radiographic interpretation of a lesion

RADIOGRAPHIC INTERPRETATION

J.RAHUL RAGHAVENDER

CRI

• Radiographs are often obtained as part of a complete examination.

• Appropriate radiographic interpretation is used along with clinical information and other tests to formulate a differential diagnosis.

Normal radiographic anatomy

• ENAMEL

Most radiopaque structure

• DENTIN

Slightly lighter than enamel

• PULP CAVITY

Radiolucent lines within the tooth

• ALVEOLAR CREST

Gingival margin of the alveolar process appear as a radiopaque line

• PDL SPACE

Narrow radiolucent line around tooth surface

• LAMINA DURA

Radiopaque line representing tooth socket

Periapical radiograph interpretation of a lesion

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Interpretation is an orderly process

Normal variation Abnormal

Developmental abnormalities

Acquired abnormalities

Cyst Benign neoplasia

Vascular anomaly

MetabolicInflammatorylesion

Malignant neoplasia

Bone dysplasia

Trauma

Describing the Lesion

• 1. Size

• 2. Shape

• 3. Location

• 4. Density

• 5. Borders

• 6. Internal Architecture

• 7. Effect on adjacent structures

1. Size

• Measure the lesion with a ruler. If you must estimate, use surrounding structures as your guide

• Measure in two dimensions, width and height in mm or cm, as appropriate

2. Shape

• Regular

Round

Triangular

Rhomboid, etc.

• Irregular shape

3. Location

• Is the lesion localized or generalized?

• Unilateral or bilateral

• Where is the lesion in relation to other structures and anatomic landmarks?

• Use terms such as:

Mesial, Distal

Inferior, Superior

Posterior, Anterior

• If the epicenter of the lesion is above the mandibular canal, the likelihood is that the lesion is odontogenic in origin.

• Epicentre- below mandibular canal, non odontogenic(likely)

• Cartilaginous lesions are found nearer the condyles.

• If the epicenter of the lesion is in the sinus, it probably is not odontogenic in origin.

4. Density

• Is the lesion Radiopaque, Radiolucent,orMixed Density

• Remember that opacity is relative to the adjacent structures.

• If the lesion is of mixed density, describe the appearance

5. Borders

• Well or poorly demarcated

• Punched out (muliple myeloma)

• Corticated (osteomyelitis)

• Sclerotic (wide, uneven opaque border)

• Hyperostotic (increased density of trabeculation)

6. Internal architecture

• Is the lesion uniform?

• Internal structures such as septae or loculations

• Use terms such as: soap bubble ,honey comb , cotton wool, ground glass, wispy, orange peel, etc.

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7. Effect on adjacent structures

Is the lesion causing:

• Displacement ( such as teeth, maxillary sinus, inferior alveolar canal, etc.)

• Scalloping

• Root resorption

• Destruction

• Remodelling

• Expansion(any benign lesion)

• Epicentre above crown of teeth-follicular cysts-teeth apically

• Lesion-ramus of mandible-cherubism-anterior direction

• Widening of PDL, broken lamina dura-periapical abscess

• Reactive bone-periphery of lesion-benign slow growth