Visualising cervical lymph nodes in jaw osteonecrosis using diffusion-weighted imaging.

OBJECTIVES: This study aimed to apply diffusion-weighted imaging to the evaluation of cervical lymph nodes affected by medication-related osteonecrosis of the jaw (MRONJ). METHODS: This retrospective study analysed the diffusion-weighted imaging data of 70 patients with or without MRONJ (Stages 0-3). The mean apparent diffusion coefficient (ADC) values of the submandibular (level IB) and superior internal jugular (level IIA) nodes in the control and MRONJ groups were calculated, and differences were analysed using the Mann-Whitney test. Moreover, receiver operating characteristic (ROC) curve analysis was performed to evaluate the ability of ADC values to predict lymph nodes that were affected by MRONJ. p < 0.05 was considered statistically significant. RESULTS: The median [interquartile range] (×10-3 mm2/s) of level IB was 0.74 [0.7-0.81] and 0.93 [0.84-1.09] and that of level IIA was 0.79 [0.76-0.85] and 0.97 [0.84-1.06] in the control and MRONJ groups respectively. ROC analysis revealed that the ADC value had excellent ability to discriminate between the control and MRONJ groups. CONCLUSIONS: The study findings indicate that diffusion-weighted imaging can contribute to differentiation of MRONJ from other cervical lymph node diseases and facilitate early detection of MRONJ.

Differentiation of submandibular sialadenitis based on apparent diffusion coefficient.

OBJECTIVES: This study aimed to quantify the submandibular gland in suppurative sialadenitis, primary Sjögren's syndrome (pSS) and radiation-induced sialadenitis using the apparent diffusion coefficient (ADC) for differential diagnosis. SUBJECTS AND METHODS: This retrospective study included 16 patients with suppurative sialadenitis (n = 9), pSS (n = 3) and radiation-induced sialadenitis (n = 4) who underwent magnetic resonance imaging between June 2006 and May 2022. The ADC of the submandibular glands in each state was calculated, and the differences were analysed using a one-way analysis of variance and Tukey's post hoc test. Receiver operating characteristic curves were used to assess the ability of the ADC to distinguish each condition. Statistical significance was set at p < 0.05. RESULTS: The mean ADC value (×10-3 mm2/s) ± standard deviation in the control (non-affected side of the suppurative sialadenitis group), suppurative sialadenitis, pSS and radiation-induced groups were 0.94 ± 0.16, 1.24 ± 0.16, 1.33 ± 0.13 and 1.5 ± 0.12, respectively (p < 0.001). The diagnostic value for distinguishing each group was ≥0.75. CONCLUSION: ADC values are useful for quantitatively assessing and distinguishing submandibular glands in suppurative sialadenitis, primary Sjögren's syndrome and radiation-induced sialadenitis.

Normal Variants of the Oral and Maxillofacial Region: Mimics and Pitfalls.

A normal variant is defined as an incidental, often asymptomatic, imaging finding that mimics a true pathologic condition. Given the complex anatomy and wide variety of normal variants in the oral and maxillofacial region, a thorough understanding of commonly encountered normal variants in this region is essential to avoid misinterpretation and unnecessary further imaging or interventions. Moreover, familiarity with normal variants that are known to become symptomatic at times is necessary to facilitate further workup and guide the treatment plan. Intraoral radiography and panoramic radiography, which are unique to oral and maxillofacial radiology, provide two-dimensional (2D) images. Hence, the overlapping of structures or the displacement of the tomographic layer on images can confuse radiologists. It is crucial to understand the principle of 2D imaging to avoid being confused by ghost images or optical illusions. In addition, understanding the normal development of the maxillofacial region is essential when interpreting maxillofacial images in children or young adults because the anatomy may be quite different from that of mature adults. Knowledge of changes in the jaw bone marrow and each tissue's growth rate is essential. It is also necessary to know when the tooth germ begins to calcify and the tooth erupts for diagnostic imaging of the maxillofacial region. The authors describe imaging findings and clinical manifestations of common normal variants in the oral and maxillofacial region, divided into four parts: the maxilla, mandible, tooth, and temporomandibular joint, and discuss the imaging approach used to differentiate normal variants from true pathologic conditions. Online supplemental material is available for this article. ©RSNA, 2022.

Texture analysis of low-flow vascular malformations in the oral and maxillofacial region: venous malformation vs. lymphatic malformation.

Purpose: It is challenging for radiologists to distinguish between venous malformations (VMs) and lymphatic malformations (LMs) using magnetic resonance imaging (MRI). Thus, this study aimed to differentiate VMs from LMs using non-contrast-enhanced MRI texture analysis. Material and methods: This retrospective case-control study included 12 LM patients (6 men and 6 women; mean age 43.58, range 7-85 years) and 29 VM patients (7 men and 22 women; mean age 53.10, range 19-76 years) who underwent MRI for suspected vascular malformations. LM and VM patients were identified by histopathological examination of tissues excised during surgery. The texture features of VM and LM were analysed using the open-access software MaZda version 3.3. Seventeen texture features were selected using the Fisher and probability of error and average correlation coefficient methods in MaZda from 279 original parameters calculated for VM and LM. Results: Among 17 selected texture features, the patients with LM and VM revealed significant differences in 1 histogram feature, 8 grey-level co-occurrence matrix (GLCM) features, and 1 grey-level run-length matrix feature. At the cut-off values of the histogram feature [skewness ≤ -0.131], and the GLCM features [S(0, 2) correlation ≥ 0.667, S(0, 3) correlation ≥ 0.451, S(0, 4) correlation ≥ 0.276, S(0, 5) correlation ≥ 0.389, S(1, 1) correlation ≥ 0.739, S(2, 2) correlation ≥ 0.446, S(2, -2) correlation ≥ 0.299, S(3, -3) correlation ≥ 0.091] had area under the curves of 0.724, 0.764, 0.773, 0.747, 0.733, 0.759, 0.730, 0.744 and 0.727, respectively. Conclusions: Non-contrast-enhanced MRI texture analysis allows us to differentiate between LMs and VMs.

Quantitative Assessment of the Apparent Diffusion Coefficient Values of the Inflammatory Connective Tissue Around the Mandibular Condyle in Rheumatoid Arthritis.

PURPOSE: Magnetic resonance imaging can detect soft- and hard-tissue abnormalities and has become the primary imaging modality for temporomandibular joints. However, few studies have quantitatively evaluated rheumatoid arthritis (RA) in temporomandibular joints using diffusion-weighted imaging. The purpose of this study was to assess the apparent diffusion coefficient (ADC) values of the inflammatory connective tissue around the mandibular condyle in RA. METHODS: This was a retrospective cohort study. We analyzed the magnetic resonance imaging studies of patients with suspected temporomandibular joint disorders performed between April 2008 and August 2020. The predictor variable was disease status (RA-y/n). The primary outcome variable was the mean of ADC values of the connective tissue around the mandibular condyle. The other variables were age and sex. Furthermore, the ADC values were compared between the 2 groups. Data were analyzed using a Mann-Whitney U test, Spearman's correlation coefficient, and a receiver operating characteristic curve. P < .05 was considered to indicate statistical significance. RESULTS: In total, 35 patients (18 normal patients and 17 patients with RA) were included. The mean ADC values were 1.26 ± 0.11 × 10-3 mm2/s and 1.60 ± 0.19 × 10-3 mm2/s in the control and RA groups, respectively (P < .001). Receiver operating characteristic analysis revealed that a cutoff of 1.37 for ADC values for RA provided an accuracy of 0.86. The sensitivity and specificity of ADC values were 0.94 and 0.83, respectively. CONCLUSIONS: ADC values of the inflammatory connective tissue around the mandibular condyle in RA were significantly higher in the RA group than those in the control group. This parameter might be useful for the quantitative evaluation of RA.

Quantitative Assessment of the Mandibular Condyle in Patients With Rheumatoid Arthritis Using Diffusion-Weighted Imaging.

PURPOSE: The purpose of this study was to quantitatively assess the mandibular condyle in patients with rheumatoid arthritis (RA) using the apparent diffusion coefficient (ADC) on diffusion-weighted imaging (DWI). PATIENTS AND METHODS: Thirty-one patients with RA and temporomandibular joint (TMJ) pain who underwent magnetic resonance imaging (MRI) examination of the TMJs at our hospital between August 2006 and March 2020 were included in this study. Twenty-one patients with normal TMJs who underwent MRI examination at our hospital between August 2006 and March 2020 were included as controls. The MRI findings were compared between the 2 groups. RESULTS: The mean ADC values of the mandibular condyle in patients with RA were 1.20 ± 0.17 × 10-3 mm2/second. The mean ADC values of the mandibular condyle in patients with RA were significantly greater than the controls (P < .01). Receiver operating characteristic curve analysis revealed a cutoff of 0.89 for the ADC values of the mandibular condyle in patients with RA. The receiver operating characteristic curve analysis revealed areas under the curve for maximum ADC values of 0.98. CONCLUSIONS: Our study found that the ADC on DWI could be used for the quantitative assessment of the mandibular condyle in patients with RA, which indicated that the ADC on DWI could be useful for predicting RA.

Increased Apparent Diffusion Coefficient Values of Masticatory Muscles on Diffusion-Weighted Magnetic Resonance Imaging in Patients With Temporomandibular Joint Disorder and Unilateral Pain.

PURPOSE: Myalgia of the masticatory muscles is difficult to evaluate quantitatively. The purpose of the present study was to quantitatively assess myalgia of the masticatory muscles in patients with temporomandibular disorders (TMDs) using the apparent diffusion coefficient (ADC) on diffusion-weighted magnetic resonance imaging (MRI). PATIENTS AND METHODS: Patients who had undergone MRI with clinically diagnosed TMDs according to the criteria of the American Academy of Orofacial Pain and unilateral temporomandibular joint pain from March 2015 to January 2017 were prospectively enrolled. The MRI techniques used included axial diffusion-weighted imaging (DWI) and short T1 inversion recovery imaging through the neck to the skull base. The regions of interest were drawn to completely include the right and left lateral pterygoid muscles, medial pterygoid muscles, and masseter muscles on a slice demonstrating the largest area of each muscle on the ADC map. We compared each masticatory muscle of the pain side with those of the contralateral side without pain. RESULTS: A total of 106 patients with TMD had met the inclusion criteria (18 males, 88 females; mean age, 48.7 years; range, 16 to 80). The mean ADC values of the masticatory muscles of the pain side were significantly greater than those of the no-pain sides (P < .01), as were those for the lateral pterygoid muscles (1.35 ± 0.79 × 10-3 mm2/second vs 1.13 ± 0.77 × 10-3 mm2/second), medial pterygoid muscles (1.28 ± 0.46 × 10-3 mm2/second vs 1.05 ± 0.69 × 10-3 mm2/second), masseter muscles (1.33 ± 0.78 × 10-3 mm2/second vs 1.09 ± 0.64 × 10-3 mm2/second). CONCLUSIONS: The ADC values of the masticatory muscles on the pain side were significantly greater than those of the contralateral side without pain. Our results suggest that DWI could be used to assess myalgia of the masticatory muscles quantitatively.

Characteristic Magnetic Resonance Imaging Findings in Rheumatoid Arthritis of the Temporomandibular Joint: Focus on Abnormal Bone Marrow Signal of the Mandibular Condyle, Pannus, and Lymph Node Swelling in the Parotid Glands.

PURPOSE: The purpose of this study was to determine the characteristic magnetic resonance imaging (MRI) findings indicating bone and soft tissue involvement in patients with rheumatoid arthritis (RA) of the temporomandibular joints (TMJs). PATIENTS AND METHODS: Twenty-one patients with RA and TMJ pain who underwent MRI examination of the TMJs at the authors' hospital from August 2006 to December 2014 were included in this study. Twenty-two patients with normal TMJs who underwent MRI examination at the authors' hospital from November to December 2014 were included as controls. MRI findings were compared between the 2 groups. RESULTS: MRI findings of RA in the TMJ included 1) abnormal disc position (95.2%), 2) abnormal disc morphology (83.3%), 3) joint effusion (30.9%), 4) osseous changes in the mandibular condyle (83.3%), 5) synovial proliferation (pannus; 85.7%), 6) erosion of the articular eminence and glenoid fossa (9.52%), 7) deformity of the articular eminence and glenoid fossa (16.6%), 8) abnormal bone marrow signal in the mandibular condyle (83.3%), and 9) swelling of lymph nodes in the parotid glands (78.5%). The abnormal bone marrow signal and pannus in the mandibular condyle and lymph node swelling in the parotid glands were markedly more common in patients with RA than in controls. CONCLUSIONS: MRI findings of RA of the TMJs were characterized by bone and soft tissue involvement, including abnormal bone marrow signal of the mandibular condyle, pannus, and swelling of lymph nodes in the parotid glands. These characteristic MRI findings could be useful in detecting RA in the TMJ in a clinical situation.

Parotid Lymphadenopathy Is Associated With Joint Effusion in Non-Neoplastic Temporomandibular Disorders.

PURPOSE: Lymphadenopathy often occurs in the setting of inflammation, with or without infection. We sought to elucidate any association of parotid lymphadenopathy with joint effusion in temporomandibular joint (TMJ) disorders. MATERIALS AND METHODS: We performed a retrospective cohort study. We analyzed the magnetic resonance imaging studies of patients with suspected TMJ disorders performed from April 2006 to March 2007. The degree of joint effusion was graded on sagittal T2-weighted spin echo images according to a commonly used system. On axial short T1-weighted short inversion recovery images, the number and short-axis diameter of the parotid lymph nodes were recorded. We performed analyses of the cluster-correlated data using the Mann-Whitney U test and Spearman's correlation coefficients. P < .05 was considered to indicate significance. To assess the possible predictive value of certain variables, a generalized linear model (generalized estimation equation) was constructed, considering the multiple measurements. RESULTS: A total of 402 TMJ disorders were analyzed from 201 patients during the study period. The number and size of the parotid lymph nodes identified was significantly greater in the patients with TMJ effusion (P < .01) than in those without effusion. CONCLUSION: In the present study, we found an association between parotid lymphadenopathy and joint effusion in TMJ disorders. These findings indicate that lymphadenopathy should be considered as an inflammation condition commonly associated with joint effusion in TMJ disorders.

Computed Tomography Findings of Mandibular Nutrient Canals.

INTRODUCTION: The purpose of this study was to assess computed tomography (CT) findings of mandibular nutrient canals using CT images. MATERIALS AND METHODS: We retrospectively analyzed the mandibular CT images of 194 consecutive patients. For image analysis such as canal prevalence, location, number, size, shape, and the CT value of nutrient foramina were determined using CT axial images of 0.5 and 3 mm slice thickness. RESULTS: We revealed that the nutrient canals were seen 94.3% in the mandible, mostly seen in the anterior region. By location, nutrient canals were particularly seen between the central and lateral incisors. The mean number of nutrient canals was 2.7. The mean diameter of the nutrient foramen between the central and lateral incisors was 1.0 mm. In about 80% of the cases, foramina between the central and lateral incisors were ovoid. The mean CT value for the nutrient foramina between the central and lateral incisors was 411 HU. DISCUSSION AND CONCLUSIONS: Mandibular nutrient canals were ovoid shape, and the mean CT value was 411 HU. By preoperative knowledge of the position and anatomy of the mandibular nutrient canals, complications such as injury to the nutrient canals can be avoided.

Analysis of mandibular condylar and glenoid fossa fractures with computed tomography.

OBJECTIVES: The purpose of this study was to investigate the prevalence of glenoid fossa and condylar fractures in patients with mandibular fractures using multidetector computed tomography (MDCT). METHODS: A prospective study was performed in 227 patients with mandibular fractures who underwent 64-MDCT. Mandibular fractures were classified into four types: median, paramedian, angle and condylar. Statistical analysis of the relationship between prevalence of condylar fractures and mandibular fracture locations was performed using χ(2) test with Fisher's exact test. A P value less than 0.05 was considered statistically significant. RESULTS: The prevalence of condylar fracture was 64.8 % of all patients with mandibular fractures, 66.7 % of median type (P = 0.667), 45.5 % of paramedian type (P = 0.001) and 12.3 % of angle type (P = 0.000), respectively. Furthermore, glenoid fossa fracture was seen in 1.4 % of patients with condylar fractures. CONCLUSIONS: The results of the presented study suggest focusing also on incidental findings such as glenoid fossa fractures. KEY POINTS: • The prevalence of condylar fracture was 64.8 % in patients with mandibular fractures. • Glenoid fossa fracture was seen in 1.4 % of patients with condylar fractures. • The study suggests a focus on incidental findings such as glenoid fossa fractures.

Nasopharyngeal cystic lesions: Tornwaldt and mucous retention cysts of the nasopharynx: findings on MR imaging.

OBJECTIVE: Nasopharyngeal cystic lesions are commonly encountered on magnetic resonance imaging with significantly overlapped imaging characteristics. The purpose of this study was to determine the prevalence and distinguishing imaging features of cystic lesions in the nasopharynx in the largest patient series to date. METHODS: After institutional review board approval, consecutive head magnetic resonance images of 3000 patients performed at 1.5 T between June 2010 and April 2011 were retrospectively reviewed for cystic nasopharyngeal lesions. Location, size, and signal characteristic of cystic lesions were recorded. Electronic medical records were reviewed for patient demographics, symptoms, and underlying conditions. RESULTS: Among 3000 patients, 6% had Tornwaldt cysts (peak prevalence, 51-60 years old) and 10% had mucous retention cysts (peak prevalence, 41-50 years old). A significant correlation between human immunodeficiency virus infection and mucous retention cysts was observed (P < 0.001). CONCLUSIONS: The prevalence of Tornwaldt cysts was slightly higher than previously described in the literature. Additionally, younger and older patients had the lowest prevalence of Tornwaldt cyst, suggesting these lesions are acquired and subsequently involute with time. A significant correlation was observed between human immunodeficiency virus infection and mucous retention cysts.

Texture analysis using short-tau inversion recovery magnetic resonance images to differentiate squamous cell carcinoma of the gingiva from medication-related osteonecrosis of the jaw.

OBJECTIVES: Despite the difficulty in distinguishing between squamous cell carcinoma (SCC) and medication-related osteonecrosis of the jaw (MRONJ) on the basis of medical imaging examinations, the two conditions have completely different treatment methods and prognoses. Therefore, differentiation of SCC from MRONJ on imaging examinations is very important. This study aimed to distinguish SCC from MRONJ by performing texture analysis using magnetic resonance imaging (MRI) short-tau inversion recovery images. METHODS: This retrospective case-control study included 14 patients with SCC of the lower gingiva and 35 with MRONJ of the mandible who underwent MRI and computed tomography (CT) for suspected SCC or MRONJ. SCC was identified by histopathological examination of tissues excised during surgery. The radiomics features of SCC and MRONJ were analyzed using the open-access software MaZda version 3.3 (Technical University of Lodz, Institute of Electronics, Poland). CT was used to evaluate the presence or absence of qualitative findings (sclerosis, sequestrum, osteolysis, periosteal reaction, and cellulitis) of SCC and MRONJ. RESULTS: Among the 19 texture features selected using MaZda feature-reduction methods, SCC of the gingiva and MRONJ of the mandible revealed differences in two histogram features, one absolute gradient feature, and 16 Gy level co-occurrence matrix features. In particular, the percentile, angular second moment, entropy, and difference entropy exhibited excellent diagnostic performance. CONCLUSION: Non-contrast-enhanced MRI texture analysis revealed differences in texture parameters between mandibular SCC and mandibular MRONJ. MRI texture analysis can be a new noninvasive quantitative method for distinguishing between SCC and MRONJ.

Graphical user interface-based convolutional neural network models for detecting nasopalatine duct cysts using panoramic radiography.

Nasopalatine duct cysts are difficult to detect on panoramic radiographs due to obstructive shadows and are often overlooked. Therefore, sensitive detection using panoramic radiography is clinically important. This study aimed to create a trained model to detect nasopalatine duct cysts from panoramic radiographs in a graphical user interface-based environment. This study was conducted on panoramic radiographs and CT images of 115 patients with nasopalatine duct cysts. As controls, 230 age- and sex-matched patients without cysts were selected from the same database. The 345 pre-processed panoramic radiographs were divided into 216 training data sets, 54 validation data sets, and 75 test data sets. Deep learning was performed for 400 epochs using pretrained-LeNet and pretrained-VGG16 as the convolutional neural networks to classify the cysts. The deep learning system's accuracy, sensitivity, and specificity using LeNet and VGG16 were calculated. LeNet and VGG16 showed an accuracy rate of 85.3% and 88.0%, respectively. A simple deep learning method using a graphical user interface-based Windows machine was able to create a trained model to detect nasopalatine duct cysts from panoramic radiographs, and may be used to prevent such cysts being overlooked during imaging.

The transcription factor OsNAC4 is a key positive regulator of plant hypersensitive cell death.

The hypersensitive response (HR) is a common feature of plant immune responses and a type of programmed cell death. However, little is known about the induction mechanism of HR cell death. We report that overexpression of OsNAC4, which encodes a plant-specific transcription factor, leads to HR cell death accompanied by the loss of plasma membrane integrity, nuclear DNA fragmentation and typical morphological changes. In OsNAC4 knock-down lines, HR cell death is markedly decreased in response to avirulent bacterial strains. After induction by an avirulent pathogen recognition signal, OsNAC4 is translocated into the nucleus in a phosphorylation-dependent manner. A microarray analysis showed that the expression of 139 genes including OsHSP90 and IREN, encoding a Ca(2+)-dependent nuclease, were different between the OsNAC4 knock-down line and control line during HR cell death. During the induction of HR cell death, OsHSP90 is involved in the loss of plasma membrane integrity, whereas IREN causes nuclear DNA fragmentation. Overall, our results indicate that two important events occurring during HR cell death are regulated by independent pathways.

Periapical lucency around the tooth: radiologic evaluation and differential diagnosis.

Periapical lucencies are often seen incidentally at head and neck imaging studies performed for indications not related to the teeth. These lesions are, however, occasionally manifestations of diseases that have a wide range of effects and may at times represent the source of symptoms that prompted the study. The vast majority of periapical lucencies are the result of apical periodontal or pulpal disease. If found in an advanced state or left untreated, disease related to the tooth may spread to adjacent tissues, including the sinuses, orbits, deep fascial spaces of the neck, and intracranial structures, and result in a significant increase in patient morbidity and mortality. Although the majority of periapical lucencies seen on radiographs and computed tomographic images occur secondary to apical periodontal or pulpal disease, not all lucencies near the tooth root are due to infection. Lucency near the tooth root may be seen in the setting of other diseases of odontogenic and non-odontogenic origin, including neoplasms. Although imaging findings for these lesions can include periapical lucent components, awareness of the varied secondary imaging features can aid the radiologist in developing an accurate differential diagnosis. Familiarity with the imaging features and differential diagnoses of diseases or conditions that cause lucency around the tooth root results in appropriate referral and prompt diagnosis, management, and treatment, and can prevent unnecessary additional imaging or intervention. In addition, early recognition and appropriate treatment of infectious processes will result in improved clinical outcomes and a decrease in morbidity and mortality.

[Investigation of radio frequency heating of dental implants made of titanium in 1.5 tesla and 3.0 tesla magnetic resonance procedure: measurement of the temperature by using tissue-equivalent phantom].

Titanium (Ti) implants are increasingly being used for dental parts. There is no problem with the attraction of a static magnetic field for Ti in magnetic resonance imaging (MRI), since Ti is paramagnetic. However, there is a risk of radio frequency (RF) heat generation within Ti. 3.0 T-MRI scanners are becoming increasingly common. The specific absorption rate (SAR) of 3.0 T-MRI is quadruple that of SAR compared with 1.5 T-MRI due to its being proportional to the square of the strength of a static magnetic field. The effect of heat generation in 3.0 T-MRI can thus be greater than in 1.5 T-MRI. So, using 1.5 T and 3.0 T-MRI scanners, we measured the temperature of several Ti implants using the same scanning parameters during MRI scanning. Our measurements showed the rise in temperature of the Ti implants to be a maximum of 0.4 degrees C. In this study, however, Ti in a human mouth was not directly measured, so we need to attempt to perform MRI carefully on patients with Ti implants.

Central vascular malformations of the mandible: characteristic findings in computed tomography and magnetic resonance imaging.

Central vascular malformations (CVMs) of the mandible are rare and can have varied clinical and radiological characteristics, thus making differential diagnosis difficult. We retrospectively reviewed 5 patients with proven CVM who underwent computed tomography (CT) and magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI) (and magnetic resonance angiography (MRA) for one patient), to assess the characteristic imaging findings of this lesion. CT revealed multilocularity in 3 lesions. All CVMs produced fine, irregular borders and low-to-intermediate density. Lesion continuity with the mandibular canal was discovered in 4 cases and enlarged feeding and outflow vessels in 3 lesions. Bone overgrowth was observed in 2 patients. CT values ranged from 30.84 to 52.87 Hounsfield units (HU). MRI exhibited low to intermediate signals on T1-weighted imaging (T1WI), signals ranging from low to intermediate-to-high on T2WI, and low to high signal intensity on short-tau inversion recovery (STIR) images, with flow voids in all patients and no inflammation in surrounding tissues. As calculated with DWI, the apparent diffusion coefficient (ADC) ranged from 0.69 to 1.74 × 10-3 mm2/s. MRA showed the presence of feeding vessels in 1 lesion. Interexaminer agreement on image interpretation ranged from moderate to excellent. These typical CVM imaging findings may aid in the differential diagnosis of this lesion.

Quantitative analysis of masticatory muscle changes by Eichner index using diffusion-weighted imaging.

OBJECTIVES: Diffusion-weighted imaging (DWI) provides quantitative functional information about the microscopic movement of water at the cellular level. However, few reports have quantitatively evaluated histological changes in masticatory muscles due to changes in occlusal relationships using DWI. This study aimed to assess the changes in masticatory muscles by Eichner index using DWI. METHODS: We analyzed magnetic resonance imaging (MRI) studies of 201 patients from November 2017 to April 2018. Each Eichner index group, age, and sex were used as criterion variables, and the average apparent diffusion coefficient (ADC) values of the masticatory muscles were the explanatory variable. The mean ADC value differences were analyzed in each Eichner index group. We analyzed the data using the Kruskal-Wallis test and post hoc Mann-Whitney test with Bonferroni adjustment multiple regression analysis with Shapiro-Wilk test and Spearman's correlation coefficients. P < 0.05 was considered statistically significant. RESULTS: The mean ADC values of each Eichner classification group were significantly different, with the lowest value in group C (P < 0.001). There was a negative correlation between the ADC value of the masseter, lateral pterygoid muscle, and age (P < 0.001). There were significant differences between the sex groups (P < 0.001). CONCLUSIONS: ADC values of masticatory muscles were significantly different in the Eichner index groups. The ADC values of masticatory muscles may be useful for the quantitative evaluation of the masticatory muscles affected by the occlusal state.

Diagnostic efficacy of apparent diffusion coefficient, texture features, and their combination for differential diagnosis of odontogenic cysts and tumors.

OBJECTIVE: This study assessed the diagnostic efficacy of apparent diffusion coefficient (ADC), texture features, and their combination for the differential diagnosis of odontogenic cysts and tumors with cyst-like features. STUDY DESIGN: In total, 14 dentigerous cysts (DCs), 12 odontogenic keratocysts (OKCs), and 6 unicystic ameloblastomas (UABs) were used as predictor variables in 32 outpatients who underwent magnetic resonance imaging. The outcome variables were ADC, texture features, and their combination for each lesion. Texture features including histogram and gray-level co-occurrence matrix (GLCM) were measured on ADC maps. Ten features were selected by using the Fisher coefficient method. The Kruskal-Wallis test and post hoc Mann-Whitney test with Bonferroni adjustment were used to analyze trivariate statistics. Statistical significance was established at P < .05. Receiver operating characteristic analysis was used to evaluate the diagnostic effect of ADC, texture features, and their combination in distinguishing the lesions from each other. RESULTS: Apparent diffusion coefficient, 1 histogram feature, 9 GLCM features, and their combination demonstrated significant differences between DC, OKC, and UAB (P ≤ .01). Receiver operating characteristic analysis revealed a high area under the curve of .95 to 1.00 for ADC, 10 texture features, and their combination. Sensitivity, specificity, and accuracy ranged from .86 to 1.00. CONCLUSIONS: Apparent diffusion coefficient and texture features, alone or in combination, can be clinically important in facilitating the distinction between these odontogenic lesions.