Eur Endod J. 2025; 10(2): 104-115 | DOI: 10.14744/eej.2024.84755

Accuracy of Ultrasound Imaging in the Differential Diagnosis of Inflammatory Radicular Cyst and Periapical Granuloma: A Systematic Review and Meta-Analysis of Operative Characteristics

Nestor Rios Osorio¹, Oscar Jiménez Peña², Marcela Contreras Ibarra², Marggie Grajales³, Rafael Fernández Grisales^4
1Biomedical Sciences PhD Programme, Universidad El Bosque, Bogotá, Colombia
²Department of Endodontics, Institución Universitaria Colegios de Colombia UNICOC, Bogotá, Colombia
³Laser Dentistry Master Programme, European Programme EMDOLA, University of Barcelona, Barcelona, Spain
⁴Department of Postgraduate Endodontics, CES University, School of Dentistry, Medellin, Colombia

This systematic review aimed to assess the accuracy of ultrasonic (US) imaging in the differential diagnosis between inflammatory radicular cysts (IRCs) and periapical granulomas (PGs) compared with the histological examination as the reference standard. Scopus, Medline (PubMed), and Web of Science were searched from inception to April 2024. The Methodological quality was assessed using the QUADAS-2 tool. Thirteen cross-sectional studies published between 2003 and 2023 were included in this study. A total sample of 275 patients (one tooth / per patient) comparing ultrasound test vs. histopathological examination was assessed. The summary measures of the US imaging test were: sensitivity= 0.96 [95% CI, 0.93–0.99], specificity= 0.83 [95% CI, 0.76–0.88], LR+ = 3.498 [95% CI, 2.079–5.885], LR- = 0.091 [95% CI, 0.050–0.164], DOR = 65.848 (95% CI, 28.857–150.25) and AUC=0.97 (95% CI, 0.95–1.00). The methodological assessment was variable in all domains and studies. Approximately 90% and 70% of the studies revealed some form of risk of bias concern in the domains -flow and timing-, and -reference standard-, respectively. US imaging can be regarded as a highly accurate and consistent method for IRC vs. PG differential diagnosis. The echotexture features of periapical lesions in US images reflected their histopathological characteristics. (EEJ-2024-09-150)

Keywords: Differential diagnosis, predictive values, radicular cysts, sensitivity, specificity, ultrasound

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