Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Diffusion-Weighted MR Imaging of Unicystic Odontogenic Tumors for Differentiation of Unicystic Ameloblastomas from Keratocystic Odontogenic Tumors

  • Han, Yifeng (Department of Interventional Radiology, Ninth People's Hospital, Shanghai Jiao Tong University) ;
  • Fan, Xindong (Department of Interventional Radiology, Ninth People's Hospital, Shanghai Jiao Tong University) ;
  • Su, Lixin (Department of Oral & Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University) ;
  • Wang, Zhenfeng (Department of Interventional Radiology, Ninth People's Hospital, Shanghai Jiao Tong University)
  • Received : 2016.10.01
  • Accepted : 2017.01.27
  • Published : 2018.02.01
⟨ Previous Next ⟩

Abstract

Objective: Differentiating unicystic ameloblastomas from keratocystic odontogenic tumors (KCOT) is necessary for the planning of different treatment strategies; however, it is difficult based on conventional CT and MR sequences alone. The purpose of this study was to investigate the utility of diffusion-weighted imaging (DWI) and apparent diffusion coefficients (ADCs) in the differentiation of the two tumors. Materials and Methods: We prospectively studied 40 patients with odontogenic cysts and tumors of the maxillomandibular region using conventional MR imaging and DWI. ADCs were measured using 2 b factors (500 and 1000). Results: Unicystic ameloblastomas (n = 11) showed free diffusion on DWI and a mean ADC value of $2.309{\pm}0.17{\times}10^{-3}mm^2/s$. KCOT (n = 15) showed restricted diffusion on DWI with a mean ADC value of $0.923{\pm}0.20{\times}10^{-3}mm^2/s$ The ADC values of unicystic ameloblastomas were significantly higher than those of KCOT (p < 0.001, Mann-Whitney U-test). An ADC cut-off value of $2.0{\times}10^{-3}mm^2/s$ to differentiate KCOT and unicystic ameloblastomas resulted in a 100% sensitivity and 100% specificity. Dentigerous cysts (n = 3) showed restricted diffusion on DWI and similar ADC values ($1.257{\pm}0.05{\times}10^{-3}mm^2/s$) to those of KCOT. Conclusion: Diffusion-weighted imaging and ADC determination can be used as an adjuvant tool to differentiate between unicystic ameloblastomas and KCOT, although the ADC values of dentigerous cysts overlap with those of KCOT.

Keywords

References

  1. Minami M, Kaneda T, Yamamoto H, Ozawa K, Itai Y, Ozawa M, et al. Ameloblastoma in the maxillomandibular region: MR imaging. Radiology 1992;184:389-393 https://doi.org/10.1148/radiology.184.2.1620834
  2. Minami M, Kaneda T, Ozawa K, Yamamoto H, Itai Y, Ozawa M, et al. Cystic lesions of the maxillomandibular region: MR imaging distinction of odontogenic keratocysts and ameloblastomas from other cysts. AJR Am J Roentgenol 1996;166:943-949 https://doi.org/10.2214/ajr.166.4.8610578
  3. Fujita M, Matsuzaki H, Yanagi Y, Hara M, Katase N, Hisatomi M, et al. Diagnostic value of MRI for odontogenic tumours. Dentomaxillofac Radiol 2013;42:20120265 https://doi.org/10.1259/dmfr.20120265
  4. Carlson ER, Marx RE. The ameloblastoma: primary, curative surgical management. J Oral Maxillofac Surg 2006;64:484-494 https://doi.org/10.1016/j.joms.2005.11.032
  5. Ecker J, Horst RT, Koslovsky D. Current role of carnoy's solution in treating keratocystic odontogenic tumors. J Oral Maxillofac Surg 2016;74:278-282 https://doi.org/10.1016/j.joms.2015.07.018
  6. Rosenstein T, Pogrel MA, Smith RA, Regezi JA. Cystic ameloblastoma--behavior and treatment of 21 cases. J Oral Maxillofac Surg 2001;59:1311-1316; discussion 1316-1318 https://doi.org/10.1053/joms.2001.27522
  7. Le Bihan D, Turner R, Douek P, Patronas N. Diffusion MR imaging: clinical applications. AJR Am J Roentgenol 1992;159:591-599 https://doi.org/10.2214/ajr.159.3.1503032
  8. Lim HK, Lee JH, Baek HJ, Kim N, Lee H, Park JW, et al. Is diffusion-weighted MRI useful for differentiation of small non-necrotic cervical lymph nodes in patients with head and neck malignancies? Korean J Radiol 2014;15:810-816 https://doi.org/10.3348/kjr.2014.15.6.810
  9. Sumi M, Ichikawa Y, Katayama I, Tashiro S, Nakamura T. Diffusion-weighted MR imaging of ameloblastomas and keratocystic odontogenic tumors: differentiation by apparent diffusion coefficients of cystic lesions. AJNR Am J Neuroradiol 2008;29:1897-1901 https://doi.org/10.3174/ajnr.A1266
  10. Srinivasan K, Seith Bhalla A, Sharma R, Kumar A, Roychoudhury A, Bhutia O. Diffusion-weighted imaging in the evaluation of odontogenic cysts and tumours. Br J Radiol 2012;85:e864-e870 https://doi.org/10.1259/bjr/54433314
  11. Kaneda T, Minami M, Kurabayashi T. Benign odontogenic tumors of the mandible and maxilla. Neuroimaging Clin N Am 2003;13:495-507 https://doi.org/10.1016/S1052-5149(03)00032-7
  12. Ackermann GL, Altini M, Shear M. The unicystic ameloblastoma: a clinicopathological study of 57 cases. J Oral Pathol 1988;17:541-546 https://doi.org/10.1111/j.1600-0714.1988.tb01331.x
  13. Probst FA, Probst M, Pautke Ch, Kaltsi E, Otto S, Schiel S, et al. Magnetic resonance imaging: a useful tool to distinguish between keratocystic odontogenic tumours and odontogenic cysts. Br J Oral Maxillofac Surg 2015;53:217-222 https://doi.org/10.1016/j.bjoms.2014.10.014
  14. Konouchi H, Asaumi J, Yanagi Y, Hisatomi M, Kawai N, Matsuzaki H, et al. Usefulness of contrast enhanced-MRI in the diagnosis of unicystic ameloblastoma. Oral Oncol 2006;42:481-486 https://doi.org/10.1016/j.oraloncology.2005.10.001
  15. Smith G, Smith AJ, Browne RM. Glycosaminoglycans in fluid aspirates from odontogenic cysts. J Oral Pathol 1984;13:614-621 https://doi.org/10.1111/j.1600-0714.1984.tb01463.x
  16. Xu XQ, Choi YJ, Sung YS, Yoon RG, Jang SW, Park JE, et al. Intravoxel incoherent motion MR imaging in the head and neck: Correlation with dynamic contrast-enhanced MR imaging and diffusion-weighted imaging. Korean J Radiol 2016;17:641-649 https://doi.org/10.3348/kjr.2016.17.5.641

Cited by

  1. Odontogene Keratozyste - Ätiologie, Pathogenese und Therapie vol.13, pp.2, 2018, https://doi.org/10.1007/s11838-019-0082-x
  2. Three-dimensional radiographic features of ameloblastoma and cystic lesions in the maxilla vol.48, pp.6, 2018, https://doi.org/10.1259/dmfr.20190066
  3. Characteristics of Recent Articles Published in the Korean Journal of Radiology Based on the Citation Frequency vol.21, pp.12, 2020, https://doi.org/10.3348/kjr.2020.1322
  4. Usefulness of MR imaging for odontogenic tumors vol.109, pp.1, 2018, https://doi.org/10.1007/s10266-020-00559-z
  5. Differentiation of cystic lesions in the jaw by conventional magnetic resonance imaging and diffusion-weighted imaging vol.51, pp.1, 2018, https://doi.org/10.1259/dmfr.20210212