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. 2023 Apr 17;13(1):6228.
doi: 10.1038/s41598-023-33483-7.

MR-orthopantomography in operative dentistry and oral and maxillofacial surgery: a proof of concept study

Adib Al-Haj Husain  1   2 , Valérie Schmidt  3 , Silvio Valdec  3 , Bernd Stadlinger  3 , Sebastian Winklhofer  4 , Daphne Schönegg  5 , Stefan Sommer  6   7   8 , Mutlu Özcan  9 , Nadin Al-Haj Husain  9   10 , Marco Piccirelli  4
Affiliations

MR-orthopantomography in operative dentistry and oral and maxillofacial surgery: a proof of concept study

Adib Al-Haj Husain et al. Sci Rep. .

Erratum in

Abstract

This prospective study aimed to present, compare, and evaluate the suitability of five different magnetic resonance imaging (MRI) protocols (3D double-echo steady-state (DESS), 3D fast spin echo short-tau inversion recovery (SPACE-STIR), 3D fast spin echo spectral attenuated inversion recovery (SPACE-SPAIR), volumetric interpolated breath-hold examination (T1-VIBE-Dixon), and ultrashort echo time (UTE)) and for orthopantomogram (OPG)-like MRI reconstructions using a novel mandibular coil. Three readers assessed MR-OPGs of 21 volunteers regarding technical image quality (4, excellent; 0, severely reduced), susceptibility to artifacts (3, absence; 0, massive), and visualization of anatomical structures in the oral cavity and surrounding skeletal structures (4, fine details visible; 0, no structures visible). Average image quality was good (3.29 ± 0.83) for all MRI protocols, with UTE providing the best image quality (3.52 ± 0.62) and no to minor artifacts (2.56 ± 0.6). Full diagnostic interpretability of the osseous structures is best in VIBE-Dixon and UTE MR-OPGs. DESS provided excellent visualization of the finest details of the nervous tissue (3.95 ± 0.22). Intra-reader and inter-reader agreement between the readers was good to excellent for all protocols (ICCs 0.812-0.957). MR-OPGs provide indication-specific accurate imaging of the oral cavity and could contribute to the early detection of pathologies, staging, and radiological follow-up of oral and maxillofacial diseases.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
All study participants underwent 3 Tesla MRI (Skyra, release VE11e, Siemens Healthineers, Erlangen, Germany) using a dedicated 15-channels mandibular coil (NORAS MRI products, Hoechberg, Germany). The mandibular coil used in this study has a field of view of 32 × 16 × 16 cm3 and is an optimized 14+ 1 receiver coil array and positioning system specifically designed for high-resolution imaging of dental structures in the oral cavity.
Figure 2
Figure 2
OPG (orthopantomogram) MRI reconstructions (MR-OPG) from a 3D double-echo steady-state (DESS) dataset. T2-w imaging using DESS-MRI (scan time approximately 12 minutes) allows visualization of the complex neural microarchitecture of the thinnest peripheral branches of the mandibular division of the trigeminal nerve. (a) MR-OPG with a slice thickness of 0.5 mm were created using the curved multiplanar reconstruction (MPR) function of syngo.via (release VB60a, Siemens Healthineers, Erlangen, Germany). (b) Overview image of a DESS MR-OPG. (c) Visualization of the fourth quadrant of a study participant’s DESS MR-OPG. The long arrow points to the inferior alveolar nerve (IAN), while the short arrow represents the lingual nerve. (d) Visualization of the course of the T2- weighted hyperintense signal of the IAN through the mandible, whereas (e) shows a retromolar branch of the IAN.
Figure 3
Figure 3
OPG (orthopantomogram) MRI reconstructions (MR-OPG) from (a–c) 3D fast spin echo short-tau inversion recovery (SPACE STIR), (d–f) 3D fast spin echo spectral attenuated inversion recovery (SPACE-SPAIR), and (g–i) volumetric interpolated breath-hold examination (T1-VIBE-Dixon) datasets. (a), (d) and (g) show the planning of the MR-OPG images. Orthopantomogram-like MR images using (b) (SPACE-STIR), (e) (SPACE-SPAIR), and (h) (VIBE-Dixon) sequences. (c), (f) and (i) visualize the anatomy of teeth in (c) (SPACE-STIR), (f) (SPACE-SPAIR), and (i) (VIBE-Dixon) MRI.
Figure 4
Figure 4
OPG (orthopantomogram) - like MRI reconstructions (MR-OPGs) from a 3D ultrashort echo time (UTE) prototype sequence for bone and teeth imaging. (a) The planning of the orthopantomogram-like MR images. (b) Overview image of a UTE MR-OPG. (c) Visualization of the positional relationship of the maxillary third molar in the first quadrant and the maxillary sinus, with a retention cyst. (d) Visualization of the course of the hypointense inferior alveolar nerve (IAN) within the inferior alveolar canal through the mandible. (e) Shows the positional relationship between the mandibular third molar and the IAN in UTE MR-OPG.
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