVA test followed by a Tukey test (a = 0.05). The bone volume fraction of newly trabecular bone (TB) and medullary area (MA) was measured as 62.75% ± 17.16% and 37.25 ± 17.16%, respectively. Significant difference in FD analysis was measured between Group 1 and Group 3. No significant difference was found in the correlation between FD and histomorphometric analysis for TB and MA (p = 0.84). In conclusion, all performed analyses were effective in assessing the bone-remodeling pattern in the maxillary sinus, offering complementary information about healing and predictable outcomes. There were no correlations between FD and histomorphometric analysis.
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Affiliation(s)
- Rafael Scaf de Molon
- Department of Diagnosis and Surgery, Araraquara Dental School, UNESP - Univ Estadual Paulista, Araraquara, SP, Brazil
| | - Wagner Nunes de Paula
- Department of Diagnosis and Surgery, Araraquara Dental School, UNESP - Univ Estadual Paulista, Araraquara, SP, Brazil
| | - Rubens Spin-Neto
- Oral Radiology, Department of Dentistry, Aarhus University, Aarhus, Denmark
| | - Mario Henrique Arruda Verzola
- Department of Diagnosis and Surgery, Araraquara Dental School, UNESP - Univ Estadual Paulista, Araraquara, SP, Brazil
| | - Guilherme Monteiro Tosoni
- Department of Diagnosis and Surgery, Araraquara Dental School, UNESP - Univ Estadual Paulista, Araraquara, SP, Brazil
| | | | - Gulnara Scaf
- Department of Diagnosis and Surgery, Araraquara Dental School, UNESP - Univ Estadual Paulista, Araraquara, SP, Brazil
| | - Elcio Marcantonio
- Department of Diagnosis and Surgery, Araraquara Dental School, UNESP - Univ Estadual Paulista, Araraquara, SP, Brazil
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Arsan B, Köse TE, Çene E, Özcan İ. Assessment of the trabecular structure of mandibular condyles in patients with temporomandibular disorders using fractal analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 123:382-391. [PMID: 28110941 DOI: 10.1016/j.oooo.2016.11.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 10/06/2016] [Accepted: 11/12/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate changes in the trabecular structure of the mandibular condyle in patients with temporomandibular disorders (TMDs) using fractal analysis. STUDY DESIGN A total of 100 patients ages 18 to 73 years were clinically assessed using the Diagnostic Criteria for Temporomandibular Disorders. The control group was age- and sex-matched with the patient group. Panoramic radiographs were obtained using a Kodak 8000 digital device with 73 kVp and 5 mA fixed parameters. The degree of degeneration in the mandibular condyles was calculated. Regions of interest (84 × 84 pixels) were selected within the cortical boundary of the mandibular condyle, and the fractal dimension (FD) was calculated using ImageJ version 1.48. RESULTS Radiographic degenerative changes were more frequently present and more severe in the patient group (P < .001). The mean value of FD was 1.22 ± 0.06 in the patient group and 1.25 ± 0.06 in the control group (P = .001). A significant decrease in FD was observed (P = .001) in the left temporomandibular joints of the patient group, whereas a nonsignificant decrease in FD was observed in the right temporomandibular joints (P = .073) as degenerative changes increased. CONCLUSIONS Lower FD values were associated with more severe degenerative changes in the patient group. The trabecular structure of condyles in patients with TMD exhibited decreased complexity when erosive and sclerotic changes were evident. As a result, fractal analysis enhanced the use of panoramic radiography in detecting degenerative changes in patients with TMD.
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Affiliation(s)
- Belde Arsan
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Okan University, Istanbul, Turkey.
| | - Taha Emre Köse
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Erhan Çene
- Department of Statistics, Yıldız Technical University, İstanbul, Turkey
| | - İlknur Özcan
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
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Hiroshima Y, Shuto K, Yamazaki K, Kawaguchi D, Yamada M, Kikuchi Y, Kasahara K, Murakami T, Hirano A, Mori M, Kosugi C, Matsuo K, Ishida Y, Koda K, Tanaka K. Fractal Dimension of Tc-99m DTPA GSA Estimates Pathologic Liver Injury due to Chemotherapy in Liver Cancer Patients. Ann Surg Oncol 2016; 23:4384-4391. [PMID: 27439417 DOI: 10.1245/s10434-016-5441-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Chemotherapy-induced liver injury after potent chemotherapy is a considerable problem in patients undergoing liver resection. The aim of this study was to assess the relationship between the fractal dimension (FD) of Tc-99m diethylenetriaminepentaacetic acid (DTPA) galactosyl human serum albumin (GSA) and pathologic change of liver parenchyma in liver cancer patients who have undergone chemotherapy. METHODS We examined 34 patients (10 female and 24 male; mean age, 68.5 years) who underwent hepatectomy. Hepatic injury was defined as steatosis more than 30 %, grade 2-3 sinusoidal dilation, and/or steatohepatitis Kleiner score ≥4. Fractal analysis was applied to all images of Tc-99m DTPA GSA using a plug-in tool on ImageJ software (NIH, Bethesda, MD). A differential box-counting method was applied, and FD was calculated as a heterogeneity parameter. Correlations between FD and clinicopathological variables were examined. RESULTS FD values of patients with steatosis and steatohepatitis were significantly higher than those without (P > .001 and P > .001, respectively). There was no difference between the FD values of patients with and without sinusoidal dilatation (P = .357). Multivariate logistic regression showed FD as the only significant predictor for steatosis (P = .005; OR 36.5; 95 % CI 3.0-446.3) and steatohepatitis (P = .012; OR, 29.1; 95 % CI 2.1-400.1). CONCLUSIONS FD of Tc-99m DTPA GSA was the significant predictor for fatty liver disease in patients who underwent chemotherapy. This new modality is able to differentiate steatohepatitis from steatosis; therefore, it may be useful for predicting chemotherapy-induced pathologic liver injury.
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Affiliation(s)
- Yukihiko Hiroshima
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Kiyohiko Shuto
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Kazuto Yamazaki
- Department of Pathology, Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Daisuke Kawaguchi
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Masatoshi Yamada
- Department of Pathology, Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Yutaro Kikuchi
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Kohei Kasahara
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Takashi Murakami
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Atsushi Hirano
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Mikito Mori
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Chihiro Kosugi
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Kenichi Matsuo
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Yasuo Ishida
- Department of Pathology, Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Keiji Koda
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan
| | - Kuniya Tanaka
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan.
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Fractal analysis of contrast-enhanced CT images to predict survival of patients with hepatocellular carcinoma treated with sunitinib. Dig Dis Sci 2014; 59:1996-2003. [PMID: 24563237 DOI: 10.1007/s10620-014-3064-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 02/05/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intratumoral heterogeneity is a well-recognized feature of malignancy. AIMS To assess the heterogeneity of tumor using fractal analysis of contrast-enhanced computed tomography (CE-CT) images for predicting survival of hepatocellular carcinoma (HCC) patients treated with sunitinib. METHODS The patient cohort comprised 23 patients (19 men, 4 women; mean age 61.5 years) with HCC who underwent CE-CT at baseline and after one cycle of sunitinib. Arterial-phase (AP) and portal-phase (PP) CE-CT images were analyzed using a plugin software for ImageJ (NIH, Bethesda, MD). A differential box-counting method was employed to calculate the fractal dimension (FD) of the tumor. Tumor FD, density, and size were compared with survival. RESULTS Median progression-free survival (PFS) was 4.43 months. Patients were grouped into a favorable PFS (PFS >4.43 months; 9 patients) and an unfavorable PFS group (PFS ≤ 4.43; 13 patients). The baseline FD on both the AP and PP images was lower in the favorable PFS group than in the unfavorable PFS group (both P = 0.03). There was a significant difference in the change of the FD on the AP image between the favorable and unfavorable PFS groups (P = 0.02). Tumor density and size showed no significant correlations with PFS. In the Kaplan-Meier analysis, patients with tumors showing lower FD on the AP image at baseline showed longer PFS (P = 0.002). Patients with tumors showing a greater reduction in the FD on the PP image after one cycle of the therapy showed longer overall survival (P = 0.002). CONCLUSION The FD of the tumor on CE-CT images may be a useful biomarker for HCC patients treated with sunitinib.
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