Dynamic contrast-enhanced magnetic resonance imaging for distinguishing vital and non-vital teeth affected by lesions in jaw bones: A validation study

AIM: To validate the diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for assessing dental pulp vitality in teeth affected by lesions in jaw bones and evaluate the reproducibility of time-intensity curve (TIC)-based classification compared with electric pulp testing (EPT). METHODOLOGY: This retrospective validation study included patients who underwent DCE-MRI to investigate lesions occurring in jaw bones and affected teeth with EPT results. The TICs of the pulp were classified as increasing or non-increasing twice by two radiologists independently. Agreement between TIC classification and EPT results was assessed using Fisher's exact test. RESULTS: We analyzed 127 teeth from 48 patients (29 males; mean age: 42.8 ± 19.8 years). Based on EPT, 113 teeth were classified as vital and 14 as non-vital. The TIC patterns were significantly associated with the EPT results, with an overall agreement rate of 94%. Seven teeth showed discordance between the two methods, and follow-up information suggested that several of these regained pulp sensitivity following surgical management. CONCLUSIONS: TIC classification from DCE-MRI showed good agreement with EPT for dental pulp vitality. In some teeth with a TIC-increasing pattern and EPT-negative results, the EPT results became positive as the lesion decreased. Therefore, DCE-MRI may provide clinically meaningful information beyond conventional sensitivity testing for teeth affected by lesions occurring in jaw bones. ADVANCES IN KNOWLEDGE: DCE-MRI could assess dental pulp vitality in teeth that were significantly associated with EPT results. In addition, DCE-MRI may provide clinically meaning information beyond conventional sensitivity testing.