Accuracy of small and medium field of view CBCT in differentiation between periapical cystic and solid lesions

Abstract Objective The aim of this study is to determine if small and medium field of view (FOV) cone beam computed tomography (CBCT) adjusted grey density values can be used to distinguish between periapical cystic and solid lesions. Materials and methods Fifty-one patients with periapical lesions having retrievable small or medium FOV CBCT images and biopsy samples were included in the study. Two oral and maxillofacial pathologists diagnosed the biopsy samples to provide the gold standard diagnosis of cystic or solid lesion. From the CBCT images, two independent examiners recorded the minimum adjusted grey density value of each lesion twice. Intra-examiner and inter-examiner reliability of the measurements were analyzed, and the sensitivity, specificity, and accuracy of the minimum grey values in distinguishing a solid from cystic lesion were calculated. An ROC curve for diagnostic ability of adjusted grey density values to differentiate between periapical cystic and solid lesions was obtained and the area under the curve (AUC) was calculated. Results The intra-examiner and inter-examiner reliability, demonstrated as the intraclass correlation coefficient of the lesion’s and dentin’s grey density values were excellent. The mean ± standard deviation of the sensitivity and specificity were determined as 0.53 ± 0.28 and 0.52 ± 0.31, respectively. The AUC was found to be 0.55 (P-value = 0.57). Conclusion Small and medium field of view CBCT adjusted grey density values obtained by the device used in the study could not be used to distinguish between periapical cystic and solid lesions. Further developments in CBCT devices are needed to improve the accuracy of grey density measurements.