Imaging Diagnosis of Endodontic Disease

Physician performance is better in detecting endodontic disease using periapical radiography compared with cone beam CT (CBCT)

October 2023

Highlights

  • This study used a factorial design to evaluate reader performance in detecting endodontic disease using periapical (PA) radiography versus cone beam CT (CBCT). Reader performance was better when periapical (PA) radiography was used to detect subtle and moderate disease. No differences in reader performance were observed between the two modalities for detecting obvious disease and subtle non-disease-related lesions. Diagnostic performance improved with both modalities as disease severity increased, and fewer false positives were achieved with CBCT.
     
  • Overall, reader performance was better for detecting endodontic disease using periapical (PA) radiography ; however, CBCT was associated with fewer false positives.

Goals

To evaluate and compare reader performance in the interpretation of digital periapical (PA) radiography and cone beam computed tomography (CBCT) in the detection of endodontic diseases, using a free-response factorial model.

Materials and methods

A reader performance study of two sets of imaging tests was conducted using a free-response factorial design, taking into account the independent variables: case type, case severity, reader type, and imaging modality.

Twenty-two readers interpreted 60 PA and 60 CBCT images divided into five categories: diseased – subtle, diseased – moderate, diseased – obvious, non-diseased – subtle, and non-diseased – obvious.

Lesion localization fraction, specificity, false positive flags, and weighted alternative free response receiver operating characteristic (wAFROC1) figure of merit were calculated.

Results

Cone beam CT (CBCT) had higher specificity than periapical (PA) radiography in obvious disease-free cases (p = 0.01) and no significant difference in the subtle disease-free category.

wAFROC1 values ​​were higher for PA than for CBCT in the subtle disease (p = 0.02) and moderate disease (p = 0.01) groups with no significant differences between the overt disease group.

CBCT had a higher mean number of false positives than PA (p<0.05) in cases of subtle disease.

The mean lesion localization fraction in the moderate disease group was higher in PA than in CBCT (p = 0.003).

No relationships were found between clinical experience and all measures of diagnostic performance, except in the CBCT group with overt disease, where increasing experience was associated with average false-positive marks (p = 0.04).

Conclusions

  • Reader performance in detecting endodontic disease is better with periapical radiography than with cone beam CT (CBCT).
     
  • Clinical experience does not influence the accuracy of interpretation of both periapical radiography (PA) and CBCT.