title: Selecting regions of interest on intraoral radiographs for the prediction of bone mineral density.
abstract: OBJECTIVE
  A previous study showed that the trabecular pattern on dental radiographs correlates with femoral and spinal bone mineral density (BMD). The objective of this study was to determine if the correlation is affected by the size and location of the region of interest (ROI).
  
  
  METHODS
  In a European research project on osteoporosis, BMD was measured at the left hip and the lumbar spine of 525 women. From all subjects, intraoral radiographs were made of the premolar region in the upper and lower jaws. Two ROIs were indicated manually on each scanned image. The smallest region involved only trabecular bone and the largest also included parts of the neighbouring teeth. The ROIs were subjected to automatic image analysis, yielding 26 measurements per ROI. Stepwise linear regression was used to predict femoral and spinal BMD.
  
  
  RESULTS
  Inner and outer regions predicted BMD equally well. The radiographs of lower and upper jaw also predicted BMD equally well. Combining inner and outer regions did not improve the prediction of femoral and spinal BMD, but combining lower and upper jaws did.
  
  
  CONCLUSIONS
  This study shows that it is possible to include parts of neighbouring teeth in the ROI used to assess the trabecular pattern and predict BMD. This simplifies the process of selecting the ROIs because no efforts have to be made to exclude neighbouring teeth. Combining ROIs of lower and upper jaws significantly improves the prediction of BMD.
authors.affiliation: Department of Oral and Maxillofacial Radiology, Academic Centre for Dentistry Amsterdam, Louwesweg 1, 1066 EA Amsterdam, The Netherlands. W.Geraets@acta.nl
authors.forename: W G M
authors.initials: WG
authors.lastname: Geraets
authors.forename: J G C
authors.initials: JG
authors.lastname: Verheij
authors.forename: P F
authors.initials: PF
authors.lastname: van der Stelt
authors.forename: K
authors.initials: K
authors.lastname: Horner
authors.forename: C
authors.initials: C
authors.lastname: Lindh
authors.forename: K
authors.initials: K
authors.lastname: Nicopoulou-Karayianni
authors.forename: R
authors.initials: R
authors.lastname: Jacobs
authors.forename: E J
authors.initials: EJ
authors.lastname: Marjanovic
authors.forename: J E
authors.initials: JE
authors.lastname: Adams
authors.forename: H
authors.initials: H
authors.lastname: Devlin
mesh_terms: D000328:Adult; D000368:Aged; D015519:Bone Density; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging; D006801:Humans; D007568:Jaw / Q000000981:diagnostic imaging*; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000000981:diagnostic imaging*; D011861:Radiography, Dental; D013131:Spine / Q000000981:diagnostic imaging