牙源性钙化囊肿与牙源性钙化上皮瘤的三维影像特点  

Three-dimensional radiographic features of calcifying odontogenic cyst and calcifying epithelial odontogenic tumor

作　　者：凌晓彤 屈留洋 郑丹妮 杨静 闫雪冰[2] 柳登高[1] 高岩[3] LING Xiaotong;QU Liuyang;ZHENG Danni;YANG Jing;YAN Xuebing;LIU Denggao;GAO Yan(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&NHC Research Center of Engineering and Technology for Computerized Dentistry&NMPA Key Laboratory for Dental Materials,Beijing 100081,China;Special Dental Department,The First Clinical Division,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&NHC Research Center of Engineering and Technology for Computerized Dentistry&NMPA Key Laboratory for Dental Materials,Beijing 100081,China;Department of Oral Pathology,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&NHC Research Center of Engineering and Technology for Computerized Dentistry&NMPA Key Laboratory for Dental Materials,Beijing 100081,China)

机构地区：[1]北京大学口腔医学院·口腔医院影像科,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,国家卫生健康委员会口腔医学计算机应用工程技术研究中心,国家药品监督管理局口腔材料重点实验室,北京100081 [2]北京大学口腔医学院·口腔医院第一门诊部特诊科,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,国家卫生健康委员会口腔医学计算机应用工程技术研究中心,国家药品监督管理局口腔材料重点实验室,北京100081 [3]北京大学口腔医学院·口腔医院口腔病理科,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,国家卫生健康委员会口腔医学计算机应用工程技术研究中心,国家药品监督管理局口腔材料重点实验室,北京100081

出　　处：《北京大学学报（医学版）》2024年第1期131-137,共7页Journal of Peking University:Health Sciences

摘　　要：目的:利用螺旋CT和锥束计算机体层摄影术(cone-beam computed tomography,CBCT)比较分析牙源性钙化囊肿(calcifying odontogenic cyst,COC)与牙源性钙化上皮瘤(calcifying epithelial odontogenic tumor,CEOT)的三维影像学特征。方法:回顾性收集北京大学口腔医院经病理证实的19例COC和16例CEOT的螺旋CT或CBCT影像资料,结合患者的临床与病理表现分析其影像学特征,包括病变位置、大小、膨隆程度、内部结构及牙齿受累情况等,并对病变内钙化特点进行分类。结果:19例COC患者中,男性12例,女性7例,平均年龄27岁,89.5%(17/19)的病变位于前牙区和前磨牙区,100.0%存在颌骨膨隆,78.9%出现骨皮质不连续。16例CEOT患者中,男性3例,女性13例,平均年龄36岁,81.3%(13/16)的病变位于前磨牙区和磨牙区,56.3%存在颌骨膨隆,93.8%出现骨皮质不连续。根据病变内钙化物的分布特点分为无钙化型(未见钙化影像)、边缘型(钙化影位于病变边缘,且仅在一侧散在分布)、弥散型(多发钙化影广泛分布于病变范围内)、团块型(存在直径大于5 mm的钙化团块)及冠周型(钙化影像聚集于阻生牙周围)。73.7%的COC病变区存在钙化,包括边缘型9例、弥散型3例及团块型2例;42.8%的CEOT病变区存在钙化,包括弥散型2例及冠周型5例。另外,6例COC病变中存在牙瘤样影像,9例无钙化的CEOT中8例为朗格汉斯(Langerhans)型,病变较小(近远中径平均为17.8 mm),不含阻生牙,且无牙根吸收。结论:COC好发于颌骨前部,膨隆明显,而CEOT好发于颌骨后部,多存在骨皮质不连续。两者的钙化特点差异较大,COC病变区钙化影像发生率高,多沿病变边缘散在分布,位于病变一侧,远离阻生牙,部分病变与牙瘤共同发生;CEOT逾半数无钙化且病变较小,其余病变中钙化物影像多围绕在阻生牙周围。Objective:To analyze the three-dimensional radiographic characteristics of calcifying odontogenic cyst and calcifying epithelial odontogenic tumor using spiral computed tomography(CT)and cone-beam computed tomography(CBCT).Methods:Clinical records,histopathological reports,and CBCT or non-enhanced spiral CT images of 19 consecutive patients with calcifying odontogenic cyst(COC)and 16 consecutive patients with calcifying epithelial odontogenic tumor(CEOT)were retrospectively acquired,and radiographic features,including location,size,expansion,internal structure and calcification,were analyzed.Results:Among the 19 COC cases(12 males and 7 females,with an average age of 27 years),89.5%(17/19)of the lesions originated from the anterior and premolar areas,100.0%of them exhibited cortex expansion,and 78.9%had discontinued cortex.Among the 16 CEOT cases(3 males and 13 females,with an average age of 36 years),81.3%(13/16)of the lesions were in the premolar and molar areas,56.3%of them exhibited cortex expansion,and 96.8%had discontinued cortex.According to the distribution of internal calcifications,these lesions were divided into:Ⅰ(non-calcification type):absence of calcification;Ⅱ(eccentric marginal type):multiple calcifications scattered along one side of the lesion;Ⅲ(diffused type):numerous calcifications diffusely distributed into the lesion;Ⅳ(plaque type):with a≥5 mm calcified patch;Ⅴ(peri-coronal type):multiple calcifications clustered around impacted teeth.Calcifications were present in 73.7%of COC lesions,including 9 typeⅡ,3 typeⅢand 2 typeⅣlesions,and 42.8%of CEOT lesions had calcification images,including 2 typeⅢand 5 typeⅤlesions.Six COC lesions had odontoma-like images.Moreover,8 of 9 typeⅠCEOTs were histologically Langerhans cell-rich subtype,which had a smaller size(with an average mesiodistal diameter of 17.8 mm)and were not associated with impacted teeth.Conclusion:COC lesions tended to originate from the anterior part of the jaw and exhibit cortex expansion,and were sometimes ass

关 键 词：牙源性钙化囊肿 牙源性钙化上皮瘤 三维成像 锥束计算机体层摄影术 

分 类 号：R739.8[医药卫生—肿瘤]