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In vivo reliability of 3D cephalometric landmark determination on magnetic resonance imaging: a feasibility study

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Abstract

Objective

3D cephalometric analysis performed on cone-beam or multi-slice computed tomography (CBCT, MSCT) has superior diagnostic value compared to 2D cephalometry based on radiographs. However, this comes at the expense of increased radiation risks for the predominantly young patients. Magnetic resonance imaging (MRI) has the potential to overcome this diagnostic dilemma but has not been established for 3D cephalometry so far. Since landmark reliability forms the basis for 3D cephalometry, we evaluated the in vivo reliability of established 3D landmarks using MRI.

Materials and methods

Sixteen orthodontic patients underwent MRI at 3 Tesla using a 0.5 mm 3D sequence. On each MRI scan, 44 cephalometric landmarks were determined. Image analysis was performed twice by two independent observers. Intra- and inter-rater agreement was assessed by mean measurement errors and intraclass correlation coefficients (ICCs). Measurement errors were calculated as Euclidean distances and distances for x-, y-, and z-coordinates.

Results

Overall, MRI-based 3D cephalometric landmarks revealed a high reliability comparable to prior in vivo studies using CBCT/MSCT. Intra- and inter-rater ICCs were consistently higher than 0.9. Intra-rater comparisons showed mean measurement differences (ranges) of 0.87 mm (0.41–1.63) for rater I and 0.94 mm (0.49–1.28) for rater II. Average inter-rater difference was 1.10 mm (0.52–2.29). Distinct differences in reliability between the various landmarks were observed, corresponding well with the landmarks’ specific shapes.

Conclusions

The present study demonstrates that MRI enables reliable determination of 3D cephalometric landmarks in vivo.

Clinical relevance

This study emphasizes the potential of MRI to perform treatment planning and monitoring in orthodontics as well as oral and maxillofacial surgery without radiation exposure.

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Acknowledgments

The authors would like to thank the Dietmar Hopp Foundation for their friendly support of this research project. Many thanks to Mathias Nittka, PhD, from Siemens Healthcare for his cooperation and assistance in the setup of the MSVAT-SPACE sequence. A.J. receives funding from a postdoctoral fellowship of the Medical Faculty of the University of Heidelberg.

Funding

This study was supported by the Dietmar Hopp Foundation (grant no. 23011228; grant holders—A.J., S.H., C.J.L., and S.Z.).

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Authors and Affiliations

  1. Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    Alexander Juerchott, Johann M. E. Jende, Martin Bendszus & Tim Hilgenfeld

  2. Department of Oral and Maxillofacial Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    Christian Freudlsperger

  3. Department of Orthodontics and Dentofacial Orthopedics, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    Sebastian Zingler & Christopher J. Lux

  4. Division of Experimental Radiology, Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    Muhammad Abdullah Saleem & Sabine Heiland

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  1. Alexander Juerchott
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Correspondence to Tim Hilgenfeld.

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All methods were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the local research ethics committee of the University of Heidelberg (approval no. S-294/2014).

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Juerchott, A., Freudlsperger, C., Zingler, S. et al. In vivo reliability of 3D cephalometric landmark determination on magnetic resonance imaging: a feasibility study. Clin Oral Invest 24, 1339–1349 (2020). https://doi.org/10.1007/s00784-019-03015-7

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