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Radiomics as a Decision Support Tool for Detecting Occult Periapical Lesions on Intraoral Radiographs.

Barbara Obuchowicz1, Joanna Zarzecka1, Marzena Jakubowska1

  • 1Department of Conservative Dentistry with Endodontics, Institute of Dentistry, Jagiellonian University Medical College, Montelupich 4, 31-155 Krakow, Poland.

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Radiomics analysis reveals quantifiable signatures of periapical pathology on conventional radiographs, even when lesions are hidden. This technique can aid in detecting cone-beam computed tomography (CBCT)-only periapical lesions during routine imaging.

Keywords:
apical periodontitisartificial intelligencecone-beam computed tomographydental radiographyendodonticsperiapical diseasesradiomics

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Area of Science:

  • Dentistry
  • Radiology
  • Medical Imaging Analysis

Background:

  • Periapical lesions are common after pulp necrosis.
  • These lesions are often undetectable on conventional radiographs, requiring cone-beam computed tomography (CBCT).
  • Improving detection on standard radiographs is clinically significant.

Purpose of the Study:

  • To investigate the presence of radiomic signatures for periapical lesions on conventional intraoral radiographs.
  • To assess the potential of radiomics as a tool for identifying lesions not visible on standard X-rays.

Main Methods:

  • Retrospective analysis of 56 matched intraoral periapical radiographs (RVG) and CBCT scans.
  • Extraction of radiomic texture features from regions of interest (ROIs) on RVG images using PyRadiomics.
  • Logistic regression model with nested cross-validation for classification of lesions.

Main Results:

  • Forty-four radiomic features showed significant differences between lesions visible only on CBCT and normal regions.
  • A classifier achieved a mean AUC of 0.71, 68% accuracy, and 73% sensitivity for detecting lesions.
  • Smaller ROIs (20-40 pixels) provided better accuracy than larger ones.

Conclusions:

  • Radiomic signatures of periapical pathology exist on conventional radiographs, even for occult lesions.
  • Radiomics can serve as a decision support tool to identify CBCT-only periapical lesions.
  • This approach enhances the diagnostic capabilities of routine dental imaging.