下颌阻生第三磨牙周围常见囊性病变的锥形束CT影像特点分析  

Cone-beam CT imaging features of common cystic lesions associated with the impacted mandibular third molar

作　　者：李敏 杜菡 王硕[1] 李刚[1] Li Min;Du Han;Wang Shuo;Li Gang(Department of Oral and Maxillofacial Radiology,Peking University School and Hospital of Stomatology&National Center for Stomatology&National Clinical Research Center for Oral Diseases&National Engineering Research Center of Oral Biomaterials and Digital Medical Devices&Beijing Key Laboratory of Digital Stomatology,Beijing 100081,China)

机构地区：[1]北京大学口腔医学院·口腔医院医学影像科、国家口腔医学中心、国家口腔疾病临床医学研究中心、口腔生物材料和数字诊疗装备国家工程研究中心、口腔数字医学北京市重点实验室,北京100081

出　　处：《中华口腔医学杂志》2023年第9期913-918,共6页Chinese Journal of Stomatology

摘　　要：目的探讨发生于下颌阻生第三磨牙周围的成釉细胞瘤(ameloblastoma,AB)、牙源性角化囊肿(odontogenic keratocyst,OKC)及含牙囊肿的锥形束CT影像学特点,为临床诊断提供参考。方法收集2016年8月至2021年12月北京大学口腔医学院·口腔医院医学影像科收治的109例有完整临床资料、病理诊断及锥形束CT影像,发生于下颌阻生第三磨牙周围的AB(14例)、OKC(23例)及含牙囊肿(72例)患者,其中男性73例,女性36例;患者年龄为11~70岁。分析病变部位、病变内密度、膨隆方向、邻牙牙根吸收及阻生牙的阻生类型等。应用χ^(2)检验比较不同病变患者的性别差异,应用Fisher精确检验比较不同病变的影像学特征计数资料的差异,以单侧P<0.05为差异有统计学意义。通过logistic回归分析评估有助于正确影像诊断的重要影像学特征。计算多变量模型中对诊断有影响的所有因素的相应P值。结果23例OKC患者的病变中心部位未见特殊偏好,21.7%(5/23)内部可见不均匀高密度影,56.5%(13/23)颌骨不膨隆,阻生牙位方向未见特殊偏好。14例AB患者中,7例(7/14)病变中心主要位于下颌支部位;14例(14/14)病变均出现颌骨膨隆;8例(8/14)邻牙牙根吸收;6例(6/14)阻生牙呈近中阻生。72例含牙囊肿患者中,88.9%(64/72)病变中心主要局限于阻生第三磨牙牙冠周围,72.2%(52/72)颌骨不膨隆,56.9%(41/72)阻生牙呈倒置阻生。3种病变的性别差异有统计学意义(χ^(2)=7.30,P=0.026),AB及含牙囊肿男性较女性更多发,而OKC男女的发病率大致相等。Fisher精确检验结果显示,3种囊性病变的病变中心部位(P<0.001)、内部密度(P=0.001)、颌骨膨隆(P<0.001)及阻生牙阻生类型(P<0.001)的差异均有统计学意义,而邻牙牙根吸收差异无统计学意义(P=0.153)。结论病变部位、病变内密度、颌骨膨隆以及阻生牙类型对准确诊断有明显作用。同时考虑病变部位和阻生牙类型,可将含牙囊肿与Objective To analyze the imaging features of cone-beam CT(CBCT)of ameloblastoma(AB),odontogenic keratocyst(OKC)and dentigerous cysts(DC)associated with the mandibular impacted third molars,so as to provide useful information for differential diagnosis of these lesions.Methods The patients who were with complete clinical data,pathological diagnosis and CBCT images from AB,OKC and DC around the mandibular impacted third molars were collected in Peking University Hospital of Stomatology from August 2016 to December 2021.A total of 109 patients(14 were diagnosed as AB,23 were diagnosed as OKC and the others were diagnosed as dental cysts)were collected,including 73 males and 36 females.The age ranged from 11 to 70.The analyzed imaging features included location and internal density of the lesions,bone expansion,root resorption of adjacent teeth and types of the impacted teeth.The Chi square test was used to compare the gender of different lesions,and the Fisher′s exact test was used to compare imaging features of lesions.When P<0.05,there was a significant difference among the three.Logistic regression analysis was performed to determine the imaging features that significantly contribute to correct imaging diagnosis.Corresponding P-values were calculated for all factors from multivariate models.Results In the 23 cases of OKC,no special location was observed for the center of the lesion,heterogeneous high-density were seen in 21.7%of the cases,56.5%of the cases had no significant bone expansion and the impacted teeth were not specially oriented.Among the 14 AB,7 cases(7/14)were mainly located in the ramus of the mandible,and all cases(14/14)had buccal/lingual expansion of the jaw,8 cases(8/14)presented root resorption of the adjacent teeth,and mesial impacted mandibular third molar were seen in 6 cases(6/14).Among the 72 DC,88.9%(64/72)of the cases were mainly limited to the crown of the impacted third molar,72.2%(52/72)of the cases had no obvious bone expansion,inverted impacted teeth were shown in 56.9%(41/72)of t

关 键 词：锥束计算机体层摄影术 牙 阻生 成釉细胞瘤 含牙囊肿 牙源性角化囊肿 

分 类 号：R781[医药卫生—口腔医学]