Accuracy of magnetic resonance imaging compared with computed tomography for implant planning

Magnetic resonance imaging for jawbone assessment: a systematic review

PURPOSE

To evaluate the accuracy of magnetic resonance imaging (MRI) for jawbone assessment compared to reference-standard measurements in the literature.

MATERIALS AND METHODS

An electronic database search was conducted in PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Library in June 2022, and updated in August 2023. Studies evaluating the accuracy of MRI for jawbone assessment compared with reference-standard measurements (histology, physical measurements, or computed tomography) were included. The outcome measures included bone histomorphometry and linear measurements. The risk of bias was assessed by the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). The review was registered in the PROSPERO database (CRD42022342697).

RESULTS

From 63 studies selected for full-text analysis, nine manuscripts were considered eligible for this review. The studies included assessments of 54 participants, 35 cadavers, and one phantom. A linear measurement error ranging from 0.03 to 3.11 mm was shown. The accuracy of bone histomorphometry varies among studies. Limitations of the evidence included heterogeneity of MRI protocols and the methodology of the included studies.

CONCLUSION

Few studies have suggested the feasibility of MRI for jawbone assessment, as MRI provides comparable results to those of standard reference tests. However, further advancements and optimizations are needed to increase the applicability, validate the efficacy, and establish clinical utility of these methods.

Normative Measurements of L1 to S1 Neuroforaminal Dimensions Derived From Plain Film Radiography, Computed Tomography, and Magnetic Resonance Imaging

STUDY DESIGN

Retrospective cohort.

OBJECTIVE

To report normative measurements of L1 to S1 lumbar neuroforamina on plain film radiography (PFR), computed tomography (CT), and magnetic resonance imaging (MRI), accounting for patients' sex and ethnicity.

BACKGROUND

The quantitative criteria fothe diagnosis of neuroforaminal stenosis remains unknown. Acquiring a thorough understanding of normative foraminal dimensions is a key step in formulating objective parameters for neuroforaminal stenosis.

PATIENTS AND METHODS

We measured 988 images from 494 patients between 18 and 35 years old without spinal pathology who received PFR, CT, or MRI within 1 year of each other. Neuroforaminal measurements were defined as the height, area, and sagittal and axial widths. Statistical analyses were performed to assess relationships among PFR, CT, and MRI-derived neuroforaminal measurements, as well as the influence of patients' sex and ethnicity.

RESULTS

330 PFR, 377 CT, and 281 MRI were measured. Of these, 213 PFR and CT, 117 PFR and MRI, and 164 MRI and CT intrapatient images were compared. Statistically significant differences were observed among PFR, CT, and MRI measurements across all levels L1 to S1. PFR measurements were larger compared with those derived from CT and MRI. Weak-to-moderate correlations were observed between PFR and CT, PFR and MRI, and CT and MRI, with the magnitude of correlation decreasing caudally from L1 to S1. Variations in neuroforaminal anatomy were observed based on sex and ethnicity.

CONCLUSION

This study reports 25,951 measurements of normal L1 to S1 neuroforaminal anatomy assessed by PFR, CT, and MRI. The values reported in this study may be used as normative reference measurements of the lumbar neuroforamina. PFR measurements of the neuroforamina are larger compared with those derived from CT and MRI across all levels from L1 to S1. There is a poor correlation between PFR, CT, and MRI when measuring the lumbar neuroforamina. Differences in neuroforaminal anatomy are evident based on patients' sex and ethnicity.

Correlation among alveolar bone assessments provided by CBCT, micro-CT, and 14 T MRI

Objectives:

The aim of this study was to evaluate bone mineral adipose tissue (BMAT) volume in 21 alveolar bone specimens, as determined by 14 T magnetic resonance imaging (MRI), and correlate them to the radiodensity values obtained preoperatively of regions of interest by cone beam computed tomography (CBCT), and to the BV/TV ratio values obtained by micro-CT, the gold-standard for morphometric data collection.

Methods:

Partially edentulous patients were submitted to a CBCT scan, and the radiographic bone densities in each ROI were automatically calculated using coDiagnostiX software. Based on the CBCT surgical planning, a CAD/CAM stereolithographic surgical guide was fabricated to retrieve a bone biopsy from the same ROIs scanned preoperatively, and then to orientate the subsequent implant placement. The alveolar bone biopsies were then collected and scanned using the micro-CT and 14 T MRI techniques. Pearson’s correlation test was performed to correlate the results obtained using the three different techniques.

Results:

In the 21 eligible bone specimens (6 females, 15 males), age (mean age 52.9 years), micro-CT, and 14 T MRI variables were found to be normally distributed (p > 0.05). The strongest—and only statistically significant (p < 0.05)—correlation was found between micro-CT and 14 T MRI values (r = 0.943), and the weakest, between 14 T MRI and CBCT values (r = –0.068).

Conclusions:

The findings suggest that 14 T MRI can be used to evaluate BMAT as an indirect marker for bone volume, and that CBCT is not a reliable technique to provide accurate bone density values.

Influence of receiver bandwidth on MRI artifacts caused by orthodontic brackets composed of different alloys

Purpose

The aim of this in vitro study was to assess the role of bandwidth on the area of magnetic resonance imaging (MRI) artifacts caused by orthodontic appliances composed of different alloys, using different pulse sequences in 1.5 T and 3.0 T magnetic fields.

Materials and Methods

Different phantoms containing orthodontic brackets (ceramic, ceramic bracket with a stainless-steel slot, and stainless steel) were immersed in agar gel and imaged in 1.5 T and 3.0 T MRI scanners. Pairs of gradient-echo (GE), spin-echo (SE), and ultrashort echo time (UTE) pulse sequences were used differing in bandwidth only. The area of artifacts from orthodontic devices was automatically estimated from pixel value thresholds within a region of interest (ROI). Mean values for similar pulse sequences differing in bandwidth were compared at 1.5 T and 3.0 T using analysis of variance.

Results

The comparison of groups revealed a significant inverse association between bandwidth values and artifact areas of the stainless-steel bracket and the self-ligating ceramic bracket with a stainless-steel slot (P<0.05). The areas of artifacts from the ceramic bracket were the smallest, but were not reduced significantly in pulse sequences with higher bandwidth values (P<0.05). Significant differences were also observed between 1.5 T and 3.0 T MRI using SE and UTE, but not using GE 2-dimensional or 3-dimensional pulse sequences.

Conclusion

Higher receiver bandwidth might be indicated to prevent artifacts from orthodontic appliances in 1.5 T and 3.0 T MRI using SE and UTE pulse sequences.

Trabecular Bone Assessment Using Magnetic-Resonance Imaging: A Pilot Study

The aim of this study was to assess trabecular bone morphology via magnetic-resonance imaging (MRI) using microcomputed tomography (µCT) as the control group. Porcine bone samples were scanned with T1-weighted turbo spin echo sequence imaging, using TR 25 ms, TE 3.5 ms, FOV 100 × 100 × 90, voxel size 0.22 × 0.22 × 0.50 mm, and scan time of 11:18. µCT was used as the control group with 80 kV, 125 mA, and a voxel size of 16 µm. The trabecular bone was segmented on the basis of a reference threshold value and morphological parameters. Bone volume (BV), Bone-volume fraction (BvTv), Bone specific surface (BsBv), trabecular thickness (TbTh), and trabecular separation (TbSp) were evaluated. Paired t-test and Pearson correlation test were performed at p = 0.05. MRI overestimated BV, BvTv, TbTh, and TbSp values. BsBv was the only parameter that was underestimated by MRI. High statistical correlation (r = 0.826; p < 0.05) was found for BV measurements. Within the limitations of this study, MRI overestimated trabecular bone parameters, but with a statistically significant fixed linear offset.

Use of dental MRI for radiation-free guided dental implant planning: a prospective, in vivo study of accuracy and reliability

OBJECTIVES

To evaluate the accuracy and reliability of dental MRI for static guided implant surgery planning.

MATERIALS AND METHODS

In this prospective study, a 0.4-mm isotropic, artifact-suppressed, 3T MRI protocol was used for implant planning and surgical guide production in participants in need of dental implants. Two dentists decided on treatment plan. Surgical guides were placed intraorally during a subsequent reference cone beam computed tomography (CBCT) scan. Inter-rater and inter-modality agreement were assessed by Cohen's kappa. For each participant, dental MRI and CBCT datasets were co-registered to determine three-dimensional and angular deviations between planned and surgically guided implant positions.

RESULTS

Forty-five implants among 30 study participants were planned and evaluated (17 women, 13 men, mean age 56.9 ± 13.1 years). Inter-rater agreement (mean κ 0.814; range 0.704-0.927) and inter-modality agreement (mean κ 0.879; range 0.782-0.901) were both excellent for the dental MRI-based treatment plans. Mean three-dimensional deviations were 1.1 ± 0.7 (entry point) and 1.3 ± 0.7 mm (apex). Mean angular deviation was 2.4 ± 1.5°. CBCT-based adjustments of MRI plans were necessary for implant position in 29.5% and for implant axis in 6.8% of all implant sites. Changes were larger in the group with shortened dental arches compared with those for tooth gaps. Except for one implant site, all guides were suitable for clinical use.

CONCLUSION

This feasibility study indicates that dental MRI is reliable and sufficiently accurate for surgical guide production. Nevertheless, more studies are needed to increase its accuracy before it can be used for implant planning outside clinical trials.

KEY POINTS

• An excellent reliability for the dental MRI-based treatment plans as well as agreement between dental MRI-based and CBCT-based (reference standard) decisions were noted. • Ideal implant position was not reached in all cases by dental MRI plans. • For all but one implant site surgical guides derived from dental MRI were sufficiently accurate to perform implant placement (mean three-dimensional deviations were 1.1 ± 0.7 (entry point) and 1.3 ± 0.7 mm (apex); mean angular deviation was 2.4 ± 1.5°).

Estimating bone mineral density using MRI in medicine and dentistry: a literature review

OBJECTIVES

Studies performed in the medical area have shown that an indirect diagnosis of bone mineral density (BMD) is feasible by assessing the amount of bone marrow fat with non-ionizing magnetic resonance imaging (MRI). In dentistry, radiographic methods are still the most used for alveolar bone diagnosis. The present literature review aimed at addressing the role of MRI in assessing BMD in medicine and dentistry.

METHODS

MEDLINE and EMBASE databases were searched for articles published up to 2019.

RESULTS

A total of 428 potentially eligible papers were screened. Of these, 397 were excluded after title, abstract and keyword assessment, yielding 31 papers that potentially met the inclusion criteria. Eleven studies were then excluded because their full texts did not discuss the role of MRI in the indirect diagnosis of BMD. As a result, a total of 20 studies were finally identified as eligible for inclusion in this literature review. Most studies found satisfactory accuracy of MRI for indirectly assessing BMD by quantifying bone mineral fat (BMF). However, only one of these studies was on dentistry.

CONCLUSION

Within the limitations of this study, the present findings suggest that MRI is accurate to indirectly estimate bone density by assessing BMF, and could be clinically relevant during dental treatment planning.

Correlation between magnetic resonance imaging and cone-beam computed tomography for maxillary sinus graft assessment

Purpose

Little is known regarding the accuracy of clinical magnetic resonance imaging (MRI) protocols with acceptable scan times in sinus graft assessment. The aim of this study was to evaluate the correlations between MRI and cone-beam computed tomographic (CBCT) measurements of maxillary sinus grafts using 2 different clinical MRI imaging protocols.

Materials and Methods

A total of 15 patients who underwent unilateral sinus lift surgery with biphasic calcium phosphate were included in this study. CBCT, T1-weighted MRI, and T2-weighted MRI scans were taken 6 months after sinus lift surgery. Linear measurements of the maximum height and buccolingual width in coronal images, as well as the maximum anteroposterior depth in sagittal images, were performed by 2 trained observers using CBCT and MRI Digital Imaging and Communication in Medicine files. Microcomputed tomography (micro-CT) was also performed to confirm the presence of bone tissue in the grafted area. Correlations between MRI and CBCT measurements were assessed with the Pearson test.

Results

Significant correlations between CBCT and MRI were found for sinus graft height (T1-weighted, r=0.711 and P<0.05; T2-weighted, r=0.713 and P<0.05), buccolingual width (T1-weighted, r=0.892 and P<0.05; T2-weighted, r=0.956 and P<0.05), and anteroposterior depth (T1-weighted, r=0.731 and P<0.05; T2-weighted, r=0.873 and P<0.05). The presence of bone tissue in the grafted areas was confirmed via micro-CT.

Conclusion

Both MRI pulse sequences tested can be used for sinus graft measurements, as strong correlations with CBCT were found. However, correlations between T2-weighted MRI and CBCT were slightly higher than those between T1-weighted MRI and CBCT.

Comparison of MRI with dedicated head and neck signal amplification coil and cone beam computed tomography: MRI is a useful tool in diagnostics of cranio-facial growth disorders

OBJECTIVE

Magnetic resonance imaging (MRI) shows excellent image quality for the depiction of soft tissues and is therefore an important imaging technique in medical diagnostics. However, the practical simultaneous presentation of hard and soft tissue structures of the mouth, jaw and facial area is not fully satisfactory at this time. We investigated the image quality of 1.5 T MRI using a dedicated signal amplifying coil for the application in the oral and maxillofacial field of and compared it with cone beam computed tomography (CBCT). We hypothesized that imaging quality for growth disorders of the facial skull does not differ significantly between the two imaging techniques.

MATERIALS AND METHODS

12 patients were consecutively enrolled into this study between 01/2016 and 12/2017. Patients received diagnostic imaging for clinical indications using 1,5 T MRI using a dedicated head and neck coil for signal amplification as well as an CBCT. For each patient 5 different MRI sequences and one CBCT protocol were assessed. Images were evaluated by a radiologist and a dentist in consensus. On the basis of 51 anatomical structures and orthodontic, cephalometric reference points, the five datasets were subjectively rated and compared to the CBCT dataset.

RESULTS

Patient age was in the range of 19-78 years. 2614 (69.8%) out of 3744 possible valuations were assessable. Compared to CBCT, MRI images were rated to have a superior image quality of presentation for 42 out of 51 anatomic structures (p < 0.05). Notably, 5 out of 51 structures were not assessable due to missing values. T1-weighted MRI images were rated superiorly to T2-weighted images in displaying anatomically relevant landmarks in the oral and maxillofacial field. MRI datasets were inferior in imaging cephalometric and orthodontic reference points in comparison to CBCT images.

CONCLUSION

In conclusion, this pilot study demonstrates that radiation-free dental MRI enables a reliable detection of important anatomical structures. Thus, the signal amplified MRI presents a radiation-free imaging alternative to established CBCT in craniofacial growth disorders protocols. However, imaging quality in MRI datasets remains inferior to CBCT images for cephalometric and orthodontic reference points.

In vivo accuracy of tooth surface reconstruction based on CBCT and dental MRI-A clinical pilot study

OBJECTIVES

Guided implant surgery (GIS) requires alignment of virtual models to reconstructions of three-dimensional imaging. Accurate visualization of the tooth surfaces in the imaging datasets is mandatory. In this prospective clinical study, in vivo tooth surface accuracy was determined for GIS using cone-beam computed tomography (CBCT) and dental magnetic resonance imaging (dMRI).

MATERIALS AND METHODS

CBCT and 3-Tesla dMRI were performed in 22 consecutive patients (mean age: 54.4 ± 15.2 years; mean number of restorations per jaw: 6.7 ± 2.7). Altogether, 92 teeth were included (31 incisor, 29 canines, 20 premolars, and 12 molars). Surfaces were reconstructed semi-automatically and registered to a reference standard (3D scans of stone models made from full-arch polyether impressions). Reliability of both methods was assessed using intraclass correlation coefficients. Accuracy was evaluated using the two one-sided tests procedure with a predefined equivalence margin of ±0.2 mm root mean square (RMS).

RESULTS

Inter- and intrarater reliability of tooth surface reconstruction were comparable for CBCT and dMRI. Geometric deviations were 0.102 ± 0.042 mm RMS for CBCT and 0.261 ± 0.08 mm RMS for dMRI. For a predefined equivalence margin, CBCT and dMRI were statistically equivalent. CBCT, however, was significantly more accurate (p ≤ .0001). For both imaging techniques, accuracy did not differ substantially between different tooth types.

CONCLUSION

Cone-beam computed tomography is an accurate and reliable imaging technique for tooth surfaces in vivo, even in the presence of metal artifacts. In comparison, dMRI in vivo accuracy is lower. Still, it allows for tooth surface reconstruction in satisfactory detail and within acceptable acquisition times.

Differentiation of periapical granulomas and cysts by using dental MRI: a pilot study

The purpose of this pilot study was to evaluate whether periapical granulomas can be differentiated from periapical cysts in vivo by using dental magnetic resonance imaging (MRI). Prior to apicoectomy, 11 patients with radiographically confirmed periapical lesions underwent dental MRI, including fat-saturated T2-weighted (T2wFS) images, non-contrast-enhanced T1-weighted images with and without fat saturation (T1w/T1wFS), and contrast-enhanced fat-saturated T1-weighted (T1wFS+C) images. Two independent observers performed structured image analysis of MRI datasets twice. A total of 15 diagnostic MRI criteria were evaluated, and histopathological results (6 granulomas and 5 cysts) were compared with MRI characteristics. Statistical analysis was performed using intraclass correlation coefficient (ICC), Cohen's kappa (κ), Mann-Whitney U-test and Fisher's exact test. Lesion identification and consecutive structured image analysis was possible on T2wFS and T1wFS+C MRI images. A high reproducibility was shown for MRI measurements of the maximum lesion diameter (intraobserver ICC = 0.996/0.998; interobserver ICC = 0.997), for the "peripheral rim" thickness (intraobserver ICC = 0.988/0.984; interobserver ICC = 0.970), and for all non-quantitative MRI criteria (intraobserver-κ = 0.990/0.995; interobserver-κ = 0.988). In accordance with histopathological results, six MRI criteria allowed for a clear differentiation between cysts and granulomas: (1) outer margin of lesion, (2) texture of "peripheral rim" in T1wFS+C, (3) texture of "lesion center" in T2wFS, (4) surrounding tissue involvement in T2wFS, (5) surrounding tissue involvement in T1wFS+C and (6) maximum "peripheral rim" thickness (all: P < 0.05). In conclusion, this pilot study indicates that radiation-free dental MRI enables a reliable differentiation between periapical cysts and granulomas in vivo. Thus, MRI may substantially improve treatment strategies and help to avoid unnecessary surgery in apical periodontitis.

Protocol for the Evaluation of MRI Artifacts Caused by Metal Implants to Assess the Suitability of Implants and the Vulnerability of Pulse Sequences

As the number of magnetic resonance imaging (MRI) scanners and patients with medical implants is constantly growing, radiologists increasingly encounter metallic implant-related artifacts in MRI, resulting in reduced image quality. Therefore, the MRI suitability of implants in terms of artifact volume, as well as the development of pulse sequences to reduce image artifacts, are becoming more and more important. Here, we present a comprehensive protocol which allows for a standardized evaluation of the artifact volume of implants on MRI. Furthermore, this protocol can be used to analyze the vulnerability of different pulse sequences to artifacts. The proposed protocol can be applied to T1- and T2-weighted images with or without fat-suppression and all passive implants. Furthermore, the procedure enables the separate and three-dimensional identification of signal loss and pile-up artifacts. As previous investigations differed greatly in evaluation methods, the comparability of their results was limited. Thus, standardized measurements of MRI artifact volumes are necessary to provide better comparability. This may improve the development of the MRI suitability of implants and better pulse sequences to finally improve patient care.

High-resolution dental magnetic resonance imaging for planning palatal graft surgery-a clinical pilot study

AIM

To evaluate whether high-resolution, non-contrast-enhanced dental magnetic resonance imaging (MRI) can be used for accurate determination of palatal masticatory mucosa thickness (PMMT) and to locate the greater palatal artery (GPA).

MATERIALS AND METHODS

In five volunteers (four males, one female; mean age 30.2 ± 0.4 years), two independent raters measured PMMT by use of dental MRI in 180 positions. For comparison, clinical bone sounding was performed. The GPA was identified in time-of-flight (TOF) angiography and MSVAT-SPACE-prototype sequence. Intra- and inter-observer agreement for MRI measurements, agreement between MRI and bone sounding were analysed by intra-class correlation coefficient (ICC) and Cohen's kappa (κ).

RESULTS

Reliability of dental MRI measurements was high (intra-observer-ICC 0.962; inter-observer ICC 0.959). Agreement of MRI measurements with bone sounding was moderate (ICC 0.744), and the GPA could be identified in 60% of measurement points using the TOF-angiography alone and in 85% with additional information of the MSVAT-SPACE. Good intra-observer agreement was observed for GPA identification (κ: 0.778).

CONCLUSION

Palatal masticatory mucosa thickness measured by high-resolution, non-contrast enhanced dental MRI is comparable with that obtained by bone sounding. Dental MRI enables reliable, non-invasive and radiation-free planning of palatal tissue harvesting and can also be used for location of the GPA at 85% of measurement points, which might help reduce complications during surgery.

Assessment of alveolar bone marrow fat content using 15 T MRI

OBJECTIVES

Bone marrow fat is inversely correlated with bone mineral density. The aim of this study is to present a method to quantify alveolar bone marrow fat content using a 15 T magnetic resonance imaging (MRI) scanner.

STUDY DESIGN

A 15 T MRI scanner with a 13-mm inner diameter loop-gap radiofrequency coil was used to scan seven 3-mm diameter alveolar bone biopsy specimens. A 3-D gradient-echo relaxation time (T1)-weighted pulse sequence was chosen to obtain images. All images were obtained with a voxel size (58 µm³) sufficient to resolve trabecular spaces. Automated volume of the bone marrow fat content and derived bone volume fraction (BV/TV) were calculated. Results were compared with actual BV/TV obtained from micro-computed tomography (CT) scans.

RESULTS

Mean fat tissue volume was 20.1 ± 11%. There was a significantly strong inverse correlation between fat tissue volume and BV/TV (r = -0.68; P = .045). Furthermore, there was a strong agreement between BV/TV derived from MRI and obtained with micro-CT (interclass correlation coefficient = 0.92; P = .001).

CONCLUSIONS

Bone marrow fat of small alveolar bone biopsy specimens can be quantified with sufficient spatial resolution using an ultra-high-field MRI scanner and a T1-weighted pulse sequence.

The accuracy of ultrashort echo time MRI sequences for medical additive manufacturing

OBJECTIVES

Additively manufactured bone models, implants and drill guides are becoming increasingly popular amongst maxillofacial surgeons and dentists. To date, such constructs are commonly manufactured using CT technology that induces ionizing radiation. Recently, ultrashort echo time (UTE) MRI sequences have been developed that allow radiation-free imaging of facial bones. The aim of the present study was to assess the feasibility of UTE MRI sequences for medical additive manufacturing (AM).

METHODS

Three morphologically different dry human mandibles were scanned using a CT and MRI scanner. Additionally, optical scans of all three mandibles were made to acquire a "gold standard". All CT and MRI scans were converted into Standard Tessellation Language (STL) models and geometrically compared with the gold standard. To quantify the accuracy of the AM process, the CT, MRI and gold-standard STL models of one of the mandibles were additively manufactured, optically scanned and compared with the original gold-standard STL model.

RESULTS

Geometric differences between all three CT-derived STL models and the gold standard were <1.0 mm. All three MRI-derived STL models generally presented deviations <1.5 mm in the symphyseal and mandibular area. The AM process introduced minor deviations of <0.5 mm.

CONCLUSIONS

This study demonstrates that MRI using UTE sequences is a feasible alternative to CT in generating STL models of the mandible and would therefore be suitable for surgical planning and AM. Further in vivo studies are necessary to assess the usability of UTE MRI sequences in clinical settings.

Dental MRI using a dedicated RF-coil at 3 Tesla

PURPOSE

To assess the benefit of a dedicated surface coil to visualize dental structures in comparison to standard head/neck coil.

METHODS

Measurements were performed using the standard head/neck coil and a dedicated array coil for dental MRI at 3 T. As MRI methods, we used a T1-weighted spin-echo sequence with and without spectral fat saturation, a T2-weighted turbo-spin-echo sequence and a 3-dimensional T2-weighted SPACE sequence. Measurements were performed in a phantom to examine sensitivity profiles. Then the signal gain in dental structures was examined in volunteers and in a patient.

RESULTS

As expected for a surface coil, the signal gain of the dental coil was highest at the surface of the phantom and decreased with increasing distance to the coil; it was >120% even at a depth of 30 mm, measured from the centre of the coil. The signal gain within the pulp of the volunteers ranged between 236 and 413%.

CONCLUSION

The dedicated array coil offers a significantly higher signal within the region of interest for dental MR imaging thus allowing for better depiction of pathologies within the periodontium and for delineation and tracking of the branches of the maxillary and mandibular nerves.

Influence of pulse sequence parameters at 1.5 T and 3.0 T on MRI artefacts produced by metal-ceramic restorations

OBJECTIVES

Susceptibility artefacts from dental materials may compromise MRI diagnosis. However, little is known regarding MRI artefacts of dental material samples with the clinical shapes used in dentistry. The present phantom study aims to clarify how pulse sequences and sequence parameters affect MRI artefacts caused by metal-ceramic restorations.

METHODS

A phantom consisting of nickel-chromium metal-ceramic restorations (i.e. dental crowns and fixed bridges) and cylindrical reference specimens immersed in agar gel was imaged in 1.5 and 3.0 T MRI scanners. Gradient echo (GRE), spin echo (SE) and ultrashort echo time (UTE) pulse sequences were used. The artefact area in each image was automatically calculated from the pixel values within a region of interest. Mean values for similar pulse sequences differing in one parameter at a time were compared. A comparison between mean artefact area at 1.5 and 3.0 T, and from GRE and SE was also carried out. In addition, a parametric correlation between echo time (TE) and artefact area was performed.

RESULTS

A significant correlation was found between TE and artefact area in GRE images. Higher receiver bandwidth significantly reduced artefact area in SE images. UTE images yielded the smallest artefact area at 1.5 T. In addition, a significant difference in mean artefact area was found between images at 1.5 and 3.0 T field strengths (p = 0.028) and between images from GRE and SE pulse sequences (p = 0.005).

CONCLUSIONS

It is possible to compensate the effect of higher field strength on MRI artefacts by setting optimized pulse sequences for scanning patients with metal-ceramic restorations.

A new method for displaying the lingual artery using high-resolution three-dimensional phase-contrast magnetic resonance angiography

The aim of this study was to display the lingual artery superimposed on the anatomical image and to confirm its course and relation to the adjacent structures, noninvasively. Nineteen volunteers participated in the magnetic resonance imaging (MRI) study and one was excluded for excessive movement during scanning. A three-dimensional phase-contrast sequence (3D-PC) of magnetic resonance angiography (MRA) was used for vessel images, and a 3D-T1 high-resolution volume examination (THRIVE) was used for anatomical images. Colour-coded vessel images from 3D-PC MRA were superimposed on the 3D volume anatomical images, and the arterial course and relation to the adjacent structures were confirmed with multiplanar reconstructed cross-sectional (MPR) images. 3D-PC MRA images visualized the lingual artery in all 18 subjects and the sublingual artery in 14 subjects. In seven of 18 cases the bilateral sublingual arteries were shown to run side by side but had no contact with the sublingual veins. They ran together with the sublingual veins in four cases. Three cases showed irregular patterns. The bilateral sublingual arteries could not be identified in four cases. 3D-PC MRA images of the lingual artery superimposed on the anatomical images may be clinically useful to confirm its course and relationship to the adjacent structures before surgery, in order to prevent haemorrhage.

Position statement of the American Academy of Oral and Maxillofacial Radiology on selection criteria for the use of radiology in dental implantology with emphasis on cone beam computed tomography

A Position Paper Subcommittee of the American Academy of Oral and Maxillofacial Radiology (AAOMR) reviewed the literature since the original position statement on selection criteria for radiology in dental implantology, published in 2000. All current planar modalities, including intraoral, panoramic, and cephalometric, as well as cone beam computed tomography (CBCT) are discussed, along with radiation dosimetry and anatomy considerations. We provide research-based, consensus-derived clinical guidance for practitioners on the appropriate use of specific imaging modalities in dental implant treatment planning. Specifically, the AAOMR recommends that cross-sectional imaging be used for the assessment of all dental implant sites and that CBCT is the imaging method of choice for gaining this information. This document will be periodically revised to reflect new evidence.

Diagnosis of dental abnormalities in children using 3-dimensional magnetic resonance imaging

PURPOSE

To assess the feasibility of magnetic resonance imaging (MRI) of dental abnormalities in children.

MATERIALS AND METHODS

The study included 16 patients (mean age, 10.8 yr) prospectively selected from 1,500 orthodontic patients. The selected patients included 3 with a mesiodens, 9 with supernumerary teeth other than a mesiodens, 1 with gemination, 1 with dilacerations, 1 with transmigration, and 1 with transposition. Three-dimensional (3D) images were acquired on a 1.5-T MRI scanner using a 3D turbo spin echo pulse sequence with a voxel size of 0.8 × 0.8 × 1 mm. The measurement time was 4 to 5 minutes.

RESULTS

Using natural MRI contrast, the teeth, dental pulp, mandibular canal, and cortical bone could be clearly delineated. The position and shape of malformed teeth could be assessed in all 3 spatial dimensions.

CONCLUSION

MRI was found to be a well-tolerated imaging modality for the diagnosis of dental abnormalities in children and for orthodontic treatment and surgical planning. Compared with conventional radiography, dental MRI provides the advantage of 3-dimensionality and complete elimination of ionizing radiation, which is particularly relevant for repeated examinations in children.

Ultrashort echo time (UTE) MRI for the assessment of caries lesions

OBJECTIVE

Direct in vivo MRI of dental hard tissues by applying ultrashort echo time (UTE) MRI techniques has recently been reported. The objective of the presented study is to clinically evaluate the applicability of UTE MRI for the identification of caries lesions.

METHODS

40 randomly selected patients (mean age 41 ± 15 years) were enrolled in this study. 39 patients underwent a conventional clinical assessment, dental bitewing X-ray and a dental MRI investigation comprising a conventional turbo-spin echo (TSE) and a dedicated UTE scan. One patient had to be excluded owing to claustrophobia. In four patients, the clinical treatment of the lesions was documented by intraoral pictures, and the resulting volume of the cavity after excavation was documented by dental imprints and compared with the MRI findings.

RESULTS

In total, 161 lesions were identified. 157 (97%) were visible in the UTE images, 27 (17%) in the conventional TSE images and 137 (85%) in the X-ray images. In total, 14 teeth could not be analysed by MR owing to artefacts caused by dental fillings. All lesions appear significantly larger in the UTE images as compared with the X-ray and TSE images. In situ measurements confirm the accuracy of the lesion dimensions as observed in the UTE images.

CONCLUSION

The presented data provide evidence that UTE MR imaging can be applied for the identification of caries lesions. Although the current data suggest an even higher sensitivity of UTE MRI, some limitations must be expected from dental fillings.

Study of inferior dental canal and its contents using high-resolution magnetic resonance imaging

The aim of this study was to evaluate the visualizability, topography, and course of the mandibular canal with particular attention to the incisive canal on 3-T MRI. Particular attention was paid to the incisive canal anastomosis at the symphysis. A total of 64 dentate patients were examined using a modified T2 space sequence using 3-T MRI. The scans were analyzed with respect to the topography of the entire course of the mandibular canal, mental canal, incisive canal, and nutrient canals. The high-field MRI of the lower jaw allowed detailed visualization of the mandibular canal, the incisive canal, and the surrounding connective tissue structures. In the context of the present study, 3-T MRI was found to be a potentially useful imaging method for displaying the course of the entire inferior dental canal for pre-implantation planning, surgical planning, and diagnosis.