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北京大学学报（医学版） ›› 2024, Vol. 56 ›› Issue (1): 131-137. doi: 10.19723/j.issn.1671-167X.2024.01.020

• 论著 • 上一篇    下一篇

牙源性钙化囊肿与牙源性钙化上皮瘤的三维影像特点

凌晓彤1,屈留洋1,郑丹妮1,杨静1,闫雪冰2,柳登高1,*(),高岩3   

  1. 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
  • 收稿日期:2023-06-27 出版日期:2024-02-18 发布日期:2024-02-06
  • 通讯作者: 柳登高 E-mail:kqldg@bjmu.edu.cn

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

Xiaotong LING1,Liuyang QU1,Danni ZHENG1,Jing YANG1,Xuebing YAN2,Denggao LIU1,*(),Yan GAO3   

  1. 1. 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
    2. 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
    3. 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
  • Received:2023-06-27 Online:2024-02-18 Published:2024-02-06
  • Contact: Denggao LIU E-mail:kqldg@bjmu.edu.cn

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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。

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

Abstract:

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 type Ⅱ, 3 type Ⅲ and 2 type Ⅳ lesions, and 42.8% of CEOT lesions had calcification images, including 2 type Ⅲ and 5 type Ⅴ lesions. Six COC lesions had odontoma-like images. Moreover, 8 of 9 type Ⅰ CEOTs 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 associated with odontoma. CEOT commonly occurred in the posterior jaw and had discontinued cortex. Two lesions had significantly different calcification map. Over 70% of COC lesions had calcification images, which were mostly scattered along one side of the cysts, far from the impacted teeth. Approximately 60% of CEOT lesions exhibited smaller size and non-calcification, and the remaining CEOT cases often had calcification images clustered around the impacted teeth.

Key words: Calcifying odontogenic cyst, Calcifying epithelial odontogenic tumor, Three-dimensional imaging, Cone-beam computed tomography

中图分类号: 

  • R739.8

图1

COC和CEOT患者的年龄分布"

图2

COC和CEOT的位置分布图"

表1

COC和CEOT的颌骨膨隆及骨皮质连续性"

Lesions Cortex expansion Discontinued cortex
Presence, n Absence, n P value Presence, n Absence, n P value
COC 19 0 0.002 15 4 0.374
CEOT 9 7 15 1

图3

COC伴牙瘤"

图4

COC多房影像"

图5

无钙化型：病变范围内未见钙化影像(CEOT)"

图6

边缘型：病变内钙化影像沿病变边缘且仅在一侧散在分布(COC)"

图7

弥散型：钙化影像广泛分布于病变范围内(COC)"

图8

团块型：存在一个直径≥5 mm的钙化影像"

图9

冠周型：钙化影像聚集于阻生牙周围(CEOT)"

表2

COC和CEOT的钙化情况"

Lesions Calcification features, n P value
Type Ⅱ Type Ⅲ Type Ⅳ Type Ⅴ
COC 9 3 2 0 < 0.001
CEOT 0 2 0 5

图10

COC病理图像(HE染色)"

图11

CEOT病理图像"

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CN 11-4691/R
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