Contrast-enhanced multidetector computed tomography features and histogram analysis can differentiate ameloblastomas from central giant cell granulomas

Abstract

BACKGROUND No qualitative or quantitative analysis of contrast-enhanced computed tomography (CT) images has been reported for the differentiation between ameloblastomas and central giant cell granulomas (CGCGs). AIM To describe differentiating multidetector CT (MDCT) features in CGCGs and ameloblastomas and to compare differences in enhancement of these lesions qualitatively and using histogram analysis. METHODS MDCT of CGCGs and ameloblastomas was retrospectively reviewed to evaluate qualitative imaging descriptors. Histogram analysis was used to compare the extent of enhancement of the soft tissue. Fisher’s exact tests and Mann–Whitney U test were used for statistical analysis ( P < 0.05). RESULTS Twelve CGCGs and 33 ameloblastomas were reviewed. Ameloblastomas had a predilection for the posterior mandible with none of the CGCGs involving the angle. CGCGs were multilocular (58.3%), with a mixed lytic sclerotic appearance (75%). Soft tissue component was present in 91% of CGCGs, which showed hyperenhancement (compared to surrounding muscles) in 50% of cases, while the remaining showed isoenhancement. Matrix mineralization was present in 83.3% of cases. Ameloblastomas presented as a unilocular (66.7%), lytic (60.6%) masses with solid components present in 81.8% of cases. However, the solid component showed isoenhancement in 63%. No matrix mineralization was present in 69.7% of cases. Quantitatively, the enhancement of soft tissue in CGCG was significantly higher than in ameloblastoma on histogram analysis ( P < 0.05), with a minimum enhancement of > 49.05 HU in the tumour providing 100% sensitivity and 85% specificity in identifying a CGCG. CONCLUSION A multilocular, lytic sclerotic lesion with significant hyperenhancement in soft tissue, which spares the angle of the mandible and has matrix mineralization, should indicate prospective diagnosis of CGCG .

Characterization of tumors of jaw: Additive value of contrast enhancement and dual-energy computed tomography

“…On the first comparison between ameloblastomas and CGCG, the CGCGs had higher mean iodine, water, mean HU at 65 Kev, and NIC compared to ameloblastomas. This was in accordance with the earlier studies, which showed that central giant cell lesions had significantly higher angiogenetic potential compared to ameloblastomas[ 17 , 18 ]. The differential analysis based on the calculated threshold IC value showed that a value of 32.1 × 100 μg/cm 3 , best represented the differences based on the AUC values on the ROC curves, with a sensitivity and specificity of 81.8% and 65%, respectively.…”