7. Principles of radiographic interpretation using descriptive terminology

What are the seven descriptions of radiographic findings?

1. Location

2. Extent

3. Periphery/borders

4. Shape/size

5. Internal architecture

6. Effect on adjacent structures

What are the four steps of descriptive terminology for abnormal findings?

1. Location

2. Periphery/borders

3. Internal architecture

4. Effect on adjacent structures

Explain the possible descriptive terminology for location

• Localized vs generalized

• Periapical vs Pericoronal vs Interradicular

• extent:

  • focal, multi-focal, extensive

local vs generalized

position in the jaws

generalized = all osseous structures affected, radiopaque appearance of bones

what diseases do generalized lesions hint to?

generalized radiopaque hint at systemic or metabolic disease

define interradicular

between roots

focal vs multifocal vs extensive

• focal = single tooth/site

• multifocal = multiple teeth/site same condition

• extensive = 1 tooth but disseminated to mandible and/or maxilla

four ways to describe a well-defined border?

• corticated

• non corticated

• sckerotic margin

• soft tissue capsule

corticated vs non-corticated lesion

both describe a defined lesion:

• corticated: well-defined, opaque, and often curved or sclerotic border on a radiographic image

• non-corticated: lacks a well-defined, opaque (radiopaque) rim of reactive bone around its periphery

which signals malignancy: corticated or non corticated?

non-corticated

what is a sclerotic margin and how does it differ from a corticated border?

sclerotic margins appears as a rim of dense, white bone, indicating increased bone production

corticated is very defined radiopaque, appears as a rim of dense, white bone, indicating increased bone production

both signal benign

explain presentation of a soft tissue capsule around a lesion

radiolucent border

explain an ill-defined border on an xray

infiltrative, invasive, blending

size, shape, and border descriptions align with which step of interpretation?

step 2: periphery/borders

fusiform lesion

ill-defined border

radiolucent lesion spindle-shaped (~ tapered tear drop) area indicating less bone density, often caused by the expansion of a slow-growing benign cyst or tumor. This "spindle shape" is distinctive because it expands along the length of the jawbone, distinguishing it from lesions that are rounder or more defined

which border description indicates benign, developmental, or inflammatory lesions?

well-defined, corticated

which border description indicates inflammatory or benign lesions?

defined, corticated

which border description indicates inflammatory, malignant, and systemic lesions?

ill-defined

which border description indicates malignant and inflammatory lesions?

ill-defined and infiltrative

which corder descriptions indicated fibro-osseous lesions?

fusiform

what are the two shapes that can describe a lesion’s border?

circular and scalloped (think scalloped border crochet)

what are the four categories to describe internal architecture of a lesion?

• radiodensity

• internal septation

• internal calcifications

• abnormal trabecular patterns

two ways to describe internal septation:

unilocular and multilocular

internal calcifications apply to radiopaque or radiolucent lesions?

radiolucent

abnormal trabecular patterns typically apply to radiopaque or radiolucent lesions?

radiopaque

abnormal trabecular patterns generally look like what four things?

orange peel, ground glass, cotton-wood, or decreased trabeculations

unilocular vs multilocular

• unilocular = no septations and have single chamber

• multilocular = septae that divide lesion ino chambers

can unilocular lesions have non-corticated borders?

yes

name some ways radiopaque lesions may appear

• focal opacity

• target lesion

• multifocal confluent

• irregularm, ill-defined

• ground glass (fibrous)

• soft tissue opacity

target lesion

central opacity surrounded by a radiolucent zone w a sclerotic or radiopaque border

what is the term for an irregular and ill-defined radiopaque pattern?

trabecular pattern

how to describe ground-glass radiopacity

diffuse, homogenous radiopaque area w hazy pattern

term for this lesion: well-defined corticated border w internal mixed density appearance

mixed density aka mixed lucent-opaque

which density is associated w impacted tooth?

mixed density aka mixed lucent-opaque

which density: central radiopacity surrounded by a radiolucent area in periapical region of mandibular anterior teeth

mixed

what are some examples of a lesion’s effects on adjacent structures?

• tooth displacement

• root resorption

• displacement of cortical boundaries or vital structures (the cortical bone, IAN, maxillary sinus)

• osseous expansion & thinning of inferior mandibular cortex

• erosion/destruction

what does root resorption look like?

blunting of root/knife edge, typically benign lesions

what does spiking of root indicate?

fast growing malignancy, free floating tooth

what is a common way IAN is displaced?

inferiorly (maybe distal)

common way the maxillary sinus is displaced

superiorly

definition: new bone formation parallel or perpendicular to the cortex of inferior mandibular

periosteal reaction

onion skin should signal

periosteal reaction’s parallel concentric layers

sunburst/sunray should signal

periosteal reaction’s perpendicular concentric layers