introduction to interpretation

1

Introduction to Interpretation of Radiolucencies

Mr N Drage

Differential diagnosis of radiolucent lesions of the jaws

• Radiolucency• Normal anatomical structure

• Artefactual

• Pathological

• Congenital

• Developmental

• Acquired

Artefactual radiolucencies

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Description of the lesion

• Site or anatomical position

• Size

• Shape

• Outline/edge or periphery

• Relative radiodensity

• Effects on adjacent structures

• Time present-if known

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Acquired causes include

• Localised infection

• Spreading infection

• Trauma

• Cysts

• A tumour or tumour like lesion

• A giant cell lesion

• A fibro-cemento-osseous lesion

• An idiopathic lesion



• Size

• Shape





SiteOdontogenic Origin

Non Odontogenic Origin

Non Odontogenic Origin-Vascular-Neural

Some lesions are absolutely site specific

• Radicular Cyst

• Dentigerous Cyst

• Incisive canal cyst


• Radicular Cyst




• Radicular Cyst



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• Size

• Shape





Follicle size >3mm then likely to be cystic

>6mm likely to be cystic change

If the radiolucency is less than 15mm then it is likely to be a periapical granulomaIf the radiolucency is greater than 15mm then it is more likely to be a radicular cyst



• Size

• Shape





Shapes

• Monolocular (unilocular)

• Multilocular

• Pseudolocular

• Round

• Oval

• Irregular

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Shapes


• Multilocular

• Pseudolocular

• Round

• Oval

• Irregular

Shapes


• Multilocular

• Pseudolocular

• Round

• Oval

• Irregular

Common ‘Multilocular lesions’

•Central Giant Cell Granuloma

•brown Tumour of hyperparathyroidism

•Cherubism

•Aneurysmal Bone Cyst

Giant Cell Lesions

•Ameloblastoma

•Odontogenic Myxoma

•Ameloblastic Fibroma

Odontogenic Tumours

•Odontogenic Keratocyst (Keratocystic

Odontogenic Tumour in the latest WHO

classification)

Cysts

Specific LesionLesion type

Shapes


• Multilocular

• Pseudolocular

• Round

• Oval

• Irregular



• Size

• Shape





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Margins

Chronic infection

Surgical defects

Myeloma

Eosinophilic granuloma

Moderated well defined, not corticated (punched out):

Acute infection

Spreading infection

Malignant tumours

Poorly defined:

Cysts

Benign odontogenic tumours

Giant Cell lesions

Well defined and corticated:

LesionMargin Type



• Size

• Shape





Relative radiodensity

• Uniformly radiolucent

• Mixed radiolucent /radiopaque

• Radiopaque

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• Size

• Shape





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Malignancy

Odontogenic Tumours

Giant Cell Lesions

Cysts

Effect on Cortex

Teeth Resorbed

Teeth displaced

Margins

Malignancy

Odontogenic Tumours

Giant Cell Lesions

Well defined

Corticated

Cysts

Effect on Cortex

Teeth Resorbed

Teeth displaced

Margins

Malignancy

Odontogenic Tumours

Well defined

Corticated

Giant Cell Lesions

Well defined

Corticated

Cysts

Effect on Cortex

Teeth Resorbed

Teeth displaced

Margins

Malignancy

Well defined

Corticated

Odontogenic Tumours

Well defined

Corticated

Giant Cell Lesions

Well defined

Corticated

Cysts

Effect on Cortex

Teeth Resorbed

Teeth displaced

Margins

Ill defined

Moth eaten

Malignancy

Well defined

Corticated

Odontogenic Tumours

Well defined

Corticated

Giant Cell Lesions

Well defined

Corticated

Cysts

Effect on Cortex

Teeth Resorbed

Teeth displaced

Margins

Ill defined

Moth eaten

Malignancy

Well defined

Corticated

Odontogenic Tumours

Well defined

Corticated

Giant Cell Lesions

YesWell defined

Corticated

Cysts

Effect on Cortex

Teeth Resorbed

Teeth displaced

Margins

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Ill defined

Moth eaten

Malignancy

Well defined

Corticated

Odontogenic Tumours

YesWell defined

Corticated

Giant Cell Lesions

YesWell defined

Corticated

Cysts

Effect on Cortex

Teeth Resorbed

Teeth displaced

Margins

Ill defined

Moth eaten

Malignancy

YesWell defined

Corticated

Odontogenic Tumours

YesWell defined

Corticated

Giant Cell Lesions

YesWell defined

Corticated

Cysts

Effect on Cortex

Teeth Resorbed

Teeth displaced

Margins

VariableIll defined

Moth eaten

Malignancy

YesWell defined

Corticated

Odontogenic Tumours

YesWell defined

Corticated

Giant Cell Lesions

YesWell defined

Corticated

Cysts

Effect on Cortex

Teeth Resorbed

Teeth displaced

Margins

VariableIll defined

Moth eaten

Malignancy

YesWell defined

Corticated

Odontogenic Tumours

YesWell defined

Corticated

Giant Cell Lesions

NoYesWell defined

Corticated

Cysts

Effect on Cortex

Teeth Resorbed

Teeth displaced

Margins

VariableIll defined

Moth eaten

Malignancy

YesWell defined

Corticated

Odontogenic Tumours

NoYesWell defined

Corticated

Giant Cell Lesions

NoYesWell defined

Corticated

Cysts

Effect on Cortex

Teeth Resorbed

Teeth displaced

Margins

VariableIll defined

Moth eaten

Malignancy

YesYesWell defined

Corticated

Odontogenic Tumours

NoYesWell defined

Corticated

Giant Cell Lesions

NoYesWell defined

Corticated

Cysts

Effect on Cortex

Teeth Resorbed

Teeth displaced

Margins

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VariableVariableIll defined

Moth eaten

Malignancy

YesYesWell defined

Corticated

Odontogenic Tumours

NoYesWell defined

Corticated

Giant Cell Lesions

NoYesWell defined

Corticated

Cysts

Effect on Cortex

Teeth Resorbed

Teeth displaced

Margins


Moth eaten

Malignancy

YesYesWell defined

Corticated

Odontogenic Tumours

NoYesWell defined

Corticated

Giant Cell Lesions

ExpansionNoYesWell defined

Corticated

Cysts

Effect on Cortex

Teeth Resorbed

Teeth displaced

Margins


Moth eaten

Malignancy

YesYesWell defined

Corticated

Odontogenic Tumours


Corticated

Giant Cell Lesions


Corticated

Cysts

Effect on Cortex

Teeth Resorbed

Teeth displaced

Margins


Moth eaten

Malignancy

ExpansionYesYesWell defined

Corticated

Odontogenic Tumours


Corticated

Giant Cell Lesions


Corticated

Cysts

Effect on Cortex

Teeth Resorbed

Teeth displaced

Margins

DestructionVariableVariableIll defined

Moth eaten

Malignancy

ExpansionYesYesWell defined

Corticated

Odontogenic Tumours


Corticated

Giant Cell Lesions


Corticated

Cysts

Effect on Cortex

Teeth Resorbed

Teeth displaced

Margins

Do the test video

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Any questions

introduction to interpretation

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