Investigation of the sensitivity and specificity of radiological signs for diagnosis of periapical infection of equine cheek teeth.
Abstract: Radiography is commonly used for the diagnosis of equine cheek teeth (CT) infection but, to our knowledge, no study to date has evaluated the relative values of individual specific radiographic signs when making a diagnosis. Objective: To investigate the sensitivity and specificity of individual radiographic signs identified from the literature for the diagnosis of CT apical infection using a retrospective case-control study. Methods: Cropped radiographs taken using computed radiography of 41 apically infected CT and 41 control CT were independently blindly evaluated by 3 clinicians for the presence of 12 predetermined radiographic signs associated with CT apical infection. A final diagnosis of either noninfected or infected was made. Sensitivity and specificity were calculated for the presence or absence of each radiographic sign for each clinician. Uni- and multivariable conditional logistic regression were used to determine strength of association of the 12 radiographic signs with apical infection. Results: Median sensitivity and specificity for the diagnosis of CT apical infection were 76 and 90%, respectively. Periapical sclerosis, clubbing of one or 2 roots, degree of clubbing and periapical halo formation had the highest sensitivities (73-90%), with moderate specificity (61-63%). Multivariable conditional logistic regression revealed that severity of periapical sclerosis and extensive periapical halo were strongly associated with CT apical infection. Conclusions: The presence of periapical sclerosis and formation of a periapical halo were strongly associated with CT apical infection. Computed radiography appears to have a higher sensitivity but similar specificity to previously published results using film radiography to detect CT apical infection. Conclusions: These findings may aid practitioners when interpreting radiographs of equine CT as to the relative significance of their findings.
© 2010 EVJ Ltd.
Publication Date: 2010-08-23 PubMed ID: 21592211DOI: 10.1111/j.2042-3306.2010.00148.xGoogle Scholar: Lookup
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- Journal Article
Summary
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This study investigates the effectiveness of various radiographic signs in diagnosing periapical infections in equine cheek teeth. The results suggest that the presence of periapical sclerosis and halo formation are strong indicators of such infections, with computed radiography showing greater sensitivity in detection compared to traditional film radiography.
Study Methodology
- The study used a retrospective case-control design with radiographs of 41 apically infected equine cheek teeth and 41 control teeth.
- The radiographs were independently evaluated by three clinicians who were blinded to the teeth’s status (infected or noninfected).
- Each clinician assessed for 12 predetermined radiographic signs associated with apical infection.
- Sensitivity and specificity calculations were used to determine the effectiveness of these radiographic signs in diagnosis.
- Uni- and multivariable conditional logistic regression methods were used to determine how strongly each of these signs is associated with apical infection.
Results of the Study
- The median sensitivity and specificity for the diagnosis of CT apical infection were found to be 76 and 90%, respectively.
- Of the 12 radiographic signs evaluated, periapical sclerosis, clubbing of one or 2 roots, degree of clubbing, and periapical halo formation had the highest sensitivities (73-90%), with moderate specificity (61-63%).
- Statistical analysis revealed that severity of periapical sclerosis and the presence of an extensive periapical halo were highly associated with CT apical infection.
Conclusions from the Study
- The presence of periapical sclerosis and the formation of a periapical halo are strong indications of periapical infections in equine cheek teeth.
- Computed radiography, used in this study, seems to have higher sensitivity but similar specificity to film radiography techniques in traces of CT apical infection.
- The findings from this study can potentially aid veterinary practitioners in interpreting equine cheek teeth radiographs, particularly in relation to the relative significance of observed findings.
Implications of the Findings
- This study is particularly noteworthy, as it suggests specific radiographic signs – namely periapical sclerosis and periapical halo formation, that veterinarians can rely on for diagnosing periapical infections in equine cheek teeth.
- The discovering of computed radiography holding higher sensitivity implies it could be more effective in accurately detecting infections, providing valuable insight for veterinary diagnostic practices.
Cite This Article
APA
Townsend NB, Hawkes CS, Rex R, Boden LA, Barakzai SZ.
(2010).
Investigation of the sensitivity and specificity of radiological signs for diagnosis of periapical infection of equine cheek teeth.
Equine Vet J, 43(2), 170-178.
https://doi.org/10.1111/j.2042-3306.2010.00148.x Publication
Researcher Affiliations
- Division of Veterinary Clinical Science, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Veterinary Centre, UK.
MeSH Terms
- Animals
- Horse Diseases / diagnosis
- Horse Diseases / diagnostic imaging
- Horse Diseases / pathology
- Horses
- Molar / diagnostic imaging
- Periapical Diseases / diagnosis
- Periapical Diseases / diagnostic imaging
- Periapical Diseases / pathology
- Periapical Diseases / veterinary
- Radiography
- Sensitivity and Specificity
- Tooth Abnormalities / diagnosis
- Tooth Abnormalities / diagnostic imaging
- Tooth Abnormalities / pathology
- Tooth Abnormalities / veterinary
- Tooth Diseases / diagnosis
- Tooth Diseases / diagnostic imaging
- Tooth Diseases / pathology
- Tooth Diseases / veterinary
Citations
This article has been cited 6 times.- Górski K, Borowska M, Turek B, Pawlikowski M, Jankowski K, Bereznowski A, Polkowska I, Domino M. An application of the density standard and scaled-pixel-counting protocol to assess the radiodensity of equine incisor teeth affected by resorption and hypercementosis: preliminary advancement in dental radiography. BMC Vet Res 2023 Aug 9;19(1):116.
- Bishop IT. Diagnostic value of full-mouth radiography in horses. Front Vet Sci 2022;9:971886.
- Liuti T, Smith S, Dixon PM. A Comparison of Computed Tomographic, Radiographic, Gross and Histological, Dental, and Alveolar Findings in 30 Abnormal Cheek Teeth from Equine Cadavers. Front Vet Sci 2017;4:236.
- Rutigliano L, Raes E, Proost K, Vlaminck L, Vanderperren K. A Comparative Study of Radiography and Computed Tomography in Detecting Periapical Infections in Alpacas (Vicugna pacos). Animals (Basel) 2025 Oct 29;15(21).
- Hardefeldt L, Thomas K, Page S, Norris J, Browning G, El Hage C, Stewart A, Gilkerson J, Muscatello G, Verwilghen D, van Galen G, Bauquier J, Cuming R, Reynolds B, Whittaker C, Wilkes E, Clulow J, Burden C, Begg L. Antimicrobial prescribing guidelines for horses in Australia. Aust Vet J 2025 Dec;103(12):781-889.
- Sidwell AE, Duz M, Khan A, Bodnàr R, Hole SL. Effect of Simple Oral Dental Extraction on Systemic Serum Amyloid A Concentrations in Horses. Vet Med Sci 2024 Nov;10(6):e70104.
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