CN109965894A - 一种利用影像增强剂及锥形束ct成像技术检测隐裂牙折裂纹的方法 - Google Patents
一种利用影像增强剂及锥形束ct成像技术检测隐裂牙折裂纹的方法 Download PDFInfo
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Abstract
本发明涉及一种利用影像增强剂及锥形束CT(CBCT)成像技术检测隐裂牙折裂纹的方法，其特征在于：利用增强造影剂泛影葡胺对裂纹进行增强，待造影剂渗透进入裂纹内，迅速通过锥形束CT成像显影，从而判断隐裂牙裂纹的位置，深度，并与根管充填物形成的线状低密度伪影相鉴别。通过上述方法的实施，能够有效提升CBCT诊断牙隐裂的准确性，灵敏度和特异性，并提高CBCT对隐裂牙折裂纹的定位准确率。
Description
技术领域
本发明属于口腔颌面医学影像技术领域，具体涉及一种利用影像增强剂及锥形束CT成像技术检测隐裂牙折裂纹的方法。
背景技术
牙隐裂是继牙周病、龋病引起成年人牙齿缺失的三大主要病因之一。由于隐裂牙不同临床阶段临床表现的多种多样，诊断的复杂性及不确定性，隐裂牙一直以来都备受国内外牙体牙髓领域研究者的广泛关注。1997年美国牙髓病协会(American Association ofEndodontists，AAE)将隐裂牙分为5类：牙釉质表面裂纹(Craze line)；牙尖折裂(Fractured cusp)；隐裂牙(Cracked tooth)；纵折牙(Split tooth)；垂直性牙根折裂(Vertical root facture，VRF)，这一分类将广义的隐裂牙分为5类，其中的第三类狭义隐裂牙特指从牙冠咬合面向根尖方向延伸的折裂线，第四类纵折牙指是指沿近远中方向并扩展至牙齿边缘嵴的完全性劈裂牙，第五类VRF特指牙根发生折裂的牙齿，多呈颊舌方向，由于发生于牙根无法直视其诊断则更加困难，常常要依靠牙周手术探查以明确诊断。
隐裂牙的诊断对于合理的治疗方案的设计，预后的判断有着重要的临床意义。然而，裂纹的发生可以仅为发生于牙表面的极其隐匿细小的裂纹，也可以是已经完全分离并明显移位；并且由于裂纹宽度，深度，长度、发生部位的不一样，隐裂牙的表现千差万别，对应于诊断也就存在着很大的差异性，越细小的裂纹其诊断就越困难，发生于牙根的隐裂比发生于牙冠的隐裂更加难以诊断，常常要依靠牙周手术探查以明确诊断，隐裂牙尤其是牙根纵裂诊断一直是一个让临床医生深感困扰的难题。近年来新出现的锥形束CT(Cone beamCT,CBCT)，图像分辨率已达亚毫米级，并且检查时间短，剂量低，患者照射剂量仅为大型高分辨CT检查放射剂量的1/40。CBCT作为口腔医学具有重大意义的革命性影像学成像技术，为牙体牙髓病的诊断和治疗尤其是对各种疑难牙体牙髓病的规范化精准医疗提供了一种全新的诊断手段，开拓了全新的视野。CBCT作为一种可靠的、非侵入性的检查方法，可以直接解决临床上部分牙根纵裂无法明确诊断的难题，很快得到了广泛的推广和运用。然而在使用CBCT诊断隐裂牙的过程中，由于牙根纵裂的复杂性(深度、长度、宽度、部位)，不同的CBCT扫描体系(体素分辨率、扫描剂量、探测器、图像后处理)、充填物伪影等因素使得CBCT牙根纵裂诊断的准确性，灵敏度和特异性尚有很大提升的空间，特别是根管内充填物形成的线状低密度伪影类似于牙根折裂的裂纹，大大影响了诊断的准确率。
附图说明
图1为增强前图像；
图2为增强后图像。
发明内容
为了提升CBCT图像上裂纹显影的效果，本发明拟通过造影剂对裂纹进行增强，使得CBCT图像能够更好的显示裂纹的位置，深度，同时由于增强造影剂将原本的低密度裂纹影像变为高密度影像，从而与根管充填物形成的低密度伪影相鉴别，从而使得CBCT诊断的准确性，灵敏度和特异性进一步提升，定位的准确率得以提升。
一种利用影像增强剂及锥形束CT成像技术检测隐裂牙折裂纹的方法：其特征在于：利用增强造影剂泛影葡胺对裂纹进行增强，待造影剂渗透进入裂纹内，迅速通过锥形束CT成像显影，从而判断隐裂牙裂纹的位置，深度，并与根管充填物形成的线状低密度伪影相鉴别。
隐裂牙为三类隐裂牙时，其检测方法为：将30％-40％的泛影葡胺使用棉签在隐裂牙的表面反复涂抹，10分钟后，待造影剂渗透到裂纹内后，使用常规剂量的锥形束CT扫描对隐裂牙进行扫描，通过造影剂对裂纹增强后的影像来确定裂纹的位置及性质。
在临床上，对于三类的隐裂牙，常常因为裂纹过窄及口内环境的复杂，不易定位。同时部分裂纹的位置，范围及深度运用目前的检测手段无法明确，常常会影响治疗方案的制定。最重要的是，三类的隐裂牙的预后常常是由裂纹的位置，范围及深度所决定。为了确认裂纹的位置及裂纹的性质，通过增强后的影像提高诊断效率，减少漏诊。
当隐裂牙为四类纵折牙时，其检测方法为：使用直径为0.2mm的细针管抽取50％-60％的泛影葡胺0.5ml在裂纹处或在髓腔内加压注射，等待10分钟后，进行CBCT常规剂量检测，以确定纵折牙折裂线的位置。
对于四类的纵折牙临床医生常希望通过影像学的检测去确定折裂的深度及位置，但由于结合上皮以及牙周韧带的阻隔，直接涂抹法无法在根面上进行操作，考虑到裂纹的深度及宽度，故使用加压法。
当隐裂牙为五类牙根纵裂牙时，其检测方法为：去除髓腔及根管中上段充填物，对于发生在牙根上的裂纹，使用直径为0.2mm的细针管抽取50％-60％的泛影葡胺1ml在髓腔内加压注射，等待10分钟后，待造影剂渗透到裂纹内后，迅速通过锥形束CT成像显影，判断牙根中上段裂纹有无。
通过上述方法的实施，能够有效提升CBCT诊断牙隐裂的准确性，灵敏度和特异性，并提高CBCT对牙隐裂裂纹的定位准确率。
具体实施方式
实施例1：
一种利用影像增强剂及锥形束CT成像技术检测隐裂牙折裂纹的方法：利用增强造影剂泛影葡胺对裂纹进行增强，待造影剂渗透进入裂纹内，迅速通过锥形束CT成像显影，从而判断隐裂牙裂纹的位置，深度，并与根管充填物形成的线状低密度伪影相鉴别。
隐裂牙为三类隐裂牙时，其检测方法为：将30％-40％的泛影葡胺使用棉签涂在隐裂牙的表面反复涂抹，10分钟后，待造影剂渗透到裂纹内后，使用常规剂量的锥形束CT扫描对隐裂牙进行扫描，通过造影剂对裂纹增强后的影像来确定裂纹的位置及性质。
实施例2：
一种利用影像增强剂及锥形束CT成像技术检测隐裂牙折裂纹的方法：利用增强造影剂泛影葡胺对裂纹进行增强，待造影剂渗透进入裂纹内，迅速通过锥形束CT成像显影，从而判断隐裂牙裂纹的位置，深度，并与根管充填物形成的线状低密度伪影相鉴别。
当隐裂牙为四类纵折牙时，其检测方法为：使用直径为0.2mm的细针管抽取50％-60％的泛影葡胺0.5ml在裂纹处或在髓腔内加压注射，等待10分钟后，进行CBCT常规剂量检测，以确定纵折牙折裂线的位置。
实施例3：
一种利用影像增强剂及锥形束CT成像技术检测隐裂牙折裂纹的方法：利用增强造影剂泛影葡胺对裂纹进行增强，待造影剂渗透进入裂纹内，迅速通过锥形束CT成像显影，从而判断隐裂牙裂纹的位置，深度，并与根管充填物形成的线状低密度伪影相鉴别。
当隐裂牙为五类牙根纵裂牙时，其检测方法为：去除髓腔及根管中上段充填物，对于发生在牙根上的裂纹，使用直径为0.2mm的细针管抽取50％-60％的泛影葡胺1ml在髓腔内加压注射，等待10分钟后，待造影剂渗透到裂纹内后，迅速通过锥形束CT成像显影，判断牙根中上段裂纹有无。
Claims (4)
1.一种利用影像增强剂及锥形束CT成像技术检测隐裂牙折裂纹的方法：其特征在于：利用造影剂泛影葡胺对裂纹进行增强造影，待造影剂渗透进入裂纹内，迅速通过锥形束CT成像显影，从而判断隐裂牙裂纹的位置，深度，并与根管充填物形成的线状低密度伪影相鉴别。
2.根据权利要求1所述的利用影像增强剂及锥形束CT显影技术检测隐裂牙折裂纹的方法，其特征在于：当所述的隐裂牙为美国牙体牙髓病协会定义的三类隐裂牙时，其检测方法为：
将30％-40％的泛影葡胺使用棉签在隐裂牙的表面反复涂抹，10分钟后，待造影剂渗透到裂纹内后，使用常规剂量的锥形束CT扫描对隐裂牙进行扫描，通过造影剂对裂纹增强后的影像来确定裂纹的位置及深度。
3.根据权利要求1所述的利用影像增强剂及锥形束CT显影技术检测隐裂牙折裂纹的方法，其特征在于：当隐裂牙为美国牙体牙髓病协会定义的四类纵折牙时，其检测方法为：
使用直径为0.2mm的细针管抽取50％-60％的泛影葡胺0.5ml在裂纹处或在髓腔内加压注射，等待10分钟后，进行CBCT常规剂量检测，以确定纵折牙折裂线的位置。
4.根据权利要求1所述的利用影像增强剂及锥形束CT显影技术检测隐裂牙折裂纹的方法，其特征在于：当隐裂牙为美国牙体牙髓病协会定义的五类牙根纵裂牙时，其检测方法为：
去除髓腔及根管中上段充填物，使用直径为0.2mm的细针管抽取50％-60％的泛影葡胺1ml在髓腔内加压注射，等待10分钟后，待造影剂渗透到裂纹内后，迅速通过锥形束CT成像显影，判断牙根中上段裂纹有无。
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| CN111557686A (zh) * | 2020-03-05 | 2020-08-21 | 天津医科大学口腔医院 | 一种用于隐裂牙真空加造影剂渗透裂纹的方法 |
| CN111557686B (zh) * | 2020-03-05 | 2023-08-18 | 天津医科大学口腔医院 | 一种用于隐裂牙真空加造影剂渗透裂纹的方法 |
| CN112288735A (zh) * | 2020-11-06 | 2021-01-29 | 南京大学 | 一种基于神经网络的利用牙齿锥形束ct图自动检测牙折裂的方法 |
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