北京大学学报(医学版) ›› 2019, Vol. 51 ›› Issue (4): 753-757. doi: 10.19723/j.issn.1671-167X.2019.04.028

• 论著 • 上一篇    下一篇

扫频光学相干断层扫描根管内窥影像系统的建立及其在根裂诊断的应用

戚苈源1,陈晨2,姜岚2,李嘉男3,(),梁宇红1,4,()   

  1. 1. 北京大学口腔医学院?口腔医院,牙体牙髓科 国家口腔疾病临床医学研究中心 口腔数字化医疗技术和材料国家工程实验室 口腔数字医学北京市重点实验室, 北京 100081
    2. 北京大学口腔医学院?口腔医院第一门诊部, 北京 100034
    3. 中国科学院西安光学精密机械研究所瞬态光学与光子技术国家重点实验室, 西安 710000
    4. 北京大学国际医院口腔科, 北京 102206
  • 收稿日期:2018-10-10 出版日期:2019-08-18 发布日期:2019-09-03
  • 通讯作者: 李嘉男,梁宇红 E-mail:jli@vivo.light.com;leungyuhong@sina.com

Construction of swept source optical coherence tomography imaging system for root canal endoscopy and application in diagnosis of root fractures

Li-yuan QI1,Chen CHEN2,Lan JIANG2,Jia-nan LI3,(),Yu-hong LIANG1,4,()   

  1. 1. Department of Cariology and Endodontology,Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology,Beijing 100081,China
    2. First Clinical Division,Peking University School and Hospital of Stomatology,Beijing 100034,China
    3. State Key Laboratory of Transient Optics and Photonics,Xian Institute of Optics and Precision Mechanics,Chinese Academy of Sciences,Xian,Shanxi 710000,China
    4. Department of Stomatology,Peking University International Hospital,Beijing 102206,China
  • Received:2018-10-10 Online:2019-08-18 Published:2019-09-03
  • Contact: Jia-nan LI,Yu-hong LIANG E-mail:jli@vivo.light.com;leungyuhong@sina.com

摘要:

目的:建立扫频光学相干断层扫描(swept source-optical coherence tomography, SS-OCT)根管内窥影像系统,并评价该系统应用于诊断模拟根管内壁裂的准确性。方法:自主研发基于压电调谐滤波器并应用傅里叶(Fourier)域锁模技术构建的40 kHz超高速扫频激光光源系统(专利号200620135940.2),利用超微型梯度折射率透镜(专利号201320241218.7)制作极细根管内窥探头(直径0.86 mm),实现实时成像传输。构建的SS-OCT根管内窥影像系统扫频光源中心波长为1 310 nm,带宽为100 nm; 扫描图像的横向和纵向分辨率分别为25 μm和15 μm。利用人离体下颌前磨牙牙根制作人工模拟根裂(内壁裂),并制备高度1 mm的牙根横断面切盘。立体显微镜下观察发现,41个待测样本中有27个根管内壁裂样本(宽度在52~284 μm),另14个样本无根裂。应用上述构建的SS-OCT根管内窥影像系统扫描待测样本,重建图像的层厚为30 μm,层间距为30 μm。对1名口腔放射科医师和1名牙体牙髓科医师进行培训,判读SS-OCT扫描重建图像,判读根管内壁裂的有无及具体位置,评价两名观察者的自身一致性和观察者之间的一致性。以立体显微镜(组织学)检查结果作为金标准,评价应用SS-OCT根管内窥影像系统诊断模拟根管内壁裂的准确性。结果:两位观察者自身一致性的Kappa值分别为1.000和0.709,观察者之间的Kappa值为0.792。应用SS-OCT根管内窥影像系统扫描后27个根裂样本均被正确诊断,灵敏度为1.000,14个无根裂的样本有12个被正确判读,特异度为0.857, 2个无根裂样本被判读为有根裂,为假阳性。阳性预测值、阴性预测值分别为0.931、1.000,准确性为0.951。结论:扫频光学相干断层扫描根管内窥影像系统应用于观察根管内壁裂有临床应用前景。

关键词: 扫频光学相干断层扫描, 根管内窥, 人工模拟根裂

Abstract:

Objective: To construct swept source optical coherence tomography (SS-OCT) imaging system for root canal endoscopy,and to evaluate the accuracy of diagnosing artificial root fractures.Methods: An ultra-high-speed (40 kHz) swept laser source was developed based on the piezoelectric tuning filter and the Fourier domain mode locking (FDML) swept laser technology (patent number: 200620135940.2). Ultra-miniature gradient index lens technology (patent number: 201320241218.7) was used to create a thin endoscopic probe with a diameter of 0.86 mm for real-time image transmission. The SS-OCT light source had a wavelength of 1 310 nm and a bandwidth of 100 nm. The axial and transverse image resolutions were 15 μm and 25 μm,respectively. Artificial fractures were created on human mandibular premolars with single root and the premolar roots were prepared to 41 horizontal sections (1 mm thick). 27 root sections with fractures (width: 52-284 μm) and 14 the sections without fractures were observed under an optical stereomicroscope with a cold light source as the gold standard. The horizontal root sections were scanned by self-developed SS-OCT imaging system for root canal endoscopy with a central wavelength of 1 310 nm and bandwidth of 100 nm. The data were reconstructed with 30 μm thick slices at an interval of 30 μm. Two observers,a radiologist and an endodontist,were trained and independently evaluated all the reconstructed images blindly. The diagnostic performance of SS-OCT imaging system was calculated,and statistical analysis was performed.Results: SS-OCT root canal endoscopic imaging system composed of high-speed swept laser source, fiber coupler, endoscopic probe, reference arm and differential detector. Root sections could be scanned by SS-OCT and imaged in realtime at a depth of 1 to 2 mm. The kappa value for interobserver agreement was 0.792,and the intraobserver agreement was 1.000 and 0.709 for two observers respectively. All of 27 fractured root sections and 12 of 14 root sections without fractures were accurately diagnosed while 2 unfractured root sections were misdiagnosed. The sensitivity was 1.000 and the specificity was 0.857 for diagnosis of artificial root fractures by SS-OCT. The positive predictive value (PPV),negative predictive value (NPV) and the overall accuracy rate were 0.931,1.000 and 0.951 respectively.Conclusion: The swept source optical coherence tomography imaging system for root canal endoscopy is a promising imaging method for observing root fractures.

Key words: Swept source optical coherence tomography (SS-OCT), Root canal endoscopy, Artificial root fractures

中图分类号: 

  • R781

图1

扫频光学相干断层扫描根管内窥影像系统示意图"

图2

SS-OCT扫描重建图像显示根管内壁裂"

图3

待测样本立体显微镜检查图像(×15倍)(左)及SS-OCT扫描重建图像(右)"

[1] Fercher AF, Drexler W, Hitzenberger CK , et al. Optical coherence tomography-principles and applications[J]. Rep Prog Phys, 2003,66(2):239.
[2] Oliveira BPD , CÂmara AC, Duarte DA, et al. Detection of apical root cracks using spectral domain and swept-source optical co-herence tomography [J]. Int Endod J, 2017,43(7):1148-1151.
[3] Lavinsky F, Lavinsky D . Novel perspectives on swept-source optical coherence tomography[J]. Int J Retina Vitreous, 2016,2(1):25.
[4] Ha FJ, Giblett JP, Nerlekar N , et al. Optical coherence tomography guided percutaneous coronary intervention[J]. Heart Lung Circ, 2017,26(12):1267-1276.
[5] Colston B, Everett M, Da Silva LB , et al. Imaging of hard-and soft-tissue structure in the oral cavity by optical coherence tomography[J]. Applied Optics, 1998,37(16):3582-3585.
[6] Baumgartner A, Dichtl S, Hitzenberger CK , et al. Polarization-sensitive optical coherence tomography of dental structures[J]. Caries Res, 1999,34(1):59-69.
[7] Shemesh H, van Soest G, Wu MK , et al. Diagnosis of vertical root fractures with optical coherence tomography[J]. J Endod, 2008,34(6):739-742.
[8] Zain E, Zakian CM, Chew HP . Influence of the loci of non-cavitated fissure caries on its detection with optical coherence tomography[J]. J Dent, 2018,71(4):31-37.
[9] Majkut P, Sadr A, Shimada Y , et al. Validation of optical coherence tomography against micro-computed tomography for evaluation of remaining coronal dentin thickness[J]. J Endod, 2015,41(8):1349-1352.
[10] Han SH, Sadr A, Tagami J , et al. Non-destructive evaluation of an internal adaptation of resin composite restoration with swept-source optical coherence tomography and micro-CT[J]. Dent Mater, 2015,32(1):e1-e7
[11] Yoshioka T, Sakaue H, Ishimura H , et al. Detection of root surface fractures with swept-source optical coherence tomography (SS-OCT)[J]. Photomed Laser Surg, 2013,31(1):23-27.
[12] 陈晨, 章文欣, 戚苈源 , 等. 光学相干断层扫描技术诊断牙根裂的实验研究[J]. 北京大学学报(医学版), 2018,50(3):547-552.
[13] Wang P, Yan X, Liu D , et al. Detection of dental root fractures by using cone-beam computed tomography[J]. Dentomaxillofac Radiol, 2011,40(5):290-298.
[14] Li G . Patient radiation dose and protection from cone-beam computed tomography[J]. Imaging Sci Dent, 2013,43(2):63-69.
[15] Paul RA, Tamse A, Rosenberg E . Cracked and broken teeth definitions, differential diagnosis and treatment[J]. Refuat Hapeh Vehashinayim, 2007,24(2):7-12.
[16] Huang D, Swanson EA, Lin CP , et al. Optical coherence tomography[J]. Science, 1991,254(5035):1178-1181
[17] Bahcall JK, Barss JT . Fiberoptic endoscope usage for intracanal visualization[J]. J Endod, 2001,27(2):128-129.
[18] Hassan B, Metska ME, Ozok AR , et al. Detection of vertical root fractures in endodontically treated teeth by a cone beam computed tomography scan[J]. J Endod, 2009,35(5):719-722.
[19] Özer SY . Detection of vertical root fractures of different thicknesses in endodontically enlarged teeth by cone beam computed tomography versus digital radiography[J]. J Endod, 2010,36(7):1245-1249.
[20] Patel S, Brady E, Wilson R , et al. The detection of vertical root fractures in root filled teeth with periapical radiographs and CBCT scans[J]. Int Endod J, 2013,46(12):1140-1152.
[21] Chavda R, Mannocci F, Andiappan M , et al. Comparing the in vivo diagnostic accuracy of digital periapical radiography with cone-beam computed tomography for the detection of vertical root fracture[J]. J Endod, 2014,40(10):1524-1529.
[22] Makeeva IM, Byakova SF, Novozhilova NE , et al. Detection of artificially induced vertical root fractures of different widths by cone beam computed tomography in vitro and in vivo[J]. Int Endod J, 2016,49(10):980-989.
[1] 孙菲,李思琪,危伊萍,钟金晟,王翠,胡文杰. 种植体周病非手术治疗中联合应用甘氨酸粉喷砂的临床效果评价[J]. 北京大学学报(医学版), 2022, 54(1): 119-125.
[2] 袁临天,马利沙,刘润园,齐伟,张栌丹,王贵燕,王宇光. 计算机模拟亚甲基蓝与牙龈卟啉单胞菌部分蛋白的分子对接[J]. 北京大学学报(医学版), 2022, 54(1): 23-30.
[3] 王铮,丁茜,高远,马全诠,张磊,葛兮源,孙玉春,谢秋菲. 氧化锆多孔表面显微形貌对成骨细胞增殖及分化的影响[J]. 北京大学学报(医学版), 2022, 54(1): 31-39.
[4] 朱小玲,李文静,王宪娥,宋文莉,徐莉,张立,冯向辉,路瑞芳,释栋,孟焕新. 细胞色素B-245α链及胆固醇酯转运蛋白基因多态性与广泛型侵袭性牙周炎易感性的关系[J]. 北京大学学报(医学版), 2022, 54(1): 18-22.
[5] 范莹莹,刘云,曹烨,谢秋菲. 海马参与雌激素加重咬合干扰致去卵巢大鼠慢性咬肌痛敏[J]. 北京大学学报(医学版), 2022, 54(1): 40-47.
[6] 徐欣然,霍芃呈,和璐,孟焕新,朱筠轩,靳东思奇. 伴与不伴糖尿病的牙周炎患者牙周基础治疗的疗效比较及其与白细胞水平的相关分析[J]. 北京大学学报(医学版), 2022, 54(1): 48-53.
[7] 陈超伦,苏家增,俞光岩. 酸刺激对腮腺和下颌下腺唾液流率及成分的影响[J]. 北京大学学报(医学版), 2022, 54(1): 89-94.
[8] 钱锟,潘洁,朱文昊,赵晓一,刘畅,雍颹. 两种硅酸钙类材料用于成熟恒牙牙髓切断术的临床效果[J]. 北京大学学报(医学版), 2022, 54(1): 113-118.
[9] 朱正达,高岩,何汶秀,方鑫,刘洋,魏攀,闫志敏,华红. 红色诺卡氏菌细胞壁骨架治疗糜烂型口腔扁平苔藓的疗效及安全性[J]. 北京大学学报(医学版), 2021, 53(5): 964-969.
[10] 郜洪宇,孟焕新,侯建霞,黄宝鑫,李玮. 钙结合蛋白在健康牙周组织和实验性牙周炎组织的表达分布[J]. 北京大学学报(医学版), 2021, 53(4): 744-749.
[11] 孟圆,张丽琪,赵雅宁,柳登高,张祖燕,高岩. 67例上颌根尖周囊肿的三维影像特点分析[J]. 北京大学学报(医学版), 2021, 53(2): 396-401.
[12] 李峥,王霄,洪天配,王浩杰,高展翼,万蒙. 晚期糖基化终末产物抑制大鼠外周血单个核细胞及成骨细胞增殖的作用机制[J]. 北京大学学报(医学版), 2021, 53(2): 355-363.
[13] 张胜男,安娜,欧阳翔英,刘颖君,王雪奎. 生长停滞特异性蛋白6在人牙周膜细胞迁移及成骨分化中的作用[J]. 北京大学学报(医学版), 2021, 53(1): 9-15.
[14] 赵思铭,赵晓含,张杰,王党校,王晓燕. 虚拟现实技术用于龋坏识别教学[J]. 北京大学学报(医学版), 2021, 53(1): 139-142.
[15] 周培茹, 蒋析, 华红. 口腔黏膜病患者口腔种植的时机及注意事项[J]. 北京大学学报(医学版), 2021, 53(1): 5-8.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 张三. 中文标题测试[J]. 北京大学学报(医学版), 2010, 42(1): 1 -10 .
[2] 赵磊, 王天龙 . 右心室舒张末期容量监测用于肝移植术中容量管理的临床研究[J]. 北京大学学报(医学版), 2009, 41(2): 188 -191 .
[3] 万有, , 韩济生, John E. Pintar. 孤啡肽基因敲除小鼠电针镇痛作用增强[J]. 北京大学学报(医学版), 2009, 41(3): 376 -379 .
[4] 张燕, 韩志慧, 钟延丰, 王盛兰, 李玲玲, 郑丹枫. 骨骼肌活组织检查病理诊断技术的改进及应用[J]. 北京大学学报(医学版), 2009, 41(4): 459 -462 .
[5] 林红, 王玉凤, 吴野平. 学校生活技能教育对小学三年级学生行为问题影响的对照研究[J]. 北京大学学报(医学版), 2007, 39(3): 319 -322 .
[6] 丰雷, 程嘉, 王玉凤. 注意缺陷多动障碍儿童的运动协调功能[J]. 北京大学学报(医学版), 2007, 39(3): 333 -336 .
[7] 李岳玲, 钱秋瑾, 王玉凤. 儿童注意缺陷多动障碍成人期预后及其预测因素[J]. 北京大学学报(医学版), 2007, 39(3): 337 -340 .
[8] . 书讯[J]. 北京大学学报(医学版), 2007, 39(3): 225 -328 .
[9] 牟向东, 王广发, 刁小莉, 阙呈立. 肺黏膜相关淋巴组织型边缘区B细胞淋巴瘤一例[J]. 北京大学学报(医学版), 2007, 39(4): 346 -350 .
[10] 燕太强, 杨荣利, 郭卫, 沈丹华. 胫骨平滑肌肉瘤伴全身多发骨转移一例[J]. 北京大学学报(医学版), 2007, 39(4): 369 -373 .