Imaging Sci Dent.  2017 Jun;47(2):99-107. 10.5624/isd.2017.47.2.99.

Effectiveness of digital subtraction radiography in detecting artificially created osteophytes and erosions in the temporomandibular joint

• Demirturk Kocasarac H
• Celenk P

• KMID: 2389890
• DOI: http://doi.org/10.5624/isd.2017.47.2.99

Abstract

PURPOSE
Erosions and osteophytes are radiographic characteristics that are found in different stages of temporomandibular joint (TMJ) osteoarthritis. This study assessed the effectiveness of digital subtraction radiography (DSR) in diagnosing simulated osteophytes and erosions in the TMJ.
MATERIALS AND METHODS
Five intact, dry human skulls were used to assess the effectiveness of DSR in detecting osteophytes. Four cortical bone chips of varying thicknesses (0.5 mm, 1.0 mm, 1.5 mm, and 2.0 mm) were placed at the medial, central, and lateral aspects of the condyle anterior surface. Two defects of varying depth (1.0 mm and 1.5 mm) were created on the lateral, central, and medial poles of the condyles of 2 skulls to simulate erosions. Panoramic images of the condyles were acquired before and after artificially creating the changes. Digital subtraction was performed with Emago dental image archiving software. Five observers familiar with the interpretation of TMJ radiographs evaluated the images. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic accuracy of the imaging methods.
RESULTS
The area under the ROC curve (Az) value for the overall diagnostic accuracy of DSR in detecting osteophytic changes was 0.931. The Az value for the overall diagnostic accuracy of panoramic imaging was 0.695. The accuracy of DSR in detecting erosive changes was 0.854 and 0.696 for panoramic imaging. DSR was remarkably more accurate than panoramic imaging in detecting simulated osteophytic and erosive changes.
CONCLUSION
The accuracy of panoramic imaging in detecting degenerative changes was significantly lower than the accuracy of DSR (P<.05). DSR improved the accuracy of detection using panoramic images.

Keyword

Subtraction Technique; Osteophyte; Radiography, Panoramic; Temporomandibular Joint; Osteoarthritis

MeSH Terms

Humans
Osteoarthritis
Osteophyte*
Radiography*
Radiography, Panoramic
ROC Curve
Skull
Subtraction Technique
Temporomandibular Joint*

Figure

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  Fig. 1 A. Bone chips were used to simulate osteophyte formation on the condylar heads. B. An artificial erosion was created on the medial pole of the right condyle. C. The skull was positioned for panoramic image acquisition.

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  Fig. 2 A. A panoramic image shows the 2.0-mm bone chip placed on the anterolateral aspect of the right condylar head. B. A subtracted image shows the same condyle with the same bone chip.

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  Fig. 3 A. A panoramic image shows a 1.5-mm erosion created on the medial pole of the right mandibular condyle. B. A subtracted image shows the same condyle with the erosion.

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  Fig. 4 A. Receiver operating characteristic (ROC) analysis of the detection of overall condylar osteophytes. Curves were plotted from the data obtained for each modality when all osteophyte sizes and locations were considered. B. ROC analysis of the detection of overall condylar erosions. Curves were plotted from the data obtained for each modality when all erosion sizes and locations were considered.

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