目的:应用螺旋CT(CT)和锥形束CT(CBCT)分析牙源性钙化囊肿和牙源性钙化上皮肿瘤的三维影像学特征。
方法:临床记录,组织病理学报告,回顾性获得了19例连续的钙化性牙源性囊肿(COC)患者和16例连续的钙化性上皮牙源性肿瘤(CEOT)患者的CBCT或非增强螺旋CT图像,和射线照相特征,包括位置,尺寸,扩展,内部结构和钙化,进行了分析。
结果:在19例COC中(男性12例,女性7例,平均年龄27岁),89.5%(17/19)的病变起源于前磨牙区,其中100.0%表现为皮质扩张,78.9%的人停用皮质。在16例CEOT病例中(男性3例,女性13例,平均年龄36岁),81.3%(13/16)的病灶位于前磨牙和磨牙区,其中56.3%表现为皮质扩张,96.8%的患者出现皮质中断。根据内部钙化的分布,这些病变分为:Ⅰ(非钙化型):无钙化;Ⅱ(偏心边缘型):沿病变一侧散布的多个钙化;Ⅲ(弥散型):大量钙化弥散分布在病变中;Ⅳ(斑块型):钙化斑块≥5mm;Ⅴ(冠状周围型):多个钙化聚集在阻生牙齿周围。73.7%的COC病变存在钙化,其中Ⅱ型9个,3个Ⅲ型和2个Ⅳ型病变,42.8%的CEOT病变有钙化图像,其中Ⅲ型病变2例,Ⅴ型病变5例。六个COC病变具有牙瘤样图像。此外,9例Ⅰ型CEOTs中有8例组织学上为Langerhans细胞丰富亚型,其具有较小的尺寸(平均中远侧直径为17.8mm)并且与阻生牙齿无关。
结论:COC病变倾向于起源于颌骨的前部,并表现出皮质扩张,有时与牙瘤有关。CEOT通常发生在后颌骨,并已中断皮质。两个病变的钙化图明显不同。超过70%的COC病变有钙化图像,大部分分散在囊肿的一侧,远离受影响的牙齿。大约60%的CEOT病变表现出较小的尺寸和非钙化,其余的CEOT病例通常有钙化图像聚集在受累牙齿周围。
OBJECTIVE: To analyze the three-dimensional radiographic characteristics of calcifying odontogenic cyst and calcifying epithelial odontogenic tumor using spiral computed tomography (CT) and cone-beam computed tomography (CBCT).
METHODS: Clinical records, histopathological reports, and CBCT or non-enhanced spiral CT images of 19 consecutive patients with calcifying odontogenic cyst (COC) and 16 consecutive patients with calcifying epithelial odontogenic tumor (CEOT) were retrospectively acquired, and radiographic features, including location, size, expansion, internal structure and calcification, were analyzed.
RESULTS: Among the 19 COC cases (12 males and 7 females, with an average age of 27 years), 89.5% (17/19) of the lesions originated from the anterior and premolar areas, 100.0% of them exhibited cortex expansion, and 78.9% had discontinued cortex. Among the 16 CEOT cases (3 males and 13 females, with an average age of 36 years), 81.3% (13/16) of the lesions were in the premolar and molar areas, 56.3% of them exhibited cortex expansion, and 96.8% had discontinued cortex. According to the distribution of internal calcifications, these lesions were divided into: Ⅰ (non-calcification type): absence of calcification; Ⅱ (eccentric marginal type): multiple calcifications scattered along one side of the lesion; Ⅲ (diffused type): numerous calcifications diffusely distributed into the lesion; Ⅳ (plaque type): with a ≥ 5 mm calcified patch; Ⅴ (peri-coronal type): multiple calcifications clustered around impacted teeth. Calcifications were present in 73.7% of COC lesions, including 9 type Ⅱ, 3 type Ⅲ and 2 type Ⅳ lesions, and 42.8% of CEOT lesions had calcification images, including 2 type Ⅲ and 5 type Ⅴ lesions. Six COC lesions had odontoma-like images. Moreover, 8 of 9 type Ⅰ CEOTs were histologically Langerhans cell-rich subtype, which had a smaller size (with an average mesiodistal diameter of 17.8 mm) and were not associated with impacted teeth.
CONCLUSIONS: COC lesions tended to originate from the anterior part of the jaw and exhibit cortex expansion, and were sometimes associated with odontoma. CEOT commonly occurred in the posterior jaw and had discontinued cortex. Two lesions had significantly different calcification map. Over 70% of COC lesions had calcification images, which were mostly scattered along one side of the cysts, far from the impacted teeth. Approximately 60% of CEOT lesions exhibited smaller size and non-calcification, and the remaining CEOT cases often had calcification images clustered around the impacted teeth.