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©The Author(s) 2022.
World J Radiol. Sep 28, 2022; 14(9): 329-341
Published online Sep 28, 2022. doi: 10.4329/wjr.v14.i9.329
Published online Sep 28, 2022. doi: 10.4329/wjr.v14.i9.329
Table 1 Comparison of the various multidetector computed tomography imaging features between ameloblastoma and central giant cell granuloma
| MDCT features | Pathology | Fisher’s exact test (exact sig. two-sided) | ||||
| Ameloblastoma | CGCG | |||||
| Count | % of all cases | Count | % of all cases | |||
| Zone wise location (figure × for reference) | 1, 2, 3 | 9 | 27.3 (14.4–43.9) | 1 | 8.3 (0.9–32.8) | < 0.0001a |
| 1 | 0 | 0.00% | 6 | 50 (24.3–75.7) | ||
| 1, 2 | 4 | 12.1 (4.2–26.3) | 0 | 0.00% | ||
| 2 | 0 | 0.00% | 3 | 25 (7.6–52.9) | ||
| 2,3 | 6 | 18.2 (8–33.7) | 0 | 0.00% | ||
| 3 | 14 | 42.4 (26.8–59.3) | 2 | 16.7 (3.6–43.6) | ||
| Density | Mixed | 13 | 39.4 (24.2–56.4) | 9 | 75 (47.1–92.4) | 0.036a |
| Lytic | 20 | 60.6 (43.6–75.8) | 3 | 25 (7.6–52.9) | ||
| Multilocularity; 1-Unilocular with 1 or 2 thin septae/2-Multilocular/3-Honeycombing | 1 | 22 | 66.7 (49.7–80.8) | 3 | 25 (7.6–52.9) | 0.047a |
| 2 | 8 | 24.2 (12.2–40.6) | 7 | 58.3 (31.2–82) | ||
| 3 | 3 | 9.1 (2.6–22.3) | 2 | 16.7 (3.6–43.6) | ||
| Bucco-lingual expansion | 1 | 33 | 100.00% | 12 | 100.00% | - |
| Solid component | Absent | 6 | 18.2 (8–33.7) | 1 | 8.3 (0.9–32.8) | 0.309 |
| Present | 27 | 81.8 (66.3–92) | 11 | 91.7 (67.2–99.1) | ||
| Cortical erosion | Thinning | 1 | 3 (0.3–13.3) | 1 | 8.3 (0.9–32.8) | 1.000 |
| Erosion | 32 | 97 86.7–99.7) | 11 | 91.7 (67.2–99.1) | ||
| Angle involved (of lesions in mandible) | No | 14 | 50 (32.2–67.8) | 8 | 100.00% | 0.013a |
| Yes | 14 | 50 (32.2–67.8) | 0 | 0.00% | ||
| Inferior alveolar canal displacement | No | 3 | 14.3 (4.2–33.4) | 2 | 25 (5.6–59.2) | 0.597 |
| Yes | 18 | 85.7 (66.6–95.8) | 6 | 75 (40.8–94.4) | ||
| Status of overlying teeth; Missing-0/Adjoining roots-1/Present-2 | 0 | 19 | 57.6 (40.7–73.2) | 8 | 72.7 (43.5–91.7) | 0.152 |
| 1 | 12 | 36.4 21.6–53.4) | 1 | 9.1 (1–35.3) | ||
| 2 | 2 | 6.1 (1.3–18.1) | 2 | 18.2 (4–46.7) | ||
| Inferior alveolar canal erosion | No | 2 | 9.5 (2–27.2) | 3 | 37.5 (11.9–70.5) | 0.112 |
| Yes | 19 | 90.5 (72.8–98) | 5 | 62.5 (29.5–88.1) | ||
| Adjacent fat stranding | Absent | 27 | 81.8 (66.3–92) | 10 | 83.3 (56.4–96.4) | 1.000 |
| Present | 6 | 18.2 (8–33.7) | 2 | 16.7 (3.6–43.6) | ||
| Adjacent muscle thickening | Absent | 26 | 78.8 (62.8–90) | 11 | 91.7 (67.2–99.1) | 0.419 |
| Present | 7 | 21.2 (10–37.2) | 1 | 8.3 (0.9–32.8) | ||
| Extent of enhancement of soft tissue component in venous phase; 0-cystic/1- hypoenhancing/2- isoenhancing/3- hyperenhancing | 0 | 6 | 22.2 (9.8–40.2) | 0 | 0.00% | 0.013a |
| 2 | 17 | 63 (44.2–79.1) | 4 | 50 (19.9–80.1) | ||
| 3 | 1 | 3.7 (0.4–16) | 4 | 50 (19.9–80.1) | ||
| 1 | 3 | 11.1 (3.2–26.8) | 0 | 0.00% | ||
| Amount of solid component | > 75% | 9 | 33.3 (17.9–52.1) | 6 | 75 (40.8–94.4) | 0.061 |
| 0- < 10% | 8 | 29.6 (15.1–48.2) | 0 | 0.00% | ||
| 10%-25% | 3 | 11.1 (3.2–26.8) | 0 | 0.00% | ||
| 25%-50% | 5 | 18.5 (7.4–35.9) | 0 | 0.00% | ||
| 50%-75% | 2 | 7.4 (1.6–21.7) | 2 | 25 (5.6–59.2) | ||
| Matrix mineralisation; Mineralised osteoid-1; Absent- 2; Thick septae with associated matrix-3; Thin bony septa- 4 | 1 | 1 | 3 (0.3–13.3) | 3 | 25 (7.6–52.9) | 0.004a |
| 2 | 23 | 69.7 (52.9–83.2) | 2 | 16.7 (3.6–43.6) | ||
| 3 | 4 | 12.1 (4.2–26.3) | 3 | 25 (7.6–52.9) | ||
| 4 | 5 | 15.2 (6–30.1) | 4 | 33.3 (12.5–61.2) | ||
| Diameter | 33 | 5.1(4.5–6) | 12 | 3.7(2.1–4.8) | 0.011a | |
| Volume | 33 | 35.9 (23.05–47.59) | 12 | 10.31 (3.67–59.37) | 0.027a | |
Table 2 First-order histogram parameters comparing the extent of enhancement seen in the soft tissue component of ameloblastomas and central giant cell granulomas
| Ameloblastoma (n = 21); median (95%CI) | CGCG (n = 8); median(95%CI) | P value
| ||
| Histogram parameter (n = 29) | Skewness | 0.1 (-0.23–0.22) | 0.07 (-0.51–0.47) | 0.981 |
| Median (HU) | 74.91 (56.97–93.24) | 106.21 (95.1–134.52) | 0.002 | |
| Maximum (HU) | 121.01 (100.11–150.05) | 154.2 (133.42–183.09) | 0.013 | |
| 90 percentile (HU) | 95.32 (75.72–113.71) | 137.43 (113.91–150.17) | 0.001 | |
| Entropy | 1.62 (1.57–1.8) | 1.5 (1.34–1.98) | 0.487 | |
| 10 percentile (HU) | 53.32 (34.2–71.13) | 82.65 (74.86–116.64) | 0.002 | |
| Kurtosis | 3.11 (2.71–3.54) | 3.25 (2.69–4.08) | 0.83 | |
| Mean (HU) | 74.06 (58.58–91.92) | 106.95 (97.48–132.39) | 0.002 | |
Table 3 Area under the curve of the various statistically significant histogram parameters of tumours in differentiating central giant cell granulomas from ameloblastomas
| Variable | 10 percentile | 90 percentile | Mean | Median | Minimum |
| Area under the ROC curve (AUC) | 0.863 | 0.875 | 0.863 | 0.869 | 0.887 |
| 5, 95%CI | 0.685 to 0.962 | 0.699 to 0.968 | 0.685 to 0.962 | 0.692 to 0.965 | 0.714 to 0.974 |
| Associated criterion (HU) | > 71.13 | > 106.33 | > 91.92 | > 93.24 | > 49.05 |
| 95%CI | > 66.43 to > 96.63 | > 82.80 to > 113.71 | > 88.68 to > 114.75 | > 93.15 to > 110.22 | > 48.51 to > 49.05 |
| Sensitivity % | 100 (63.1-100.0) | 100 (63.1-100.0) | 100 (63.1-100.0) | 100 (63.1-100.0) | 100 (63.1-100.0) |
| Specificity % | 76.19 (52.8-91.8) | 66.67 (43.0-85.4) | 76.19 (52.8-91.8) | 76.19 (52.8-91.8) | 85.71 (63.7-97.0) |
| Leave-one out sensitivity % | 100 (63.06–100) | 100 (63.06–100) | 100 (63.06–100) | 100 (63.06–100) | 100 (63.06–100) |
| Leave-one out specificity % | 71.43 (47.82–88.72) | 47.62 (25.71–70.22) | 71.43 (47.82–88.72) | 71.43 (47.82–88.72) | 80.95 (58.09–94.55) |
Table 4 Summary of radiographic, multidetector computed tomography and magnetic resonance imaging findings in central giant cell granulomas and ameloblastomas
| Ameloblastoma | CGCG | |
| Radiography | Posterior mandible; unilocular or multilocular; scalloped margins; root resorption, root displacement and bone expansion- may erode the cortex | Central mandible; multilocular sclerotic; root resorption, root displacement and bony expansion and cortical erosion |
| CBCT or MDCT | Mixed solid and cystic or purely cystic with thick enhancing rim or enhancing nodule (in unicystic variant) | Avid enhancement of soft tissue; mineralised matrix; better bony details |
| Our findings | Unilocular 66.7%; lytic 60.6%; solid component shows isoenhancement compared to surrounding muscles 63%; no matrix mineralisation in 69.7% | Multilocular 58.3%; mixed lytic sclerotic 75%; solid component shows hyperenhancement compared to surrounding muscles 50%; matrix mineralisation in 83.3% |
| MRI | T1 weighted – isointense; T2 weighted – hyperintense- cystic component; Heterogenous solid component | T1 weighted isointense; T2 weighted hyperintense to heterogeneous solid component |
- Citation: Ghosh A, Lakshmanan M, Manchanda S, Bhalla AS, Kumar P, Bhutia O, Mridha AR. Contrast-enhanced multidetector computed tomography features and histogram analysis can differentiate ameloblastomas from central giant cell granulomas . World J Radiol 2022; 14(9): 329-341
- URL: https://www.wjgnet.com/1949-8470/full/v14/i9/329.htm
- DOI: https://dx.doi.org/10.4329/wjr.v14.i9.329