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A computer-aided diagnosis system to screen for osteoporosis using dental panoramic radiographs

¹Department of Oral and Maxillofacial Radiology, Division of Medical Intelligence and Informatics, Graduate School of Biomedical Sciences, Hiroshima University, Japan; ²Department of Oral and Maxillofacial Radiology, Hiroshima University Hospital, Japan; ³Department of Obstetrics and Gynecology, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, Japan; ⁴Department of Information Engineering, Graduate School of Engineering, Hiroshima University, Higashi-Hiroshima, Japan

*Correspondence to: Takashi Nakamoto, DDS, PhD, Department of Oral and Maxillofacial Radiology Division of Medical Intelligence and Informatics, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734–8553, Japan; E-mail: tnk{at}hiroshima-u.ac.jp

Received 15 April 2007; revised 2 August 2007; accepted 6 August 2007

Objectives: An eroded inferior cortex of the mandible detected on dental panoramic radiographs is useful for identifying post-menopausal women with low skeletal bone mineral density (BMD) or osteoporosis. The purposes of this study were to develop a computer-aided diagnosis (CAD) system that automatically determines cortical erosion of the mandible on dental panoramic radiographs and to assess the validation of this CAD system.

Methods: A CAD system was developed based on mathematical morphology for identifying post-menopausal women with low skeletal BMD or osteoporosis, based on World Health Organization criteria, by identifying whether the endosteal margin of mandibular cortical bone was eroded. The sensitivity, specificity, predictive value, accuracy and likelihood for a positive risk result were calculated using dichotomous 2x2 tables using 100 panoramic radiographs.

Results: For identifying women with low skeletal BMD, the sensitivity and specificity were 76.8% and 61.1%, respectively, the positive and negative predictive values were 90.0% and 36.7%, accuracy was 74.0% and the likelihood for positive risk was 1.96. The respective values for identifying women with osteoporosis were 94.4% and 43.8%, the positive and negative predictive values were 48.6% and 93.3%, respectively, the accuracy was 62.0% and the likelihood for positive risk was 1.68.

Conclusion: Our results suggest that a CAD system applied to dental panoramic radiographs may be useful for identifying post-menopausal women with low skeletal BMD or osteoporosis.

Keywords: diagnostic imaging; mandible; osteoporosis; radiography