Accuracy of Grayscale Value in Diagnosis of Odontogenic Keratocyst and Radicular Cyst
Gray Scale Accuracy in Odontogenic Cyst Diagnosis
Abstract
Objectives: Radicular cyst (RC) and odontogenic keratocyst (OKC) are among the most commonly identified cysts in both the maxilla and mandible. With the advancements in 3D imaging techniques such as cone-beam computed tomography (CBCT), there is an opportunity to thoroughly examine the boundaries of these lesions and quantify the grayscale of CBCT images, known as the grayscale value (GSV). This study investigated the reliability of CBCT GSV in distinguishing between RC and OKC.
Materials and Methods: A total of 60 specimens with confirmed pathological diagnoses of RC and OKC were meticulously selected. Before surgical biopsy of each lesion, CBCT images were obtained and analyzed using Romexis version 2.9.2 software to compute the mean GSV of each lesion. Statistical analysis was then conducted using SPSS version 1.0.0.1406, and a linear, backward regression model was used to analyze the differences in GSV between lesion categories (alpha=0.05).
Results: Upon extracting the mean GSV of the selected sections of each type of lesion, no statistically significant difference was observed between the mean GSVs of the two lesion categories (P>0.05).
Conclusion: The present findings regarding lack of a significant difference in the mean GSV between RC and OKC were substantial, and suggest that the GSV may not be a reliable index for differentiating these cystic lesions from each other, a conclusion that could potentially impact future diagnostic practices.
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14. Valiyaparambil JV, Yamany I, Ortiz D, Shafer DM, Pendrys D, Freilich M, Mallya SM. Bone quality evaluation: comparison of cone beam computed tomography and subjective surgical assessment. Int J Oral Maxillofac Implants. 2012 Sep-Oct;27(5):1271-7.
15. Razi T, Niknami M, Alavi Ghazani F. Relationship between Hounsfield Unit in CT Scan and Gray Scale in CBCT. J Dent Res Dent Clin Dent Prospects. 2014 Spring;8(2):107-10.
16. Simon JH, Enciso R, Malfaz JM, Roges R, Bailey-Perry M, Patel A. Differential diagnosis of large periapical lesions using cone-beam computed tomography measurements and biopsy. J Endod. 2006 Sep;32(9):833-7.
17. Guo J, Simon JH, Sedghizadeh P, Soliman ON, Chapman T, Enciso R. Evaluation of the reliability and accuracy of using cone-beam computed tomography for diagnosing periapical cysts from granulomas. J Endod. 2013 Dec;39(12):1485-90.
18. Rosenberg PA, Frisbie J, Lee J, Lee K, Frommer H, Kottal S, et al. Evaluation of pathologists (histopathology) and radiologists (cone beam computed tomography) differentiating radicular cysts from granulomas. J Endod. 2010 Mar;36(3):423-8.
19. Nasim A, Mohan RP, Nagaraju K, Malik SS, Goel S, Gupta S. Application of cone beam computed tomography gray scale values in the diagnosis of cysts and tumors. J. Indian Acad. Oral Med. Radiol. 2018 Jan 1;30(1):4-9.
20. De Rosa CS, Bergamini ML, Palmieri M, Sarmento DJS, de Carvalho MO, Ricardo ALF, et al. Differentiation of periapical granuloma from radicular cyst using cone beam computed tomography images texture analysis. Heliyon. 2020 Oct 9;6(10):e05194.
21. Kruse C, Spin-Neto R, Wenzel A, Kirkevang LL. Cone beam computed tomography and periapical lesions: a systematic review analysing studies on diagnostic efficacy by a hierarchical model. Int Endod J. 2015 Sep;48(9):815-28.
22. Etöz M, Amuk M, Avcı F, Yabacı A. Investigation of the effectiveness of CBCT and gray scale values in the differential diagnosis of apical cysts and granulomas. Oral Radiol. 2021 Jan;37(1):109-117.
23. Razi T, Emamverdizadeh P, Nilavar N, Razi S. Comparison of the Hounsfield unit in CT scan with the gray level in cone-beam CT. J Dent Res Dent Clin Dent Prospects. 2019 Summer;13(3):177-182.
24. Wang X, Wei L, Li B, Li J, Li W, Wang F et al. Clinical and Cone-Beam Computed Tomography Features of Orthokeratinized Odontogenic Cysts and Odontogenic Keratocysts in the Mandible. J Oral Maxillofac Surg. 2021 Jun;79(6):1255-1261.
25. Yalçin BK, Berberoğlu HK, Aralaşmak A, Köseoğlu BG, Çakarer S, Tekkesin MS, et al. Evaluation of CT and MRI Imaging Results of Radicular Cysts, Odontogenic Keratocysts, and Dentigerous Cysts and their Contribution to the Differential Diagnosis. Curr Med Imaging. 2022;18(14):1447-1452.
2. Andrić M, Brković B, Jurišić V, Jurišić M, Milašin J. Keratocystic odontogenic tumors – Clinical and molecular features. In: Motamedi MHK, editor. A Textbook of Advanced Oral and Maxillofacial Surgery, Vol. 1. Chapter 25, pp. 613–636. IntechOpen, London, United Kingdom; 2013.
3. Neville BW, Damm DD, Allen CM, Chi AC. Oral and Maxillofacial Pathology. 5th ed. Chapter 15: Odontogenic Cysts and Tumors, pp. 683–714. Elsevier Health Sciences, St. Louis, Missouri, USA; 2023.
4. Borghesi A, Nardi C, Giannitto C, Tironi A, Maroldi R, Di Bartolomeo F, et al. Odontogenic keratocyst: imaging features of a benign lesion with an aggressive behaviour. Insights Imaging. 2018 Oct;9(5):883-897.
5. Mallya SM, Lam EWN. White and Pharoah’s Oral Radiology: Principles and Interpretation. 8th ed. Chapter 27: Cysts of the Jaws, pp. 360–365. Elsevier Health Sciences, St. Louis, Missouri, USA; 2018.
6. Nair PN. New perspectives on radicular cysts: do they heal? Int Endod J. 1998 May;31(3):155-60.
7. Johnson NR, Gannon OM, Savage NW, Batstone MD. Frequency of odontogenic cysts and tumors: a systematic review. J Investig Clin Dent. 2014 Feb;5(1):9-14.
8. Azeredo F, de Menezes LM, Enciso R, Weissheimer A, de Oliveira RB. Computed gray levels in multislice and cone-beam computed tomography. Am J Orthod Dentofacial Orthop. 2013 Jul;144(1):147-55.
9. Uehara K, Hisatomi M, Munhoz L, Kawazu T, Yanagi Y, Okada S, et al. Assessment of Hounsfield unit in the differential diagnosis of odontogenic cysts. Dentomaxillofac Radiol. 2021 Feb 1;50(2):20200188.
10. Yilmaz E, Kayikcioglu T, Kayipmaz S. Computer-aided diagnosis of periapical cyst and keratocystic odontogenic tumor on cone beam computed tomography. Comput Methods Programs Biomed. 2017 Jul;146:91-100.
11. AlMadi DM, Al-Hadlaq MA, AlOtaibi O, Alshagroud RS, Al-Ekrish AA. Accuracy of mean grey density values obtained with small field of view cone beam computed tomography in differentiation between periapical cystic and solid lesions. Int Endod J. 2020 Oct;53(10):1318-1326.
12. Mah P, Reeves TE, McDavid WD. Deriving Hounsfield units using grey levels in cone beam computed tomography. Dentomaxillofac Radiol. 2010 Sep;39(6):323-35.
13. Parsa A, Ibrahim N, Hassan B, Motroni A, van der Stelt P, Wismeijer D. Reliability of voxel gray values in cone beam computed tomography for preoperative implant planning assessment. Int J Oral Maxillofac Implants. 2012 Nov-Dec;27(6):1438-42.
14. Valiyaparambil JV, Yamany I, Ortiz D, Shafer DM, Pendrys D, Freilich M, Mallya SM. Bone quality evaluation: comparison of cone beam computed tomography and subjective surgical assessment. Int J Oral Maxillofac Implants. 2012 Sep-Oct;27(5):1271-7.
15. Razi T, Niknami M, Alavi Ghazani F. Relationship between Hounsfield Unit in CT Scan and Gray Scale in CBCT. J Dent Res Dent Clin Dent Prospects. 2014 Spring;8(2):107-10.
16. Simon JH, Enciso R, Malfaz JM, Roges R, Bailey-Perry M, Patel A. Differential diagnosis of large periapical lesions using cone-beam computed tomography measurements and biopsy. J Endod. 2006 Sep;32(9):833-7.
17. Guo J, Simon JH, Sedghizadeh P, Soliman ON, Chapman T, Enciso R. Evaluation of the reliability and accuracy of using cone-beam computed tomography for diagnosing periapical cysts from granulomas. J Endod. 2013 Dec;39(12):1485-90.
18. Rosenberg PA, Frisbie J, Lee J, Lee K, Frommer H, Kottal S, et al. Evaluation of pathologists (histopathology) and radiologists (cone beam computed tomography) differentiating radicular cysts from granulomas. J Endod. 2010 Mar;36(3):423-8.
19. Nasim A, Mohan RP, Nagaraju K, Malik SS, Goel S, Gupta S. Application of cone beam computed tomography gray scale values in the diagnosis of cysts and tumors. J. Indian Acad. Oral Med. Radiol. 2018 Jan 1;30(1):4-9.
20. De Rosa CS, Bergamini ML, Palmieri M, Sarmento DJS, de Carvalho MO, Ricardo ALF, et al. Differentiation of periapical granuloma from radicular cyst using cone beam computed tomography images texture analysis. Heliyon. 2020 Oct 9;6(10):e05194.
21. Kruse C, Spin-Neto R, Wenzel A, Kirkevang LL. Cone beam computed tomography and periapical lesions: a systematic review analysing studies on diagnostic efficacy by a hierarchical model. Int Endod J. 2015 Sep;48(9):815-28.
22. Etöz M, Amuk M, Avcı F, Yabacı A. Investigation of the effectiveness of CBCT and gray scale values in the differential diagnosis of apical cysts and granulomas. Oral Radiol. 2021 Jan;37(1):109-117.
23. Razi T, Emamverdizadeh P, Nilavar N, Razi S. Comparison of the Hounsfield unit in CT scan with the gray level in cone-beam CT. J Dent Res Dent Clin Dent Prospects. 2019 Summer;13(3):177-182.
24. Wang X, Wei L, Li B, Li J, Li W, Wang F et al. Clinical and Cone-Beam Computed Tomography Features of Orthokeratinized Odontogenic Cysts and Odontogenic Keratocysts in the Mandible. J Oral Maxillofac Surg. 2021 Jun;79(6):1255-1261.
25. Yalçin BK, Berberoğlu HK, Aralaşmak A, Köseoğlu BG, Çakarer S, Tekkesin MS, et al. Evaluation of CT and MRI Imaging Results of Radicular Cysts, Odontogenic Keratocysts, and Dentigerous Cysts and their Contribution to the Differential Diagnosis. Curr Med Imaging. 2022;18(14):1447-1452.
| Issue | Vol 23 (Continuously Published Article-Based) | |
| Section | Original Article | |
| Keywords | ||
| Cone-Beam Computed Tomography Jaw Cysts Odontogenic Cysts Radicular Cyst | ||
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How to Cite
1.
Niknami M, Hoseini AA, Bayati M. Accuracy of Grayscale Value in Diagnosis of Odontogenic Keratocyst and Radicular Cyst. Front Dent. 2026;23.
