Evaluation of inflammatory vascular responses in patients with severe periodontitis by contrast-enhanced perfusion dental MRI.

Background: Periodontitis is characterized by the inflammatory destruction of tooth-supporting alveolar bone. Dental magnetic resonance imaging (MRI) using dynamic contrast-enhanced perfusion can potentially detect vascular inflammatory responses. This study aims to assess the feasibility of perfusion dental MRI and characterize periodontal lesions with perfusion profiles.

Materials and methods: In this prospective study, 19 patients with severe periodontitis underwent pretreatment 3-T dental MRI with T2-weighted, high-resolution dynamic contrast-enhanced T1-weighted perfusion protocol, and contrast-enhanced T1-weighted fat-suppressed sequences as well as cone-beam computed tomography (CBCT). Periodontal bone lesions were segmented semiautomatically using a multistep threshold-based algorithm, guided by T1-weighted contrast enhancement, T2-weighted hyperintensity, as well as CBCT-based bone loss. Volumetric analyses and clinical data were compared with perfusion parameters.

Results: In all 95 assessed periodontal lesions, perfusion parameter elevations were significantly different when compared to normal distant bone (p < 0.001 to 0.026). Moreover, structurally normal-appearing bone adjacent to T2-hyperintense/T1-contrast-enhancing signal alterations exhibited increased permeability (p = 0.036-006) but showed no significant change in blood flow (p = 0.270) compared to bone control areas. Lesions with bleeding showed higher vascular permeability and blood flow markers than lesions without bleeding (p = 0.004-0.006). Additionally, lesions with excessive edema and areas of bone loss exhibited significantly elevated permeability and blood flow parameters (p = 0.001-0.028).

Conclusion: Perfusion dental MRI for periodontal lesion assessment is feasible. Permeability/perfusion parameters elevations are related to clinical signs of inflammation and CBCT-based bone loss, with the potential for detecting early inflammatory responses.

Relevance statement: Perfusion dental MRI effectively characterizes periodontal disease by detecting inflammation-related vascular changes beyond structural imaging on CBCT and conventional MR, offering potential for improved diagnosis, monitoring, and treatment evaluation. Longitudinal studies are needed.

Key points: Perfusion dental MRI detects increased blood flow and vascular permeability in periodontal lesions. Increased permeability in adjacent bone suggests early inflammatory changes before structural loss. Dental MRI perfusion metrics could aid early lesion detection and monitoring of periodontitis.