Viswanathan DJ, Bhalla AS, Manchanda S, Roychoudhury A, Mishra D, Mridha AR. Characterization of tumors of jaw: Additive value of contrast enhancement and dual-energy computed tomography. World J Radiol 2024; 16(4): 82-93 [PMID: 38690548 DOI: 10.4329/wjr.v16.i4.82]
Corresponding Author of This Article
Ashu Seith Bhalla, MBBS, MD, Professor, Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, No. 71 Ansari Nagar East, New Delhi 110029, India. ashubhalla2@gmail.com
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Deepak Justine Viswanathan, Ashu Seith Bhalla, Smita Manchanda, Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, India
Ajoy Roychoudhury, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi 110029, India
Deepika Mishra, Department of Oral Pathology and Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
Asit Ranjan Mridha, Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
Author contributions: Viswanathan DJ, Bhalla AS and Manchanda S designed the research study; Viswanathan DJ performed the research; Roychoudhury A contributed to referral of cases and surgical input; Mishra D and Mriddha AR contributed to histopathological analysis and pathological insight; Viswanathan DJ analyzed the data and wrote the manuscript; All authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the All India Institute of Medical Sciences, New Delhi Institutional Review Board (No. IECPG-354/22.07.2020, RT-2/26.08.2020).
Informed consent statement: All patients give their full informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at ashubhalla2@gmail.com. Participants gave informed consent for data sharing.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: Https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ashu Seith Bhalla, MBBS, MD, Professor, Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, No. 71 Ansari Nagar East, New Delhi 110029, India. ashubhalla2@gmail.com
Received: December 10, 2023 Revised: March 19, 2024 Accepted: April 16, 2024 Published online: April 28, 2024
Abstract
BACKGROUND
Currently, the differentiation of jaw tumors is mainly based on the lesion’s morphology rather than the enhancement characteristics, which are important in the differentiation of neoplasms across the body. There is a paucity of literature on the enhancement characteristics of jaw tumors. This is mainly because, even though computed tomography (CT) is used to evaluate these lesions, they are often imaged without intravenous contrast. This study hypothesised that the enhancement characteristics of the solid component of jaw tumors can aid in the differentiation of these lesions in addition to their morphology by dual-energy CT, therefore improving the ability to differentiate between various pathologies.
AIM
To evaluate the role of contrast enhancement and dual-energy quantitative parameters in CT in the differentiation of jaw tumors.
METHODS
Fifty-seven patients with jaw tumors underwent contrast-enhanced dual-energy CT. Morphological analysis of the tumor, including the enhancing solid component, was done, followed by quantitative analysis of iodine concentration (IC), water concentration (WC), HU, and normalized IC. The study population was divided into four subgroups based on histopathological analysis-central giant cell granuloma (CGCG), ameloblastoma, odontogenic keratocyst (OKC), and other jaw tumors. A one-way ANOVA test for parametric variables and the Kruskal-Wallis test for non-parametric variables were used. If significant differences were found, a series of independent t-tests or Mann-Whitney U tests were used.
RESULTS
Ameloblastoma was the most common pathology (n = 20), followed by CGCG (n = 11) and OKC. CGCG showed a higher mean concentration of all quantitative parameters than ameloblastomas (P < 0.05). An IC threshold of 31.35 × 100 μg/cm3 had the maximum sensitivity (81.8%) and specificity (65%). Between ameloblastomas and OKC, the former showed a higher mean concentration of all quantitative parameters (P < 0.001), however when comparing unilocular ameloblastomas with OKCs, the latter showed significantly higher WC. Also, ameloblastoma had a higher IC and lower WC compared to “other jaw tumors” group.
CONCLUSION
Enhancement characteristics of solid components combined with dual-energy parameters offer a more precise way to differentiate between jaw tumors.
Core Tip: Quantitative dual-energy computed tomography (DECT) parameters provide a reliable way of characterizing morphologically similar jaw lesions and can serve as a single modality to differentiate jaw lesions based on their appearance and material density concentrations. In addition to providing fast imaging and material decomposition algorithms at about comparable dosage equivalency as compared to traditional computed tomography, contrast-enhanced DECT can potentially alleviate the challenge of discriminating jaw lesions without a biopsy.
