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European Radiology
Published in: European Radiology 3/2020

01-03-2020 | Magnetic Resonance Imaging | Head and Neck

In vivo comparison of MRI- and CBCT-based 3D cephalometric analysis: beginning of a non-ionizing diagnostic era in craniomaxillofacial imaging?

Authors: Alexander Juerchott, Christian Freudlsperger, Dorothea Weber, Johann M. E. Jende, Muhammad Abdullah Saleem, Sebastian Zingler, Christopher J. Lux, Martin Bendszus, Sabine Heiland, Tim Hilgenfeld

Published in: European Radiology | Issue 3/2020

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Abstract

Objectives

To evaluate whether magnetic resonance imaging (MRI) can serve as an alternative diagnostic tool to the “gold standard” cone-beam computed tomography (CBCT) in 3D cephalometric analysis.

Methods

In this prospective feasibility study, 12 patients (8 males, 4 females; mean age ± SD, 26.1 years ± 6.6) underwent 3D MRI and CBCT before orthognathic surgery. 3D cephalometric analysis was performed twice by two independent observers on both modalities. For each dataset, 27 cephalometric landmarks were defined from which 35 measurements (17 angles, 18 distances) were calculated. Statistical analyses included the calculation of Euclidean distances, intraclass correlation coefficients (ICCs), Bland-Altman analysis, and equivalence testing (linear mixed effects model) with a predefined equivalence margin of ± 1°/1 mm.

Results

Analysis of reliability for CBCT vs. MRI (intra-rater I/intra-rater II/inter-rater) revealed Euclidean distances of 0.86/0.86/0.98 mm vs. 0.93/0.99/1.10 mm for landmarks, ICCs of 0.990/0.980/0.986 vs. 0.982/0.978/0.980 for angles, and ICCs of 0.992/0.988/0.989 vs. 0.991/0.985/0.988 for distances. Bland-Altman analysis showed high levels of agreement between CBCT and MRI with bias values (95% levels of agreement) of 0.03° (− 1.49; 1.54) for angles and 0.02 mm (− 1.44; 1.47) for distances. In the linear mixed effects model, the mean values of CBCT and MRI measurements were equivalent.

Conclusion

This feasibility study indicates that MRI enables reliable 3D cephalometric analysis with excellent agreement to corresponding measurements on CBCT. Thus, MRI could serve as a non-ionizing alternative to CBCT for treatment planning and monitoring in orthodontics as well as oral and maxillofacial surgery.

Key Points

• Clinically established 3D cephalometric measurements performed on MRI are highly reliable and show an excellent agreement with CBCT (gold standard).
• The MRI technique applied in this study could be used as a non-ionizing diagnostic tool in orthodontics as well as oral and maxillofacial surgery.
• Since most patients benefiting from 3D cephalometry are young in age, the use of MRI could substantially contribute to radiation protection and open up new possibilities for treatment monitoring.
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Metadata
Title
In vivo comparison of MRI- and CBCT-based 3D cephalometric analysis: beginning of a non-ionizing diagnostic era in craniomaxillofacial imaging?
Authors
Alexander Juerchott
Christian Freudlsperger
Dorothea Weber
Johann M. E. Jende
Muhammad Abdullah Saleem
Sebastian Zingler
Christopher J. Lux
Martin Bendszus
Sabine Heiland
Tim Hilgenfeld
Publication date
01-03-2020
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 3/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06540-x

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