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北京大学学报（医学版） ›› 2019, Vol. 51 ›› Issue (6): 1138-1143. doi: 10.19723/j.issn.1671-167X.2019.06.028

• 论著 • 上一篇    下一篇

促结缔组织增生型成釉细胞瘤的CT影像特点

孙崇珂1,张建运2,孙志鹏1,△(),傅开元1,赵燕平1,张祖燕1,马绪臣1   

  1. 1. 北京大学口腔医学院·口腔医院, 口腔医学影像科, 国家口腔疾病临床医学研究中心 口腔数字化医疗技术和材料国家工程实验室 口腔数字医学北京市重点实验室,北京 100081
    2. 北京大学口腔医学院·口腔医院, 腔病理科, 国家口腔疾病临床医学研究中心 口腔数字化医疗技术和材料国家工程实验室 口腔数字医学北京市重点实验室,北京 100081
  • 收稿日期:2017-10-11 出版日期:2019-12-18 发布日期:2019-12-19
  • 通讯作者: 孙志鹏 E-mail:sunzhipeng@bjmu.edu.cn
  • 基金资助:
    国家自然科学基金(81500877)

Computed tomographic features of desmoplastic ameloblastoma of the jaw

Chong-ke SUN1,Jian-yun ZHANG2,Zhi-peng SUN1,△(),Kai-yuan FU1,Yan-ping ZHAO1,Zu-yan ZHANG1,Xu-chen MA1   

  1. 1. Department of Oral and Maxillofacial Radiology,Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    2. Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2017-10-11 Online:2019-12-18 Published:2019-12-19
  • Contact: Zhi-peng SUN E-mail:sunzhipeng@bjmu.edu.cn
  • Supported by:
    Supported by the National Natural Science Foundation of China(81500877)

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摘要：

目的 回顾性分析促结缔组织型成釉细胞瘤(desmoplastic ameloblastoma,DA)的临床和影像学特点。方法 回顾2000年7月至2017年8月北京大学口腔医院诊治的颌骨成釉细胞瘤病例,分析各类型成釉细胞瘤的构成比和一般特征。选取具有完整病历和影像资料的DA病例28例、实性多囊型和单囊型成釉细胞瘤连续病例各50例进行对比分析,提取关键影像特征,包括边界、周围骨质、三维形态、内部结构、牙和牙周膜情况、密质骨等,并比较病变的CT值。结果 1 269例颌骨成釉细胞瘤中DA构成比为3.9%,上颌发病率达46.0%,好发于前牙区(62.0%)和前磨牙区(30.0%)。DA在CT中多表现为边界呈扇贝样,内部含有骨化结构的实性肿物。肿瘤平均高度与长轴径比值为0.76,平均颊舌径与长轴径比值为0.63,大于其他两类成釉细胞瘤。根据成骨密度特点,DA可见3种类型:成骨致密型(Ⅰ型)、蜂窝/皂泡型(Ⅱ型)和成骨稀疏型(Ⅲ型);Ⅰ~Ⅲ型CT值分别为:(488.8±164.0) HU、(171.7±102.8) HU和(42.1±8.8) HU,均高于其他两种类型成釉细胞瘤。结论 DA在CT中表现为内部含不同程度骨化的实性病变,对于影像鉴别诊断具有一定的临床意义。

关键词: 成釉细胞瘤, 颌肿瘤, 体层摄影术, X线计算机, 诊断

Abstract:

Objective: To retrospectively analyze the clinical and CT imaging features of desmoplastic ameloblastomas (DA) in comparison with other types of ameloblastomas.Methods: Patients diagnosed with ameloblastoma histopathologically in Peking University School and Hospital of Stomatology from July 2000 to August 2017 were reviewed to analyze the constituent ratios and characteristics of DA. CT imaging features of DA (28 cases) were investigated in comparison with consecutive cases of solid/multicystic and unicystic ameloblastomas. The following imaging perspectives were analyzed: the border, internal structure, three-dimensional shape, tooth, the periodontium, the cortex and the expansion of the tumors. CT values were measured in the region of interest for quantitative analysis.Results: Among the 1 269 cases of ameloblastomas, 50 (3.9%) were DA,which showed predilections for males (74.0%). The average age of DA was about 43.9 years old, which was higher than the other two types. The anterior incisor-canine region (62.0%) and premolar region (30.0%) were most frequently affected. The incidence rate of DA in mandibule was 56.0% (28/50), which was slightly higher than that of maxilla (44.0%). The DA characteristically showed scallop border and honeycomb-like or soap-bubble internal structure with bone formation on CT. The mean ratios of height to mesio-distal and buccal-lingual to mesio-distal distances were 0.76 and 0.63, which were higher than the other two types. According to the degree of internal bone formation, three subtypes of DA could be observed: densely ossifying type (Ⅰ), honeycomb/soap bubble type (Ⅱ) and sparsely ossifying type (Ⅲ). The means and standard deviations of CT values of DA were significantly higher than those of the other two types, which were (488.8±164.0) HU (type Ⅰ), (171.7±102.8) HU (type Ⅱ), (42.1±8.8) HU (type Ⅲ).Conclusion: CT is helpful for diagnosis of DA, which shows as solid tumor with varying degrees of internal ossification.

Key words: Ameloblastoma, Jaw neoplasms, Tomography, X-ray computed, Diagnosis

中图分类号: 

  • R739.82

表1

三种类型成釉细胞瘤的一般情况"

Items DA SA UA P
Gender, Femal/Male 13/37 319/415 159/191 <0.001
Age/years, x?±s 43.9±12.4 35.3±15.5 30.3±14.7 <0.001
Site <0.001
Between canine, Maxilla/Mandible 13/18 8/89 8/36 <0.001
Premolar, Maxilla/Mandible 10/5 16/98 6/45 <0.001
Molar, Maxilla/Mandible 0/2 20/166 3/119 0.037
Ramus, n 2 307 129 0.001
Other sites, n 0 10 1 <0.001

表2

促结缔组织增生型成釉细胞瘤影像学表现"

Items DA (n=28) SA (n=50) UA (n=50) P
Expansion, lingual/buccal 27/11 50/50 50/48 <0.001
Size/mm, x?±s
Height 29.2±9.6 39.5±13.9 32.6±8.8 <0.001
Mesio-distal 41.0±18.9 69.1±24.4 59.1±17.3 <0.001
Buccal-lingual 23.7±10.0 32.4±12.8 29.3±8.8 0.004
Tooth, n
Displacement 23 30 27 0.043
Root resorption 23 40 33 0.166
Periodontal destruction 25 44 41 0.584
Boundary, n
Scallop border 21 2 0 <0.001
Curved border 7 48 50 <0.001
Clear/ill defined 8/20 50/0 50/0 <0.001
Cortex thinning 17 50 50 <0.001
Cortex destruction 4 0 0 <0.001
Internal, n
Septa 24 46 17 <0.001
Ossification 21 0 0 <0.001
CT value/HU, x?±s 488.8±164.0 (Ⅰ) 33.1±36.4 21.5±7.2 <0.001*
171.7±102.8 (Ⅱ)
42.1±8.8 (Ⅲ)

图1

促结缔组织增生型成釉细胞瘤的边界形态特征"

图2

促结缔组织增生型成釉细胞瘤成骨致密型(Ⅰ型)"

图3

促结缔组织增生型成釉细胞瘤蜂窝/皂泡型(Ⅱ型)"

图4

促结缔组织增生型成釉细胞瘤成骨稀疏型(Ⅲ型)"

图5

促结缔组织增生型成釉细胞瘤混合型"

图6

典型实性多囊型(A)和单囊型(B)成釉细胞瘤"

图7

促结缔组织增生型成釉细胞瘤组织学中化生性成骨(箭头,HE ×200)"

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ISSN 1671-167X
CN 11-4691/R
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