Versatility of high resolution ultrasonography in the assessment of granulomas and radicular cysts: a comparative in vivo study

Abstract

Objectives: To evaluate and compare the diagnostic potential of high resolution ultrasound with periapical radiographs (PR) and CBCT in assessing granulomas and radicular cysts. Methods: This study included a total of 33 teeth from 33 patients with periapical lesions. Subjects were distributed among three groups. A consisted of teeth that were extracted. B consisted of teeth treated with root-canal treatment followed by apical surgery. C consisted of teeth treated with root-canal treatment only. Pre-treatment PR, ultrasound and CBCT images were obtained for Groups A, B and C and 6 month post-treatment PR and ultrasound images were obtained for Groups B and C. In addition, histopathological analysis was performed on lesions in Groups A and B. Lesions were classified as either cystic lesions or granulomas. Width, height, depth, surface area and volume of lesions were measured using the built-in softwares of the appropriate imaging modalities. Measurements were compared by Wilcoxon and paired sample t tests. Ultrasound and histopathological findings were compared with κ and Mc Nemar. Statistical significance was set at p < 0.05. Results: κ coefficient (0.667; p = 0.002) suggested good agreement between ultrasound and histopathology. No statistically significant differences were found among periapical radiography, CBCT and ultrasound in the pre-treatment measurements of lesion width ( p = 0.308) or between CBCT and periapical radiography in the pre-treatment measurements of lesion height ( p = 0.863). In all cases, mean measurement values for all variables were lower for ultrasound than for CBCT. Conclusion: Ultrasound provided useful information for the diagnosis and assessment of granulomas and radicular cysts.

Ultrasound imaging for the differential diagnosis of periapical lesions of endodontic origin in comparison with histopathology – a systematic review and meta‐analysis

“…After reading 6729 titles/abstracts, only 14 articles were found eligible for full-text assessment. Finally, a total of 12 articles (Cotti et al 2003, Gundappa et al 2006, Raghav et al 2010, Goel et al 2011, Prince et al 2012, Parvathy et al 2014, Khambete & Kumar 2015, Sandhu et al 2015, Tikku et al 2016, S€ onmez et al 2019 were included for the systematic review based on the inclusion criteria. Two articles (Cotti et al 2002, Aggarwal & Singla 2010 were excluded as reference testing with histopathology was not performed.…”

“…The remaining 44 patients (17 patients in Cotti et al 2018, 14 patients in Sandhu et al 2015 and 13 patients in S€ onmez et al 2019) consisted of lesions which were not histopathologically analysed and hence were excluded. The sample population of the included articles were patients who were primarily diagnosed with periapical lesions of endodontic origin using conventional radiography (Cotti et al 2003, Gundappa et al 2006, Raghav et al 2010, Goel et al 2011, Prince et al 2012, Parvathy et al 2014, Khambete & Kumar 2015, Sandhu et al 2015, Tikku et al 2016, S€ onmez et al 2019. Some articles used other imaging modalities such as CBCT (Cotti et al 2018(Cotti et al , S€ onmez et al 2019) and orthopantomogram (Cotti et al 2003(Cotti et al , 2006) along with conventional radiography for the diagnosis of periapical lesions.…”

“…A total of 97 periapical cysts, 90 periapical granulomas and 5 mixed lesions were diagnosed by US and confirmed by histopathological examination in the included articles. US imaging failed to diagnose the periapical lesion in one article (Tikku et al 2016) and misdiagnosed the lesions on comparison with histopathological analysis in four articles (Raghav et al 2010, Goel et al 2011, Prince et al 2012, S€ onmez et al 2019) (Table 1). US imaging was used for the differential diagnosis of periapical lesions located in the anterior region of maxilla (45 teeth) and/or mandible (14 teeth) in five articles (Cotti et al 2006, Gundappa et al 2006, Raghav et al 2010, Goel et al 2011, Sandhu et al 2015.…”

“…However, in that review, no quantitative analysis was done due to the heterogeneity of the included articles. Additionally, three more articles have been published on this topic (Tikku et al 2016, Cotti et al 2018, S€ onmez et al 2019, with all of them favouring the use of US in the differential diagnosis of periapical lesions. Hence, a qualitative and quantitative analysis of these articles will be vital and relevant for clinicians to arrive at an appropriate treatment plan.…”

Differentiation of periapical granuloma from radicular cyst using cone beam computed tomography images texture analysis

“…Precise evaluation of periapical lesions is essential to getting an accurate diagnosis and deciding on appropriate dental intervention [ 5 ]. An objective evaluation of the images could give dentists some significant information to facilitate clinical management, since periapical granulomas are tending to heal with non-surgical root canal treatment against the radicular cyst [ 6 , 7 , 8 ].…”