Ultrasound imaging versus conventional histopathology in diagnosis of periapical lesions of endodontic origin: A comparative evaluation

Context: Accurate assessment of periapical status is critical in diagnosis, treatment planning, and evaluation of healing. Novel imaging modalities like sonography offer promising results with reduced radiation risks. Aims: To evaluate the potential of ultrasound imaging technique together with the application of color Doppler to differentiate between periapical lesions of endodontic origin. Materials and Methods: Twenty patients with periapical lesions of endodontic origin who were already scheduled for undergoing endodontic surgery were examined further using sonography. Color Doppler was performed to assess blood flow. Information on the size of the lesion, its content, and vascular supply was gained and recorded by means of ultrasound images. The sonographic images were analyzed and discussed with an expert sonologist, and a tentative diagnosis between a periapical cyst and periapical granuloma was made. Endodontic surgery and histopathological examination was done for each case and the results were compared. Results: The sonograms revealed the lesions within the bone in three dimensions and their contents, that is, fluids or tissues or blood vessels. Measurements of the periapical lesions in three dimensions were also obtained. Of the twenty cases studied, ultrasound could detect periapical granulomas in all 9 cases and radicular cysts in all 11 cases. Conclusion: Ultrasound imaging had the potential to be used for the evaluation of periapical lesions of endodontic origin. However, further studies are required to establish a definite correlation.