Sensitivity and Specificity of MRI versus CBCT to Detect Vertical Root Fractures Using MicroCT as a Reference Standard

Beth R Groenke, Djaudat Idiyatullin, Laurence Gaalaas, Ashley J Petersen, Alan S Law, Brian Barsness, Mathew Royal, Alex Fok, Donald R. Nixdorf

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Introduction: Vertical root fracture (VRF) in root-canal–treated teeth frequently results in tooth loss, partly because VRFs are difficult to diagnose and when detected the fracture is often beyond the point of preservation with surgical intervention. Nonionizing magnetic resonance imaging (MRI) has demonstrated the ability to detect small VRFs, but it is unknown how its diagnostic capabilities compare with the current imaging standard for VRF detection, cone-beam computed tomography (CBCT). This investigation aimed to compare the sensitivity and specificity between MRI and CBCT for detecting VRF, using micro-computed tomography (microCT) as a reference. Methods: A total of 120 extracted human tooth roots were root canal treated using common techniques, and VRFs were mechanically induced in a proportion. Samples were imaged using MRI, CBCT, and microCT. Axial MRI and CBCT images were examined by 3 board-certified endodontists, who evaluated VRF status (yes/no) and gave a confidence assessment for that decision, from which a receiver operating characteristic curve was generated. Intra- and inter-rater reliability were calculated, sensitivity and specificity, and area under the curve. Results: Intra-rater reliability was 0.29–0.48 for MRI and 0.30–0.44 for CBCT. Inter-rater reliability for MRI was 0.37 and for CBCT 0.49. Sensitivity was 0.66 (95% confidence interval [CI], 0.53–0.78) and 0.58 (95% CI, 0.45–0.70), and specificity 0.72 (95% CI, 0.58–0.83) and 0.87 (95% CI, 0.75–0.95) for MRI and CBCT, respectively. Area under the curve was 0.74 (95% CI, 0.65–0.83) for MRI and 0.75 (95% CI, 0.66–0.84) for CBCT. Conclusions: There was no significant difference in sensitivity or specificity between MRI and CBCT in detecting VRF, despite the early-stage development of MRI.

Original languageEnglish (US)
Pages (from-to)703-709
Number of pages7
JournalJournal of Endodontics
Issue number6
StatePublished - Jun 2023

Bibliographical note

Funding Information:
Thanks to Dr. Estephan Moana-Filho, Ms. Bonita VanHeel, and Mr. Young Heo for assistance. This work was supported by the American Academy of Orofacial Pain , the National Institutes of Health ( P41-EB027061 , S10-RR023730 ), and by the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1-TR002494 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Materials donated by Dentsply Sirona and Kerr. The authors deny any conflicts of interest related to this study.

Publisher Copyright:
© 2023 American Association of Endodontists


  • Diagnosis
  • MRI
  • pain
  • root fracture
  • tooth

PubMed: MeSH publication types

  • Journal Article


Dive into the research topics of 'Sensitivity and Specificity of MRI versus CBCT to Detect Vertical Root Fractures Using MicroCT as a Reference Standard'. Together they form a unique fingerprint.

Cite this