측두 하악 관절 장애 환자의 파노라마 영상과 cone beam형 전산화 단층 영상의 비교
Comparison of bony changes between panoramic radiograph and cone beam computed tomographic images in patients with temporomandibular joint disorders
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본 연구는 교정 진단 및 치료 계획에 어려움을 줄 수 있는 측두 하악 관절 장애 증상을 보이는 환자의 cone beam computed tomography (CBCT) 영상과 파노라마 영상을 비교하여 파노라마 영상의 유용성을 알아보고자 하였다. 2008년 6월부터 2008년 11월까지 측두 하악 관절 부위의 이상 증상으로 치과 의원에 내원한 환자를 대상으로 임상 진단과 파노라마 촬영을 시행 후 CBCT로 촬영한 106명, 212개 관절을 대상으로 영상의 결과를 비교하였다. 2명의 치과의사가 하악 과두의 골변화의 양상을 관찰하여 정상(normal), 편평화(flattening), 골경화(sclerosis), 골증식체(osteophyte), 침식(erosion)으로 나누었다. 그 결과로 첫째, 검사자간 신뢰도에서 파노라마(weighted kappa: 0.714), CBCT (weighted kappa: 0.727) 각각의 영상 진단 일치도가 높았다. 둘째, CBCT 영상에 대한 파노라마 영상의 A 검사자의 민감도는 82.4%, 특이도는 58.1%였으며 B 검사자는 각각 84.3%, 61.5%였다. 셋째, 파노라마 영상과 CBCT 영상이 5% 유의수준에서 두 영상 간 판독이 동일하지 않았다. 이상의 결과는 파노라마 영상이 CBCT 영상과 비교할 때 비교적 높은 80% 이상의 민감도를 보여 측두 하악 관절 골 변화의 일차적인 진단수단으로 임상적으로 유용하게 사용될 수 있다는 것과 측두 하악 관절의 골 변화가 파노라마 영상에서 불분명한 경우 CBCT를 사용하였을 때 더욱 정밀한 진단이 될 수 있다는 것을 보여주었다. (대치교정지 2010;40(6):364-372)
Abstract
Objective: This study was designed to assess the diagnostic validity of digital panoramic radiographs compared to cone beam computed tomography (CBCT) in patients with temporomandibular joint disorders. Methods: Panoramic radiograph and CBCT were taken from a total of 212 joints from 106 subjects. The joints were examined by two dentists and divided into the following six groups: normal, flattening, osteophyte formation, erosion, sclerosis, and unclassified. The sensitivity and specificity of each observer and inter-observer reliability were statistically analyzed. Results: The results showed relatively high intra-observer reliability in the diagnosis of both panoramic and CBCT images and the weighted Kappa indices of panoramic and CBCT images were 0.714 and 0.727, respectively. The sensitivities of panoramic images of observer A and B to CBCT images was 82.35% and 84.30%, respectively, while the specificity of observer A and B was 58.06% and 61.54%, respectively. However, guided diagnosis from panoramic and CBCT images were statistically different (p ＜ 0.05). Conclusions: The present study suggests that the panoramic radiograph could be used as a primary diagnostic device to detect bony changes of temporomandibular joints in clinical orthodontics, because panoramic images showed relatively high sensitivity compared to CBCT images. However, CBCT images may be one of the best choices when a more accurate diagnosis is necessary. (Korean J Orthod 2010;40(6):364-372)
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