Maxillofac Plast Reconstr Surg.  2019 ;41(1):6. 10.1186/s40902-019-0188-2.

Early diagnosis of jaw osteomyelitis by easy digitalized panoramic analysis

Affiliations
  • 1Department of Dentistry, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, South Korea. smin5@snu.ac.kr.
  • 2Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101, Daehak-ro, Jongno-gu, Seoul, 110-768 South Korea.

Abstract

BACKGROUND
Osteomyelitis is an intraosseous inflammatory disease characterized by progressive inflammatory osteoclasia and ossification. The use of quantitative analysis to assist interpretation of osteomyelitis is increasingly being considered. The objective of this study was to perform early diagnosis of osteomyelitis on digital panoramic radiographs using basic functions provided by picture archiving and communication system (PACS), a program used to show radiographic images.
METHODS
This study targeted a total of 95 patients whose symptoms were confirmed as osteomyelitis under clinical, radiologic, pathological diagnosis over 11"‰years from 2008 to 2017. Five categorized patients were osteoradionecrosis, bisphosphonate-related osteonecrosis of jaw (BRONJ, suppurative and sclerosing type), and bacterial osteomyelitis (suppurative and sclerosing type), and the control group was 117 randomly sampled. The photographic density in a certain area of the digital panoramic radiograph was determined and compared using the "measure area rectangle," one of the basic PACS functions in INFINITT PACS® (INFINITT Healthcare, Seoul, South Korea). A conditional inference tree, one type of decision making tree, was generated with the program R for statistical analysis with SPSS®.
RESULTS
In the conditional inference tree generated from the obtained data, cases where the difference in average value exceeded 54.49 and the difference in minimum value was less than 54.49 and greater than 12.81 and the difference in minimum value exceeded 39 were considered suspicious of osteomyelitis. From these results, the disease could be correctly classified with a probability of 88.1%. There was no difference in photographic density value of BRONJ and bacterial osteomyelitis; therefore, it was not possible to classify BRONJ and bacterial osteomyelitis by quantitative analysis of panoramic radiographs based on existing research.
CONCLUSIONS
This study demonstrates that it is feasible to measure photographic density using a basic function in PACS and apply the data to assist in the diagnosis of osteomyelitis. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s40902-019-0188-2) contains supplementary material, which is available to authorized users.

Keyword

Early diagnosis; Digitalized panoramic analysis; Osteomyelitis of jaw; Decision making tree; Picture archiving and communication system (PACS)

MeSH Terms

Decision Making
Delivery of Health Care
Diagnosis
Early Diagnosis*
Humans
Jaw*
Osteomyelitis*
Osteonecrosis
Osteoradionecrosis
Seoul
Trees
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