牙源性角化囊肿(OKC)是一种相对常见的非炎性颌骨病变。已知OKC最常见于下颌角和下颌支,但很少在骨头外面。在这份报告中,我们描述了口腔空间中OKC的特征性多模态成像,尤其是具有表观扩散系数(ADC)映射的扩散加权MR成像(DWI),口外和口腔内超声检查。在临床检查中,在口腔区域的左侧发现了直径约20mm的质量,具有弹性硬度。对比增强CT显示左颊间隙内部非对比病变区域。在T1加权图像上,肿块显示多房高信号强度,和均匀的内部。T2加权图像在边缘部分显示出高信号,在内部部分显示出中值信号。STIR图像显示内部存在异质高信号。此外,DWI和ADC图显示高信号和中低信号强度,分别。病灶的ADC值为1.55×10-3mm2s-1。在口腔外超声检查中,肿瘤显示出清晰的边界,低回声,均匀的内部结构和血管信号,和病变的异质性硬。在口腔内超声检查中也显示出清晰的边界,低回声,同质的内部结构,肿瘤的异质性硬,和背面回声增强。基于完整切除标本的组织病理学诊断是牙源性角化囊肿。这种情况表明多模态成像,尤其是MR成像与ADC和DWI,以及彩色多普勒成像和弹性成像的口腔内外超声检查,可有效评估颊部病变。
Odontogenic keratocyst (OKC) is a relatively common non-inflammatory jaw lesion. OKC is known to occur most often in the mandibular angle and mandibular ramus, but rarely outside the bone. In this report, we describe characteristic multimodality imaging of OKC in the buccal space, especially diffusion-weighted MR imaging (DWI) with apparent diffusion coefficient (ADC) mapping, extra-oral and intra-oral ultrasonography. On clinical examination, an approximately 20 mm in diameter mass with elastic hardness was found the left side of the buccal area. Contrast-enhanced CT showed areas of internal non-contrast lesions in the left buccal space. On T1-weighted image, the mass showed multilocular high signal intensity, and homogeneous internal. T2-weighted images revealed high signal at the marginal part and slightly median signal in the internal part. STIR images revealed a heterogeneous high signal in the interior. Furthermore, DWI and ADC map showed high signal and moderate-to-low signal intensity, respectively. ADC value of the lesion was 1.55 × 10-3 mm2 s-1. On extra-oral ultrasonography, the tumor showed clear boundary, hypoechoic, homogeneous internal architecture and vascular signals, and heterogeneous hard of the lesion. On intra-oral ultrasonography also showed clear boundary, hypoechoic, homogeneous internal architecture, heterogeneous hard of the tumor, and back echo enhance. The histopathologic diagnosis based on a full excisional specimen was odontogenic keratocyst. This
case suggests that multimodality imaging, especially MR imaging with ADC and DWI, and extra and intra-oral ultrasonography with color Doppler imaging and elastography, could be effective for evaluating buccal lesions.