Diagnostics in dentistry

Complementary diagnostic tests CBCT, MRI, TAC

MRI

MRI stands for magnetic resonance imaging. It is able to produce cross-sectional images of
the patient's body. It does so while using magnetism and radio waves. Moreover, we will
have an insight into this technique from a physician's perspective. It started with a magnetic
field strength in a range of 0.05-0-35T. Over the past years, there have been major
improvements in data quality and diagnostic values. Nowadays, conventional systems at 1.5
and 3T remain highly expensive pieces of imaging equipment and for this reason, they are
out of the financial reach of much of the world. The full article deals with the current state of
art of low field systems. Moreover, the benefits from low field MRI systems are explained in
detail. Furthermore, developments in hardware for experimental low field scanners and
potential roles of new acquisition read outs are being debated.

In my search, I used the systemic reviews of Pubmed. Two of them, I found especially
interesting: “low-field MRI: an MR physics perspective”, as well as “ what is an MRI scan and
what can it do?”. Those articles, I was able to base my introduction part on, since they gave
me insight into the working strategy of MRI. The other article offered specific facts about
MRI, which I used to make my abstract even more interesting. Pubmed offers short abstracts
of big articles, that specifies the search that I’ve typed in. I used two different articles
because I wanted to expand my search and since they are usually short and specific on
Pubmed, I decided to expand my knowledge basis, to get a deeper insight into the topic.

Low-field MRI systems, defined as those with magnetic field strengths less than 1.5T, have
gained increasing attention in recent years due to their potential for widespread accessibility
and lower cost compared to conventional high-field MRI systems. In fact, several studies
have shown that low-field MRI systems can provide comparable diagnostic quality to
high-field systems, especially for certain types of imaging such as musculoskeletal and
neuroimaging. One major advantage of low-field MRI systems is their potential to be more
portable and accessible to a wider range of patients, including those in rural or remote areas.
These systems also have the potential to be used in point-of-care settings, such as
emergency departments or ambulances, for rapid diagnosis and treatment.However, there
are also some limitations to low-field MRI systems. For example, they may have lower
signal-to-noise ratios and longer acquisition times, which can impact image quality and
patient throughput. Additionally, the hardware and software used in low-field MRI systems
are still in the developmental stages and may not be as advanced as those used in high-field
systems.

Despite these challenges, there is ongoing research into improving the hardware and
acquisition techniques for low-field MRI systems. For example, recent studies have explored
the use of compressed sensing and machine learning algorithms to improve image quality
and reduce acquisition times. Additionally, new hardware designs, such as the use of
magnetic field gradients, can improve signal-to-noise ratios and image quality.

Low-field MRI systems have several advantages compared to high-field MRI systems,
including lower costs, improved accessibility, and potential for use in point-of-care settings.
However, the tradeoff for these benefits is that low-field systems have lower magnetic field
strengths, which can lead to lower signal-to-noise ratios and longer acquisition times.

To address these challenges, researchers have explored various strategies to optimize the
hardware and acquisition techniques used in low-field MRI systems. For example, one
recent study examined the use of multi-channel receiver coils, which can improve
signal-to-noise ratios and reduce imaging times. This approach involves using multiple small
receiver coils instead of one large coil, which can provide better coverage and reduce noise.

Another strategy that has shown promise is the use of compressed sensing algorithms,
which can significantly reduce the amount of data needed to reconstruct an image. This
approach involves acquiring only a subset of the k-space data needed for image
reconstruction, and then using a mathematical algorithm to fill in the missing information.
This can dramatically reduce acquisition times, making low-field MRI systems more practical
for clinical use.

In addition to hardware and acquisition techniques, researchers are also exploring new ways
to improve image quality and diagnostic accuracy using low-field MRI systems. For example,
one recent study investigated the use of machine learning algorithms to enhance image
resolution and contrast. The researchers used a deep learning algorithm to identify and
remove artifacts from low-field MRI images, resulting in higher resolution and improved
image quality.

Another promising approach is the use of hyperpolarized gases, such as helium-3, as

contrast agents in low-field MRI. These gases can be used to highlight specific areas of the
body, such as the lungs, and provide more detailed images for diagnosis and treatment
planning.

Overall, low-field MRI systems offer a promising avenue for improving access to MRI
technology, particularly in resource-limited settings. While there are still challenges to
overcome, ongoing research and development efforts are pushing the boundaries of what is
possible with these systems. As the technology continues to advance, we can expect to see
even more exciting developments and innovations in this field.

It's worth noting that the COVID-19 pandemic has highlighted the importance of point-of-care
imaging technologies, such as low-field MRI, in diagnosing and treating patients in a timely
and efficient manner. The use of portable low-field MRI systems in emergency departments
and ambulances could potentially improve patient outcomes and reduce healthcare costs.

background :
The use of various imaging modalities, such as magnetic resonance imaging, computed
tomography and PET, has been used in medical applications, such as neurosurgery,
orthopaedic surgery and radiotherapy.
Two-dimensional X-rays have limitations such as tissue overlap, distortion and object
displacement, which can be overcome with three-dimensional cone beam, which allows 3D
image superimposition. CBCT offers an important contribution to dentistry for the diagnosis,
treatment planning and evaluation of temporomandibular joint (TMJ) hard tissues. The use of
CBCT has been validated for image superimposition using anatomical landmarks at the base
of the skull to analyse changes in the craniofacial bones and airway. MRI and CBCT are
commonly used imaging techniques in dentistry, but multimodal image registration between
them is difficult due to differences in voxel size, pixel intensity, identification of anatomical
structures, image orientation and field of view. However, this registration is desirable as it
provides a complementary image of soft and hard tissues in a single frame for optimal
diagnosis, treatment planning and evaluation of treatment outcomes. The aim of this review
is to analyse the available literature on the relevance, applicability and feasibility of MR, CT
and CBCT image registration for TMJ anatomy and evaluation.
Material and methods:
The article describes a systematic search conducted in four major databases, namely
MEDLINE, All EBM Reviews-Cochrane DSR, DARE and American College of Physicians
Journal Club, Scopus and EMBASE. The search used keywords such as MRI, computed
tomography, CT cone beam, temporomandibular joint and TMJ, among others. The search
was performed without language restrictions and both MESH keywords and truncated terms
were searched with the help of a librarian. In addition, a manual reference search was
performed on the identified articles to avoid omitting relevant articles.

Inclusion and exclusion criteria:

This was a study that looked at various types of research designs related to MRI and
CT/CCT for temporomandibular joint problems . The study included clinical trials, cohort
studies, case-control studies, cross-sectional studies, prospective and retrospective studies
and case series/reports. However, reviews, editorials, letters, published errata and historical
articles were excluded. Articles describing multimodality imaging in head and neck oncology
were also excluded.

Selection process and data collection:

Three independent reviewers examined the research data and identified relevant abstracts
for assessment of full-text articles. Where
doubt or lack of clarity in the abstract, the full-text article was selected for assessment.
Abstracts/articles were reviewed according to the inclusion/exclusion criteria. No clear
conflicts in the article between the two reviewers were reported. Image characteristics and
registration type of the studies were collected and summarised in the table.

Bibliography:
AG;, M. J. P. S. F. F. J. W. (n.d.). Low-field MRI: An Mr Physics Perspective. Journal of
magnetic resonance imaging : JMRI. Retrieved March 24, 2023, from
https://pubmed.ncbi.nlm.nih.gov/30637943/
https://journalotohns.biomedcentral.com/counter/pdf/10.1186/s40463-016-0144-4.pdf?pdf=b
utton%20sticky
CARLA ISABELLA SORAVIA
FRANCESCO MARIA CELLI
TOM NEUKRANZ
LORENZO DI GIANFILIPPO
MARTINO PETTINI BONOMO