光学相干断层成像检出早期窝沟龋效能的体外评估

目的 比较光学相干断层成像技术（OCT）与临床探视诊对人牙窝沟早期釉质龋的检出效能。方法 获取77颗人离体恒磨牙面的97个可疑早期龋位点OCT二维图像，由3位临床医师双盲法分别通过OCT图像和探视诊方法对这些位点进行评分，以偏光显微镜获取的组织学图像为金标准，评估OCT、临床探视诊检出早期窝沟龋的敏感度（SE）、特异度（SP）、阳性预测值（PPV）、阴性预测值（NPV）及其与组织学评分结果的相关性；采用Kappa检验分析检测者间评分结果的一致性，采用非参数法Z检验比较受试者工作特征（ROC）曲线下面积（AUC）。结果对于脱矿局限于釉质表层外1/2的窝沟早期龋，OCT检出率（14/25）明显优于探视诊（3/25）。OCT检出窝沟早期釉质龋的SE、SP、PPV、NPV（0.83、0.64、0.87、0.57）均高于探视诊（0.79、0.60、0.85、0.50）。OCT与探视诊检测窝沟早期龋的AUC（95% CI）分别为0.737（0.569~0.822）、0.696（0.614~0.859），二者间差异无统计学意义。OCT评分与组织学评分呈正相关（r=0.559，P<0.05），检测者间检测结果的一致性为中等。结论 OCT能够敏感、无创、有效地检出早期窝沟龋，具有辅助临床探视诊检出早期窝沟龋的应用潜能。

Ex vivo assessment of the potency of optical coherence tomography for the detection of early occlusal caries

Objective This study aimed to evaluate the potency of optical coherence tomography (OCT) to detect early occlusal caries compared with clinical visual examination.Methods Approximately 97 sites of occlusal fissures on 77 extracted accessional human teeth were scored by three examiners using conventional visual examination and OCT. Results of histolo-gical examination on these sites obtained by polarimicroscope served as a gold standard to analyze the sensitivity (SE), speci-ficity (SP), positive predictive value (PPV), and negative predictive value (NPV). Results of the area under receiver operating characteristic (ROC) curve (AUC) by visual examination and OCT were also analyzed. The Spearman's rank correlation coefficient with histology and the inter-examiner reliability were compared.Results For sites of enamel demineralization limited to the outer 1/2 of the enamel layer, the detection rate of OCT (14/25) was obviously higher than that of the clinical and visual examination (3/25). SE, SP, PPV and NPV of OCT during diagnosis of the early occlusal caries (0.83, 0.64, 0.87 and 0.57) were higher than that of the visual examination (0.79, 0.60, 0.85 and 0.50). AUC (95%CI) of OCT and the visual examination were 0.737 (0.569-0.822) and 0.696 (0.614-0.859), respectively. No statistically significant difference was observed between the results. Results of OCT correlated well with histology (r=0.559,P<0.05). The inter-examiner reliability of OCT was medium.Conclusion OCT can accurately detect early occlusal lesions atraumatically with high sensitivity and effec-tiveness. OCT exhibits the potential of auxiliary clinical diagnosis enhancing detection rate and finally implementing early diagnosis and early intervention of early occlusal lesions in clinical practice.