Effect of region-of-interest in computerized densitometric analysis of radiographs

The region-of-interest (ROI) in computer-assisted densitometric image analysis (CADIA) is defined by its size and location. This study evaluated the effects of these variables on two quantitative parameters, the change in density and the area with change in density. Pairs of radiographs for these analyses were obtained from sites with "no change" or "known loss" in Cynomolgus monkeys during a study of ligature-induced periodontitis. The size and location of the ROI had clear effects on the two CADIA parameters. To reduce these effects, a corrective procedure hypothesizing a linear relationship between the ROI size and the area with change in density was tested. While this procedure was sufficient to correct for ROI size-dependent differences among "no change" images, it was not effective in images with "known loss". In such images, additional adjustments by increasing threshold levels for the registered change in density were found to reduce but not to eliminate differences between ROIs of different size and location. When densitometric radiographic analysis is used for quantitative comparison of different sites, it is primarily recommended to select ROIs of similar size and location. Application of corrective procedures should follow only after careful evaluation of their effects on sensitivity and specificity.