Topical contrast agents to improve soft-tissue contrast in the upper airway using cone beam CT: a pilot study.

The purpose of this study is to explore the topical use of radiographic contrast agents to enhance soft-tissue contrast on cone beam CT (CBCT) images. Different barium sulphate concentrations were first tested using an airway phantom. Different methods of barium sulphate application (nasal drops, syringe, spray and sinus wash) were then tested on four volunteers, and nebulized iodine was tested in one volunteer. CBCT images were performed and then assessed subjectively by two examiners for contrast agent uniformity and lack of streak artefact. 25.0% barium sulphate presented adequate viscosity and radiodensity. Barium sulphate administered via nasal drops and sprays showed non-uniform collection at the nostrils, along the inferior and/or middle nasal meatuses and posterior nasal choana. The syringe and sinus wash showed similar results with larger volumes collecting in the naso-oropharynx. Nebulized iodine failed to distribute into the nasal cavity and scarcely collected at the nostrils. All methods of nasal application failed to adequately reach or uniformly coat the nasal cavity beyond the inferior nasal meatuses. The key factors to consider for optimum topical radiographic contrast in the nasal airway are particle size, flow velocity and radio-opacity.

Three-dimensional segmentation of the upper airway using cone beam CT: a systematic review.

The objectives of this study were to systematically review the literature for studies that used cone beam CT (CBCT) to automatically or semi-automatically model the upper airway (including the pharyngeal, nasal and paranasal airways), and to assess their validity and reliability. Several electronic databases (MEDLINE®, MEDLINE In-Process & Other Non-Indexed Citations, all evidence-based medicine reviews including the Cochrane database, and Scopus) were searched. Abstracts that appeared to meet the initial selection criteria were selected by consensus. The original articles were then retrieved and their references were searched manually for potentially suitable articles that were missed during the electronic search. Final articles that met all the selection criteria were evaluated using a customized evaluation checklist. 16 articles were finally selected. From these, five scored more than 50% based on their methodology. Although eight articles reported the reliability of the airway model generated, only three used intraclass correlation (ICC). Two articles tested the accuracy/validity of airway models against the gold standard, manual segmentation, using volumetric measurements; however, neither used ICC. Only three articles properly tested the reliability of the three-dimensional (3D) upper airway model generated from CBCT and only one article had sufficiently sound methodology to test the airway model's accuracy/validity. The literature lacks proper scientific justification of a solid and optimized CBCT protocol for airway imaging. Owing to the limited number of adequate studies, it is difficult to generate a strong conclusion regarding the current validity and reliability of CBCT-generated 3D models.

Clinical and radiographic features of solitary and cemento-osseous dysplasia-associated simple bone cysts.

UNLABELLED: The simple bone cyst (SBC) is a pseudocyst that can occur as a solitary entity in the jaws or may occur in association with cemento-osseous dysplasia (COD). OBJECTIVE: The purpose of this study was to review the clinical and radiographic features of solitary and COD-associated SBCs. METHODS: Archived imaging reports from the Special Procedures Clinic in Oral and Maxillofacial Radiology at the Faculty of Dentistry at the University of Toronto between 1 January 1989 and 31 December 2009 revealed 23 COD-associated SBCs and 68 solitary SBCs. RESULTS: Almost all solitary and COD-associated SBCs were found in the mandible. Furthermore, 87.0% of COD-associated SBCs were found in females in their fifth decade of life (P < 0.001) while solitary SBCs were found in equal numbers in both sexes in their second decade of life (P < 0.005). COD-associated SBCs were also more likely to cause thinning of the endosteal cortex, bone expansion and scalloping of the superior border between teeth (all P < 0.001) than solitary SBCs that are classically described as having these characteristics. Finally, COD-associated SBC demonstrated a loss of lamina dura more often (P < 0.05) than solitary SBCs. CONCLUSIONS: Knowledge of the sporadic association between COD and SBC and their potential radiographic appearances should prevent inappropriate treatment and management of these patients.

Cemento-osseous dysplasia of the jaw bones: key radiographic features.

OBJECTIVE: The purpose of this study is to assess possible diagnostic differences between general dentists (GPs) and oral and maxillofacial radiologists (RGs) in the identification of pathognomonic radiographic features of cemento-osseous dysplasia (COD) and its interpretation. METHODS: Using a systematic objective survey instrument, 3 RGs and 3 GPs reviewed 50 image sets of COD and similarly appearing entities (dense bone island, cementoblastoma, cemento-ossifying fibroma, fibrous dysplasia, complex odontoma and sclerosing osteitis). Participants were asked to identify the presence or absence of radiographic features and then to make an interpretation of the images. RESULTS: RGs identified a well-defined border (odds ratio (OR) 6.67, P < 0.05); radiolucent periphery (OR 8.28, P < 0.005); bilateral occurrence (OR 10.23, P < 0.01); mixed radiolucent/radiopaque internal structure (OR 10.53, P < 0.01); the absence of non-concentric bony expansion (OR 7.63, P < 0.05); and the association with anterior and posterior teeth (OR 4.43, P < 0.05) as key features of COD. Consequently, RGs were able to correctly interpret 79.3% of COD cases. In contrast, GPs identified the absence of root resorption (OR 4.52, P < 0.05) and the association with anterior and posterior teeth (OR 3.22, P = 0.005) as the only key features of COD and were able to correctly interpret 38.7% of COD cases. CONCLUSIONS: There are statistically significant differences between RGs and GPs in the identification and interpretation of the radiographic features associated with COD (P < 0.001). We conclude that COD is radiographically discernable from other similarly appearing entities only if the characteristic radiographic features are correctly identified and then correctly interpreted.