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Software for trabecular analysis of bone on dental radiographs

Radiographic images of the jaws show a typical pattern as a result of the attenuation of the radiation by the trabecular bone. This pattern is not equivalent to the three-dimensional architecture of the trabecular bone, because the pattern is a two dimensional projection of the three-dimensional bone structure. It has, however, characteristics that are directly depending on the trabecular structure and dimensions. Therefore, the (two-dimensional) radiographic trabecular pattern can provide information about changes of the (three-dimensional) trabecular dimensions (Geraets et al., 1993; Korstjens et al., 1995, 1996).

The image analysis technique is based on segmentation of darker and lighter areas in the radiographic image and the detection of the central axis of the dark and the light regions. Subsequently, the area of dark and light regions is determined and the average width, as well as the length, number of intersections and endpoints and number of segments as shown in the image of the axis of the light and of the dark regions. Finally the polar distribution of the direction of the trabecular pattern is determined.

This work package focussed on the development and testing of software for the analysis of the trabecular pattern on intraoral radiographs of premolar regions of the upper and lower jaw. The objective was to predict the severity of osteoporotic changes in these subjects. The BMD values (see WP 1) served as the reference (golden standard) for the osteoporotic condition of each subject. A special software environment was developed to automate the analysis of larger number of radiographic images. This made it possible to analyse large series (or the complete data set) for a variety of ROIs.

The ideal ROI is a region, which shows the trabecular pattern without overprojection of other dental structures. Intra-oral radiographs have a limited size and therefore they do not fulfil this requirement always. For this reason, we investigated the effect of a small part of adjacent teeth being visible in the ROI. If the effect is negligible, a larger ROI is feasible, otherwise the selection of the ROI is critical and must be done very careful.

The difference of the outcome of the parameters on a ROI with and without a small area of overlapping tooth structures was not significant. Because the procedure of analysing the trabecular features was automated and therefore easy to carry out once set up, it was decided to include both options in the final analysis.

The predicted BMD values for spine and hip, based on the trabecular pattern analysis on intra-oral radiographs and age as parameters produced ROC values in the range between 0.77 and 0.82. This shows that the software for the analysis of the trabecular pattern for the prediction of BMD values performed very well and is a promising tool for the detection of osteoporosis.

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Reported by

ACTA, Dept. of Oral and Maxillofacial Radiology
Louwesweg 1
1066EA Amsterdam
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