Imaging Science in Dentistry

Korean Academy of Oral and Maxillofacial Radiology (대한영상치의학회)
권호 표지
DOI QR코드

DOI QR Code

Structural complexity of the craniofacial trabecular bone in multiple myeloma assessed by fractal analysis

  • Michels, Mariane (Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas) ;
  • Morais-Faria, Karina (Dental Oncology Service, Sao Paulo State Cancer Institute, Sao Paulo University Medical School) ;
  • Rivera, Cesar (Oral Medicine and Pathology Research Group, Department of Basic Biomedical Sciences, Faculty of Health Sciences, University of Talca) ;
  • Brandao, Thais Bianca (Dental Oncology Service, Sao Paulo State Cancer Institute, Sao Paulo University Medical School) ;
  • Santos-Silva, Alan Roger (Division of Oral Medicine, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas) ;
  • Oliveira, Matheus L (Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas)
  • Received : 2021.06.24
  • Accepted : 2021.09.24
  • Published : 2022.03.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: This study aimed to evaluate the structural complexity of craniofacial trabecular bone in multiple myeloma by fractal analysis of panoramic and lateral skull radiography, and to compare the fractal dimension values of healthy patients (HPs), pre-treatment patients (PTPs), and patients during bisphosphonate treatment (DTPs). Materials and Methods: Pairs of digital panoramic and lateral skull radiographs of 84 PTPs and 72 DTPs were selected. After application of exclusion criteria, 43 panoramic and 84 lateral skull radiographs of PTPs, 56 panoramic and 72 lateral skull radiographs of DTPs, and 99 panoramic radiographs of age- and sex-matched HPs were selected. The fractal dimension values from panoramic radiographs were compared among HPs, PTPs, and DTPs and between anatomical locations within patient groups using analysis of variance with the Tukey test. Fractal dimension values from lateral skull radiographs were compared between PTPs and DTPs using the Student t-test. Pearson correlation coefficients were used to assess the relationship between the mandible from panoramic radiographs and the skull from lateral skull radiographs. Intra-examiner agreement was assessed using intraclass correlation coefficients (α=0.05). Results: The fractal dimension values were not significantly different among HPs, PTPs, and DTPs on panoramic radiographs or between PTPs and DTPs on lateral skull radiographs (P>0.05). The mandibular body presented the highest fractal dimension values (P≤0.05). The fractal dimension values of the mandible and skull in PTPs and DTPs were not correlated. Conclusion: Fractal analysis was not sensitive for distinguishing craniofacial trabecular bone complexity in multiple myeloma patients using panoramic and lateral skull radiography.

Keywords

Acknowledgement

The results were presented and awarded the first prize in the poster presentations of the XI CONABRO - Brazilian Congress of Dento-Maxillo-Facial Radiology in August 2019.

References

  1. Packard E, Shahid Z, Groff A, Patel R, Jain R. Multiple myeloma in an agricultural worker exposed to pesticides. Cureus 2019; 11: e4762.
  2. Faria KM, Brandao TB, Silva WG, Pereira J, Neves FS, Alves MC, et al. Panoramic and skull imaging may aid in the identification of multiple myeloma lesions. Med Oral Patol Oral Cir Bucal 2018; 23: e38-43.
  3. Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, et al. American association of oral and maxillofacial surgeons position paper on medication-related osteonecrosis of the jaw - 2014 update. J Oral Maxillofac Surg 2014; 72: 1938-56. https://doi.org/10.1016/j.joms.2014.04.031
  4. Faria KM, Ribeiro AC, Brandao TB, Silva WG, Lopes MA, Pereira J, et al. Radiographic patterns of multiple myeloma in the jawbones of patients treated with intravenous bisphosphonates. J Am Dent Assoc 2018; 149: 382-91. https://doi.org/10.1016/j.adaj.2017.12.028
  5. Kato CN, Barra SG, Tavares NP, Amaral TM, Brasileiro CB, Mesquita RA, et al. Use of fractal analysis in dental images: a systematic review. Dentomaxillofac Radiol 2020; 49: 20180457. https://doi.org/10.1259/dmfr.20180457
  6. Grizzi F, Castello A, Qehajaj D, Russo C, Lopci E. The complexity and fractal geometry of nuclear medicine images. Mol Imaging Biol 2019; 21: 401-9. https://doi.org/10.1007/s11307-018-1236-5
  7. Oliveira-Santos N, Michels M, Freitas DQ, Haiter-Neto F, Oliveira ML. Influence of phosphor plate-based radiographic image specifications on fractal analysis of alveolar bone. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128: 418-23. https://doi.org/10.1016/j.oooo.2019.06.011
  8. Oliveira ML, Pedrosa EF, Cruz AD, Haiter-Neto F, Paula FJ, Watanabe PC. Relationship between bone mineral density and trabecular bone pattern in postmenopausal osteoporotic Brazilian women. Clin Oral Investig 2013; 17: 1847-53. https://doi.org/10.1007/s00784-012-0882-2
  9. Chen Q, Bao N, Yao Q, Li ZY. Fractal dimension: a complementary diagnostic indicator of osteoporosis to bone mineral density. Med Hypotheses 2018; 116: 136-8. https://doi.org/10.1016/j.mehy.2018.05.006
  10. Demirbas AK, Ergun S, Guneri P, Aktener BO, Boyacioglu H. Mandibular bone changes in sickle cell anemia: fractal analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 106: e41-8. https://doi.org/10.1016/j.tripleo.2008.03.007
  11. Ergun S, Saracoglu A, Guneri P, Ozpinar B. Application of fractal analysis in hyperparathyroidism. Dentomaxillofac Radiol 2009; 38: 281-9. https://doi.org/10.1259/dmfr/24986192
  12. Apolinario AC, Sindeaux R, de Souza Figueiredo PT, Guimaraes AT, Acevedo AC, Castro LC, et al. Dental panoramic indices and fractal dimension measurements in osteogenesis imperfecta children under pamidronate treatment. Dentomaxillofac Radiol 2016; 45: 20150400. https://doi.org/10.1259/dmfr.20150400
  13. Angtuaco EJ, Fassas AB, Walker R, Sethi R, Barlogie B. Multiple myeloma: clinical review and diagnostic imaging. Radiology 2004; 231: 11-23. https://doi.org/10.1148/radiol.2311020452
  14. Oravec D, Yaldo O, Bolton C, Flynn MJ, van Holsbeeck M, Yeni YN. Digital tomosynthesis and fractal analysis predict prevalent vertebral fractures in patients with multiple myeloma: a preliminary in vivo study. AJR Am J Roentgenol 2019; 213: W38-44. https://doi.org/10.2214/AJR.18.20700
  15. White SC. Oral radiographic predictors of osteoporosis. Dentomaxillofac Radiol 2002; 31: 84-92. https://doi.org/10.1038/sj.dmfr.4600674
  16. Cicchetti DV, Sparrow SA. Developing criteria for establishing interrater reliability of specific items: applications to assessment of adaptive behavior. Am J Ment Defic 1981; 86: 127-37.
  17. Sanchez I, Uzcategui G. Fractals in dentistry. J Dent 2011; 39: 273-92. https://doi.org/10.1016/j.jdent.2011.01.010
  18. Arsan B, Kose TE, Cene E, Ozcan I. Assessment of the trabecular structure of mandibular ondyles in patients with temporomandibular disorders using fractal analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123: 382-91. https://doi.org/10.1016/j.oooo.2016.11.005
  19. Mostafa RA, Arnout EA, Abo El-Fotouh MM. Feasibility of cone beam computed tomography radiomorphometric analysis and fractal dimension in assessment of postmenopausal osteoporosis in correlation with dual X-ray absorptiometry. Dentomaxillofac Radiol 2016; 45: 20160212. https://doi.org/10.1259/dmfr.20160212
  20. Kursun-Cakmak ES, Bayrak S. Comparison of fractal dimension analysis and panoramic-based radiomorphometric indices in the assessment of mandibular bone changes in patients with type 1 and type 2 diabetes mellitus. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126: 184-91. https://doi.org/10.1016/j.oooo.2018.04.010
  21. Goller Bulut D, Bayrak S, Uyeturk U, Ankarali H. Mandibular indexes and fractal properties on the panoramic radiographs of the patients using aromatase inhibitors. Br J Radiol 2018; 91: 20180442. https://doi.org/10.1259/bjr.20180442
  22. Gumussoy I, Miloglu O, Cankaya E, Bayrakdar IS. Fractal properties of the trabecular pattern of the mandible in chronic renal failure. Dentomaxillofac Radiol 2016; 45: 20150389. https://doi.org/10.1259/dmfr.20150389
  23. Takasu M, Tani C, Ishikawa M, Date S, Horiguchi J, Kiguchi M, et al. Multiple myeloma: microstructural analysis of lumbar trabecular bones in patients without visible bone lesions - preliminary results. Radiology 2011; 260: 472-9. https://doi.org/10.1148/radiol.11101746
  24. Pittari G, Costi D, Raballo M, Maulucci L, Baroni MC, Mangoni M. Intravenous neridronate for skeletal damage treatment in patients with multiple myeloma. Acta Biomed 2006; 77: 81-4.
  25. Demiralp KO, Kursun-Cakmak ES, Bayrak S, Akbulut N, Atakan C, Orhan K. Trabecular structure designation using fractal analysis technique on panoramic radiographs of patients with bisphosphonate intake: a preliminary study. Oral Radiol 2019; 35: 23-8. https://doi.org/10.1007/s11282-018-0321-4
  26. Southard TE, Southard KA, Jakobsen JR, Hillis SL, Najim CA. Fractal dimension in radiographic analysis of alveolar process bone. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996; 82: 569-76. https://doi.org/10.1016/S1079-2104(96)80205-8
  27. Feitosa EF, Vasconcellos MM, Magalhaes RJ, Domingos-Vieira AC, Visconti MA, Guedes FR, et al. Bisphophonate alterations of the jaw bones in individuals with multiple myeloma. Dentomaxillofac Radiol 2020; 49: 20190155. https://doi.org/10.1259/dmfr.20190155