The association between estrogen status and alveolar bone density changes in postmenopausal women with a history of periodontitis.

While numerous studies have demonstrated a relationship between 17-beta-estradiol (E2) deficiencies and skeletal bone loss in postmenopausal females, the influence of E2 deficiency on alveolar bone resorption is poorly understood. The purpose of this study was to examine the association between the estrogen status of postmenopausal women and alveolar bone density changes in a 1-year longitudinal study. Twenty-four postmenopausal women, within 7 years of menopause, were divided into 2 groups, E2-sufficient (n = 10) and E2-deficient (n = 14). Venous blood samples were taken at baseline, 6 months, and 1 year for radioimmunoassay determination of serum E2 levels. At baseline and 1 year, 4 vertical bite-wing radiographs were taken for computer-assisted densitometric image analysis (CADIA). Areas of interest (AOIs) for CADIA were crestal and subcrestal regions of posterior interproximal alveolar bone. Serum E2 levels were significantly higher at all 3 time points in the E2-sufficient subjects (P < 0.002), repeated measures ANOVA). Overall, mean CADIA values (0.30 +/- 0.07 for the E2-sufficient women and -0.44 +/- 0.07 for the E2-deficient women) were statistically different between groups (P < 0.001, repeated measures ANOVA), indicating that the E2-sufficient women displayed a mean net gain in alveolar bone density and the E2-deficient women displayed a mean net loss in alveolar bone density. Furthermore, the E2-sufficient women exhibited a higher frequency of sites demonstrating a gain in alveolar bone density, while the E2-deficient women exhibited a higher frequency of sites demonstrating loss in alveolar bone density. These data suggest that estrogen status may influence alveolar bone density changes as demonstrated with CADIA.

Registered image subtraction for CT-, MR- and coronary angiography.

Conventional post-processing of digital subtraction angiography (DSA) by 3D spiral CT, 3D MRI and 2D DSA is often hampered by extended artefacts due to patient movements during examination. In this paper an image registration procedure prior to the digital subtraction is introduced allowing an enhanced visualization of the contrast agent. The object displacement is detected by analysis of image deformations in small local regions. The motion pattern is used to compute a new synthetic mask of maximum congruence with the contrast medium image. This new mask image is then used in the subsequent subtraction. The algorithm works fully automatically and does not need any interactive placement of landmarks. Results obtained from subtraction of uncorrected and corrected sequences were compared with each other. The registration procedure provided good results in the suppression of subtraction artefacts and in the enhancement of vascular structures. Results are presented from subtraction of 2D and 3D data from CTA, MR mammography and coronary angiography.

Analytical methodology in quantitative digital subtraction radiography: analyses of the aluminum reference wedge.

An aluminum wedge can be used to quantify volumetric change in crestal alveolar bone which has been identified through subtraction radiography. This study compares two methods for using an aluminum wedge for this purpose: 1) the aluminum wedge is present in both radiographs and used to determine the aluminum equivalent bone density present in the region of change for each radiograph; and 2) the aluminum wedge is present in only one radiograph and the difference image of the wedge in the subtraction image is used to calculate the aluminum equivalent change in bone density. Pairs of standardized x-rays were taken with synthetic bone chips of known weights placed when the second x-ray was taken. The volumetric change produced by the bone chips was calculated by the two methods. The relationship of the calculated volumes to the chip weights had a higher r2 value (P < 0.05) for the two-wedge method than for the one-wedge method. The two-wedge method is recommended for volumetric quantification of alveolar bone change. The influence of the clarity of the aluminum wedge image in the x-ray pairs was also examined in this study and found to be significant. Attention must be given to factors which affect the aluminum wedge image characteristics to achieve optimal results.

Efficacy of quantitative digital subtraction radiography using radiographs exposed in a multicenter trial.

Digital subtraction radiography (DSR) has been shown to be a sensitive and specific method for the detection of small bony changes in periodontitis. The purpose of this study was to perform a multicenter validation of the DSR in human subjects. Seventeen subjects were enrolled at 3 centers. Feather-edged hydroxyapatite chips (approximately 1, 7 and 10 mg) were used to simulate osseous lesions. Bilateral radiographs were taken with and without chips. Geometry was standardized using a cephalostat and the order of radiographs was determined using a randomization plan. Radiographs were subtracted, lesions isolated, and quantified at a single center without knowledge of the randomization code or location of the chips used in each subject. The overall sensitivity and specificity in detecting 1 mg changes was 87.8% and 100%, respectively. Sensitivity and specificity in detecting 7 mg and 10 mg chips was 100%. A strong linear relationship between actual lesion mass and calculated mass was observed (R2 = 0.94, slope = 0.98, p < 0.0001). No significant differences were observed by center. These data indicate that the DSR is a valid technique for the assessment of alveolar bone changes in multicenter trials.

Contrast matching techniques for digital subtraction radiography: an objective evaluation.

Digital subtraction radiography (DSR) enables the detection of subtle early detrimental effects of periodontal disease as well as the evaluation of the effects of therapy. However, the differences between two radiographs due to alignment and contrast errors must be kept at minimum. In the present in vitro study we test the efficacy of three basic contrast correction methods in the reduction of contrast mismatches which can adversely affect a subtracted image. The ODTF (Optical Density Thickness Function) method, which is based on a function relating grey level values of the aluminium wedge image and the corresponding thickness of the wedge, induced less contrast correction error than the CDF (Cumulative Density Function) and the LSQA (Least Square Quadratic Approximation) methods. Moreover, CDF, ODTF, and LSQA functions obtained from the reference structure density distribution may be applied for objective contrast enhancements and for standardisation of image quality, while the ODTF function allows also bone change volume estimations.

Sequential subtraction scintigraphy with 99mTc-RBC for the early detection of gastrointestinal bleeding.

To improve the early detectability of gastrointestinal (GI) bleeding, we have developed a new subtraction scintigraphic technique using in vivo labeled 99mTc red blood cells (RBC). Use of this new sequential subtraction method every 5 min makes it possible to detect early the bleeding site and calculate the bleeding rate. In phantom experiments, focal activity was detected on subtraction images at pump rates of more than 0.20 ml/min at any urethane thickness, but was negative on conventional scintigrams. The calculated pump rate by the subtraction method correlated well with the actual syringe pump rate (y = 1.07x - 0.02, r = 0.99, p < 0.01) in the case of an 8-cm urethane board as an abdominal wall. Twenty-four of 50 patients with suspected GI bleeding were confirmed to be positive within 24 hr. The subtraction method showed 15 true positive and 2 false positive cases within 60 min. On the other hand, the conventional scintigraphic method showed only 7 true positive and 1 false positive cases. Sensitivity of the subtraction method was 62.5%, which was significantly higher (p < 0.05) than that of the conventional scintigraphic method (29.2%). These results suggest that sequential subtraction scintigraphy with 99mTc-RBC is an effective method for the early detection of GI bleeding and shortening the examination time as compared with conventional scintigraphy.

Effect of logarithmic contrast enhancement on subtraction images.

The aim of this study was to analyze logarithmic contrast enhancement as compared with regular digital subtraction and to consider effects of image texture and observer experience. Radiographs of three different textures, including computer-stimulated lesions of various sizes and densities, were subtracted from radiographs taken before lesions were placed. Logarithmically enhanced and regular subtraction images were put in random order with an equal number of nonlesion subtraction images to form a series of 300 images. Twenty subjects were asked to decide on a 5-point confidence scale whether a lesion was present. Plain texture images were diagnosed significantly better than bone and enamel images. Logarithmic contrast enhancement had a positive effect on plain texture images. There was no significant experience effect. In the student group, however, there was a significant difference between the two subtraction methods. Overall, logarithmic contrast enhancement provided better diagnostic validity than regular subtraction. Logarithmically enhanced subtraction radiography seems to be a promising method for images with low-contrast gradients.

Fast MR angiography of the aortoiliac arteries and arteries of the lower extremity: value of bolus-enhanced, whole-volume subtraction technique.

OBJECTIVE: MR angiography of the abdominal aorta and lower limb arteries has been hampered by the need to depict long segments of the arteries in short imaging times. To overcome these limitations, we combined fast acquisition of coronal sections with bolus-enhancement technique, subtraction, and whole-volume projection display. The purpose of this preliminary study was to determine the value of using this technique in patients with abdominal aortic lesions and atherosclerotic occlusive disease of the lower limbs. SUBJECTS AND METHODS: Ten healthy volunteers and 20 patients with abdominal aortic aneurysms (n = 15), vascular graft (n = 3), arteriovenous fistula (n = 1), and abdominal aortic dissection (n = 1) were examined by segmented K-space ultrafast gradient-echo sequences. Sequential 50-cm coronal sections were acquired before and after an IV bolus injection of gadolinium (0.1 mmol/kg). Subtraction images were created by subtracting precontrast from postcontrast images. In all MR images, signal intensity was measured in the aorta, the inferior vena cava, and the background tissues. The final MR angiogram was a summation image of each subtracted image and was compared with a preoperative conventional arteriogram. Data from each study were collected prospectively and analyzed in a blinded manner. The radiologist evaluated depiction of the following specific areas: the abdominal aorta, common iliac arteries on both sides, superficial femoral arteries and above-knee popliteal arteries, below-knee popliteal arteries, superior mesenteric artery, and renal arteries. The aneurysms were categorized as infrarenal or suprarenal and as involving or not involving the iliac arteries. The graft was considered patent if depicted at both its origin and its periphery. RESULTS: In the healthy volunteers, bolus-enhanced subtraction MR angiography depicted without in-plane saturation the aorta, iliac arteries, and arteries of the lower extremity in less than 2 min. Gadolinium significantly increased the aortic signal-to-noise ratio from 25 +/- 3 to 232 +/- 8 (p < .0001), whereas the signal intensity of the inferior vena cava, muscles, and fat remained relatively stable. Examinations were thought to be interpretable in all but two patients. Clear delineation of aneurysms, intimal flap and arteriovenous fistula, and graft patency (n = 3) or occlusion (n = 2) were similarly diagnosed by conventional and MR angiography. Superior mesenteric artery was depicted in all cases on postcontrast images before subtraction. The number of renal arteries (n = 29) was correctly identified in all 15 patients who had renal areas included in their aortograms on postcontrast images before subtraction. However, renal arteries throughout their full length were usually obscured by renal veins and bowel contrast enhancement on the final MR angiogram. Furthermore, bolus-enhanced subtraction MR angiography was able to depict all lower limb arteries. CONCLUSION: Although further evaluation and technical improvements are required, our preliminary results indicate that bolus-enhanced subtraction MR angiography is a promising new method for fast abdominal and peripheral vascular imaging.

The effect of independent film and object rotation on projective geometric standardization of dental radiographs.

Digital alignment of dental X-ray images using projective invariants has been shown to be a feasible method for detecting changes through digital subtraction radiography. Previous research on the validity of the standardization procedure has considered the effects of motion of the X-ray source alone. Here the effects of independent motion of the film and the object on the standardization are investigated. This is accomplished by fitting a wire grid to the X-ray source, which allows for correction of film motion separately. The usefulness of separating the motion corrections is discussed, as well as some possible sources of error in the overall standardization procedure. The results of the standardization were found not to differ significantly whether the motions were corrected for separately or simultaneously.

Effects of small angle discrepancies on interpretations of subtraction images.

The present study examines interpretations of subtraction images of pairs of radiographs taken at 0 degrees, 1 degree, or 2 degrees of angle discrepancy. The radiographs were taken at each of 48 alveolar crestal sites on 15 dried human skulls. Computer-simulated lesions were induced at the sites on three fourths of the radiographs. Ten instructed dentists were asked to interpret the subtraction images as to the presence or absence of crestal change. A 2-degree angle discrepancy between radiographs resulted in a significant difference in sensitivity from that of radiographic pairs with a 0-degree discrepancy. However, we found no significant difference in sensitivity between 1-degree and 0-degree pairs of radiographs. In conclusion, a 1-degree geometric difference between pairs of radiographs does not significantly contribute to errors in interpretation of subsequent subtraction images.

Digital sialography: imaging and intervention.

Digital subtraction imaging (DSI) has been widely used in angiography but less commonly applied to sialography. Over a 3-year period 109 patients referred for sialography, 42 males and 67 females with a mean age of 44 years (range 8-85 years), were examined using a digital subtraction imaging technique. 13 patients went on to have an interventional procedure, stone removal or duct dilatation. The role of DSI imaging in sialography and its use in facilitating interventional procedures on the salivary glands are discussed.

Computerized characterization of mammographic masses: analysis of spiculation.

Although general rules for the differentiation between benign and malignant breast lesions exist, only 10 to 20% of masses referred for surgical breast biopsy are actually malignant. We are developing, as an aid to radiologists, a computerized scheme for the classification of masses appearing on mammograms to reduce the number of false-positive diagnoses of malignancies. The classification scheme involves the extraction of the margin of masses in order to quantify the degree of spiculation, which, in turn, is related to the likelihood of malignancy. When two measures of spiculation are used as input to an artificial neural network, the scheme achieves a performance similar to that achieved when radiologist's spiculation ratings alone are used for a clinical database of 53 masses. The computerized classification scheme therefore has the potential to effectively aid radiologists in determining appropriate patient management.

Influence of contrast enhancement and pseudocolor transformation on the diagnosis with digital subtraction images (DSI).

This study evaluated the influence of the image processing step of digital subtraction images on inter- and intraexaminer agreement in the interpretation of alveolar bone changes. 52 pairs of standardized radiographs from various clinical trials were included. Six dentists were invited to interpret the images projected as slides in random order. Display one demonstrated the slide of the digitized baseline radiograph and the follow-up image. Display two showed the regular digital subtraction image. Display three represented a grey level contrast enhanced version and displays four and five were pseudo/color enhanced subtraction images. Applying kappa-statistics and multiple regression analysis it was demonstrated that better agreements were obtained when the two color coded displays of subtraction images were shown to the interpreters. The image interpretation was performed in two series. For the first evaluation the interpreters were not informed about the therapy provided nor the time elapsed between taking the pairs of standardized radiographs. In the second series this information was provided. It could be demonstrated that the agreement in the diagnosis of bone change was less influenced by the knowledge about the clinical information if the two color-converted versions of subtracted images were evaluated. Thus, it was concluded that image processing of subtraction images using color enhancement might improve agreement in the diagnostic task. The color coded images were less influenced by the bias in the interpretation of an expected change. The decision making process might be more objective when using color enhanced subtraction images.

Comparison of stent versus laser- and cephalostat-aligned periapical film-positioning techniques for use in digital subtraction radiography.

Digital subtraction radiography is a sensitive diagnostic technique that allows detection of subtle calcific changes in the jaws and teeth that would otherwise not be radiographically visible. However, a high failure rate associated with stent-based periapical film-positioning strategies combined with the complexity, expense, and time of image acquisition has limited the clinical utility of this technique. This study compares a new technique that uses film-positioning instruments, laser alignment beams, and a cephalostat with a previously validated method that used film positioners and elastic impression material. Two series of periapical radiographs were taken of six different anatomic areas of six phantoms using both techniques. Film pairs were digitally subtracted twice and analyzed. A paired t test for difference in standard deviation of mean pixel values revealed no difference in repositioning accuracy between the two techniques (p = .68). The new technique eliminates problems that are associated with the use of elastomeric impression materials.

Sensor noise in direct digital imaging (the RadioVisioGraphy, Sens-a-Ray, and Visualix/Vixa systems) evaluated by subtraction radiography.

The aim of this study was to evaluate sensor noise with the use of the subtraction method in radiographs captured with three direct digital intraoral systems. Ten radiographs were taken of the lower left molar region of a phantom head at each of three exposure times: 0.20 seconds, 0.46 seconds, and 0.60 seconds with the use of the RadioVisioGraphy (Trophy Radiologie, Vincennes, France), Sens-a-Ray (Regam Medical Systems, AB, Sundsvall, Sweden), and Visualix (Gendex, Philips Medical Systems, Inc., Monza, Italy) systems. Neither the x-ray tube nor the phantom were moved between exposures, and the three sensors were identically positioned. The images were stored in the tagged image file format provided by the systems in 8-bit depth and imported by a subtraction program. Subtractions were performed between identical images taken with the three systems. The standard deviation for the distribution of the shades of grey in the subtraction image histogram served as an expression for image noise. Paired t tests evaluated differences between the standard deviations of the subtraction images from the three systems. The standard deviation increased with increasing exposure time for all three systems (p < 0.00001). The standard deviation for the images performed with Visualix were 6.47, 10.34, and 11.16 at exposure times 0.20, 0.46, and 0.60, respectively. For the RadioVisioGraphy, these values were 1.61, 2.03, and 2.18, and for Sens-a-Ray 2.90, 3.98, and 3.96, respectively. The differences between the systems were highly statistically significant (p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of laryngeal movement by digital subtraction laryngography.

Fine movement of laryngeal components was analyzed by digital subtraction laryngography with the use of a digital fluorography system. Two kinds of image processing modes, the super pulse image subtraction mode and the time interval difference mode, were used for this purpose. By the super pulse image mode, the distance and extent of movement of laryngeal components at vocal initiation and during phonation could be observed. By the time interval difference mode, the amount and direction of motion for a certain interval and fine movement, such as vocal initiation, were determined.

Digital subtraction radiography after stannous fluoride treatment for occlusal caries diagnosis.

The material in this study consisted of 38 fully erupted, extracted third molars without clinical cavitation in the occlusal surface. A radiograph was made of each tooth before and after 5, 10, and 20 minutes of stannous fluoride treatment. The radiographs were digitized and subtraction performed between the images obtained after stannous fluoride treatment and the pretreatment image. Two observers assessed the stannous fluoride treated radiographic and the subtraction images on a monitor: 0 = no change, 1 = intensity increase (white area interpreted as a carious lesion) in dentinoenamel area. Caries was assessed on conventional film radiographs made before treatment: 0 = no caries in dentin, 1 = caries in dentin. The presence of caries in dentin was validated histologically. Sensitivity for intensity increase as a sign of caries was overall higher for the subtraction images based on 20-minute treatment than for the radiographic images (0.025 > p > 0.01) but not significantly higher than for the conventional radiographs. However, neither observer gave false-positive scorings in the subtraction images, whereas observer 1 had five false-positive scorings on the conventional films. Observer 2 had none. The subtraction method did not provide a higher sensitivity for dentinal occlusal caries than conventional film radiography, but the intensity increase could be trusted more than the traditional radiolucency as a sign of a dentinal lesion.

Results of long-term venacavography study after placement of a Greenfield vena caval filter.

Digital subtraction venacavography (DSV) as a follow-up examination was performed in 46 patients after placement of a standard stainless steel Greenfield vena caval filter (SGF). DSV is an exact method of visualizing the lumen of the inferior vena cava as well as intraluminal or captured thrombi. Eccentric filters with an angulation of more than 15 degrees were found in 8 patients causing a higher risk of pulmonary embolism from smaller emboli and propagating thrombi. Penetration of the caval wall by filter struts was however frequent (41%), without any damage to adjacent structures as demonstrated by CT scans. The long-term caval patency rate was 90%, with 4 cases of caval thrombosis. Two patients with an occluded inferior vena cava showed no venostasis. Although changes of the filter position usually remain asymptomatic, regular follow-up examinations seem necessary to recognize any impairment of the filter's clot trapping efficiency. Filters should only be used in patients with a risk of recurrent pulmonary embolism despite anticoagulation and patients with contraindications to anticoagulation therapy.

Image normalization and background subtraction in T1-201/Tc-99m parathyroid subtraction scintigraphy. Effect on lesion detection.

The authors have developed two computer algorithms for T1-201/Tc-99m parathyroid subtraction scintigraphy that was performed on patients who subsequently underwent surgical exploration of the neck. Both methods employed a region-of-interest drawn around the thyroid/parathyroid glands for image realignment. The first algorithm normalized the Tl-201 and Tc-99m images using the ratio of maximum counts over the thyroid in each image. The second computer algorithm incorporated Tl-201 image background correction and normalization by the average of the ratios of maximum counts computed over each quadrant in both images. In 10 patients with confirmed parathyroid adenomas or hyperplasia, the first method yielded a 44% sensitivity. Upon reanalysis with the second algorithm, the sensitivity improved to 100%. Subsequently, in a total of 22 patients with 30 abnormal glands analyzed with the second algorithm, a sensitivity of 80% (94% for adenoma and 62% for hyperplasia) was achieved, with a specificity of 91%, as confirmed by surgery.