Feasibility of opportunistic dental diagnostics in routine photon-counting CT examinations of the cervical spine

BACKGROUND: This study evaluates the potential of routine clinical photon-counting computed tomography (PCCT) of the cervical spine for opportunistic dental diagnostics. METHODS: Thirty-three patients undergoing routine PCCT were included in this study, with imaging performed at an average dose of 13 mGy. Images were reconstructed to a voxel size of 156 μm and a slice thickness of 0.4 mm. Quantitative image quality was assessed using the contrast-to-noise ratio (CNR) between dental structures, while qualitative assessment of structures like enamel, dentine, root canals, and cortical bone was conducted by two experienced readers using a five-point scale. RESULTS: The inter-reader reproducibility and intra-class correlation coefficient were excellent (all > 0.947). CNRs ranged from 1.6 to 6.1 for all relevant contrasts, and qualitative scores were excellent for all dental structures. Dental pathologies were detected in a significant portion of patients: caries-induced decay in 9 patients (27%) at 26 sites, apical lesions in 12 patients (36%) at 26 sites, and alveolar bone loss in 12 patients (36%) at 12 sites. At least one pathology was present in 23 patients (70%). CONCLUSIONS: PCCT offers potential for opportunistic dental diagnostics, providing earlier detection of dental issues and potentially improving overall dental care outcomes.