Detecção de lesões periapicais incipientes por subtração radiográfica com imagens panorâmicas digitais e digitalizadas

• Autor(a) principal: Miguens Júnior, Sergio Augusto Quevedo
• Data de Publicação: 2008
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional PUCRS
• Texto Completo: http://hdl.handle.net/10923/398
• topic: LESÕES PERIAPICAIS; RADIOGRAFIA DIGITAL; RADIOGRAFIA PANORÂMICA; DIAGNÓSTICO POR IMAGEM

This thesis comprises two articles. In the first article, we assessed in vitro the ability of digital subtraction radiography (DSR) in the detection of incipient periapical lesions using panoramic digital and digitized radiographs. Periapical defects were created in dried human mandibles through application of 70% perchloric acid at times 2, 4, and 6 hours. Conventional and digital radiographs were obtained twice at time zero, with the aim of evaluating reproducibility of this technique, and sequentially before each application of the acid solution. Conventional radiographs were digitized using a scanner with the same attributes than direct digital radiographs: 150-dpi resolution, 8-bit mode and stored as non-compressed TIFF format. The software Adobe Photoshop® was used for DSR of the images in the following sequence: T0x0 repeated; T0xT2; T0xT4; and T0xT6. The variable under analysis was the difference between pixel intensity in control and test areas. Using ANOVA to compare the size of the areas marked to obtain pixel intensity values in different experimental times, no differences were observed between times both for the test (F= 0. 44; P = 0. 726) and for the control area (F= 1. 20; P = 0. 310). Comparing experimental times, there were significant differences, time 6 having the highest mean of mineral loss. Times 2 and 4 had no differences, but were significantly higher than time 0, both for digitized (F= 45. 01; P< 0. 001) and for digital images (F= 30. 80; P < 0. 001). We concluded that DSR of panoramic radiographic images, whether digital or digitized, allows for detection of incipient periapical defects. In the second article, we compared in vitro specificity, sensitivity, and diagnostic accuracy of digital subtraction radiography (DSR) in digital and digitized panoramic images in the detection of incipient periapical lesions. The images were assessed by an experienced and blinded observer, who attributed scores 0 (absence of image representing mineral loss) or 1 (presence of dark image representing mineral loss) to each image. Results were evaluated using analysis of variance (ANOVA), complemented by Dunnett’s T3 multiple comparison test; the level of significance was set at 5%. The observer showed Kappa values = 0. 640 for DSR of digital images; and 0. 574 for DSR of digitized images. There was 100% intrarater agreement at time 0. Sensitivity of both modalities was statistically different in relation to experimental times. Time 6 had the highest values (digital: 1. 000; digitized: 0. 961), while time 2 showed the lowest values (0. 688 and 0. 714). Irrespective of the imaging method, the proportion of correct responses significantly increased regarding experimental times. Specificity was high for DSR of both digitized (0. 896) and digital (0,844) images. Accuracy in time 6 was higher than that of other times, both for the digitized (0. 929) and digital (0. 922) modalities. DSR of panoramic images, both digitized and digital, allows for detection of incipient periapical lesions, with satisfactory sensitivity and specificity values.