OMFPR 7 - Principles of Radiographic Interpretation using Descriptive Terminology (Dr. Campos)

- Diagnostic images

- Analysis of abnormal findings (Use radiographic descriptive terminology- Consistency, reliability)

- Formulation of a disease category based on the description of the abnormality

- Develop a differential diagnosis (DDX) for the noted abnormality (Either a definitive interpretation or a short list of disease conditions - in the order of likelihood)

What does it take to interpret radiographs?

Differential diagnosis

Systematic radiographic analysis and description --> formulates ____________ through radiographic interpretation

- Location

- Extent

- Periphery/borders

- Shape/size

- Internal architecture

- Effect on adjacent structures

What are considered the six description categories of radiographic findings?

- Periphery/borders

- Internal architecture

- Effect on adjacent structures

of the 6 types of description categories of radiographic findings, what 3 are most important in guiding you towards a more definitive diagnosis?

Location

Define the descriptive terminology for abnormal findings:

- Localized vs generalized

- Periapical vs pericoronal vs interradicular vs other

- Extent - Focal, Multi-focal, Extensive

Periphery/Borders

Define the descriptive terminology for abnormal findings:

- Defined (corticated/non-corticated)

- Ill-defined, Infiltrative

- Size, Shape and Number

Corticated border

Define the following:

Radiopaque line along the periphery of a well-defined lesion

Internal architecture

Define the descriptive terminology for abnormal findings:

- Radiodensity

- Presence of septae

- Calcifications

Effect on Adjacent Structure

Define the descriptive terminology for abnormal findings:

- Displacement of teeth

- Root resorption

- Displacement of cortical boundaries or vital structures

- Osseous expansion

- Erosion/destruction

- Extension into adjacent soft tissue

Generalized

Define the following:

If an abnormal appearance affects all osseous structures of the maxillofacial region (usually in systemic or metabolic disease)

- Localized

- Periapical to #24

- Single lesion

Describe the abnormal findings about the location of the lesion: (3)

- Localized

- Pericoronal to impacted #17

- Single lesion

Describe the abnormal findings about the location of the lesion: (3)

Pericoronal

Define the following:

Lesion surrounding the crown

- Generalized

- Radiopaque

Describe the abnormal findings about the location of the lesion: (2)

- Multi-focal (Generalized)

- Periapical

- Confluent

Describe the abnormal findings of location of the lesion: (3)

- Unilocular

- Radiolucent

- Well-defined

- Corticated Borders

Describe the periphery/borders of the lesion: (4)

- Unilocular

- Radiolucent

- Well-defined

- Partially-Corticated Borders

Describe the periphery/borders of the lesion: (4)

- Unilocular

- Radiolucent

- Well-defined

- Non-Corticated Borders

Describe the periphery/borders of the lesion: (4)

- Well defined

- Radiopacity soft tissue capsule with a radiolucent rim

- Non-Corticated Borders

- Attached to root (no PDL gap)

Describe the periphery/borders of the lesion: (4)

- Well defined

- Sclerotic border

- Not attached to root (PDL visible)

Describe the periphery/borders of the lesion: (3)

- Ill-defined invasive border (infiltrative)

- Radiolucent

Describe the periphery/borders of the lesion: (2)

- Ill-defined invasive border

- Radiolucent

(IAN is affected)

Describe the periphery/borders of the lesion: (2)

Ill-defined blending (fusiform)

(Note the gradual blending of the periphery of lesion with adjacent normal bone)

Describe the periphery/borders of the lesion:

- Benign

- Developmental

- Inflammatory

well defined corticated lesions are usually found to be... (3)

- Inflammatory

- Benign

well defined non-corticated lesions are usually found to be... (2)

- Inflammatory

- Malignant

- Systemic

ill-defined lesions are usually found to be... (3)

- Inflammatory

- Malignant

ill-defined AND infiltrative lesions are usually found to be... (2)

fibro-osseous

Fusiform lesions are usually found to be...

Scalloped

(well defined, septa= multilocular)

Describe the periphery/borders of the lesion:

circular

(focal, well-defined, radiolucent, corticated)

Describe the periphery/borders of the lesion:

- Radiodensity

- Internal septation (unilocular/multilocular)

- Internal calcifications (for radiolucent lesions)

- Abnormal trabecular patterns (orange peel, ground glass, cotton wool, decreased trabeculations)

What are we analyzing when determining the internal architecture of the lesion?

Radiodensity

Define the following:

Lesions may be described as: radiolucent, radiopaque, or mixed

- Radiolucent

- Corticated border

- Well-defined

- Round shape

Describe the internal architecture of the lesion: (4)

Unilocular lesions

Define the following:

No septations hence lesions have a single chamber

Multilocular lesions

Define the following:

Presence of septae divide the internal aspect of the lesion into multiple chambers

- Unilocular

- Radiolucent

- Well-defined

- Corticated Borders

(Location: apical of 23, 24, 25, 26)

Describe the internal architecture of the lesion: (4)

- Unilocular

- Radiolucent

- Non-Corticated Borders

- Sclerotic bone

Describe the internal architecture of the lesion: (4)

- Multilocular (multiple septae)

- Radiolucent

- Corticated

Describe the internal architecture of the lesion: (3)

- Multilocular (multiple septae)

- Radiolucent

- Corticated

Describe the internal architecture of the lesion: (3)

- Periapical at #18

- Unilocular

- Radiolucent

- Well-defined

- Corticated

Describe the characteristics of this lesion: (5)

- Inter-radicular between #26 and #27

- Unilocular

- Radiolucent

- Well-defined

- Corticated

Describe the characteristics of this lesion: (4)

- In the edentulous zone (of 19-20)

- Unilocular

- Corticated

- Radiolucent

Describe the characteristics of this lesion: (4)

- Pericoronal of #17 (extends from coronoid process and sigmoid notch to apical region of 19)

- Unilocular

- Well-defined

- Corticated

- Radiolucent

- Oval shape

Describe the characteristics of this lesion: (6)

- Pericoronal of #17

- Unilocular

- Well-defined

- Radiolucent

- Corticated

Describe the characteristics of this lesion: (5)

- Pericoronal (Mesial CEJ to Distal CEJ of 17)

- Unilocular

- Well-defined

- Radiolucent

- Corticated

Describe the characteristics of this lesion: (5)

- Focal Opacity

- Target Lesion

- Multifocal Confluent

- Irregular, Ill-defined

- Ground Glass

- Soft Tissue Opacity

What are six types of appearances of radiopaque lesions?

focal radiopacity

(well-defined, round, not attached - PDL intact)

describe the appearance of the lesion:

multifocal radiopacity

(apical to 30 and between to 28 and 29, well-defined, irregular shape)

describe the appearance of the lesion:

Multifocal Confluent Radiopacity

(confluence = connecting)

describe the appearance of the lesion:

target lesion

Define the following:

Central opacity surrounded by a radiolucent zone with a sclerotic or radiopaque border

target lesion

describe the appearance of the lesion:

target lesion

describe the appearance of the lesion:

Trabecular pattern

Define the following:

Irregular and ill-defined radiopaque pattern

Trabecular pattern

(Extends beyond borders - most likely a malignancy)

describe the appearance of the lesion:

Ground glass radiopacity

Define the following:

Characterized by a diffuse, homogeneous radiopaque area with hazy pattern, resembling texture of finely ground glass

Ground glass radiopacity

(well-defined, expansion of IAN canal - bone is affected)

describe the appearance of the lesion:

Ground glass radiopacity

describe the appearance of the lesion:

Ground glass radiopacity

describe the appearance of the lesions:

well-defined corticated borders with internal mixed density (mixed radiolucent-radiopaque) appearance, associated with impacted tooth

describe the appearance of the lesion:

Mixed (Lucent-Opaque) density lesion

(central radiopacity surrounded by a radiolucent area)

describe the appearance of the lesion:

displacement of mandibular anterior teeth

(well-defined, non-corticated, apical to 20-27)

describe the effect of the lesion:

Root resorption - blunting of roots (slow process)

describe the effect of the lesion:

Root resorption - spiking (fast process)

("floating teeth", ill-defined radiolucency)

describe the effect of the lesion:

benign

blunting of roots is typically associated with ________ lesions

malignant

spiking of roots is typically associated with ________ lesions

Floating teeth

describe the effect of the lesion:

'Floating teeth'

The loss of bone support surrounding teeth due to a lesion is known as...

- Displacement of cortical boundaries

- Osseous Expansion and thinning of inferior mandibular cortex

- Inferior displacement of the left inferior alveolar nerve canal (IAN)

describe the effects of the lesion:

True

T/F: The lesion in the left posterior mandible can be described as well-defined, radiolucent, corticated, unilocular lesion causing displacement of tooth 18 distally and inferiorly

False (It is well-defined!)

T/F: The lesion in the left posterior mandible can be described as ill-defined, radiolucent, corticated, lesion causing displacement of the IAN canal inferiorly

displacement of the floor of maxillary sinus

(lesion located in apical region of 12 and 13, well-defined, round, corticated, displacing floor of maxillary left sinus superiorly)

describe the effect of the lesion:

onion skin effect

The periosteal reaction, new bone formation parallel to the cortex of inferior mandibular border, is known as the ___________

Outer cortical bone and periosteal reaction - 'onion skin effect'

(Area of 28-32, ill-defined, radiolucent)

describe the effect of the lesion:

sunburst periosteal reaction

periosteal reaction, new bone formation perpendicular to the cortex of inferior mandibular border, is known as a ___________

Outer cortical bone and periosteal reaction - Sunburst reaction

(ill-defined, radiolucent lesion, invasive, IAN canal destroyed)

describe the effect of the lesion:

Outer cortical bone and periosteal reaction - Sunburst reaction

describe the effect of the lesion:

No reaction - destroyed inferior mandible, IAN canal, external oblique ridge of mandible, and PDL of 19

describe the effect of the lesion:

Ill defined radiolucent lesion with erosion/destruction of inferior mandibular border

Describe the characteristics of the lesion:

- Erosion of cortical bone boundary

- Ill defined radiolucent lesion with erosion/destruction of maxillary sinus floor

describe the effect of the lesion:

- Erosion of cortical bone boundary

- Soft tissue entity in the sinus perforating/eroding the floor of the sinus ( Right image)

describe the effect of the lesion:

- Left aspect of mandible; apical from 17 to 22 and to the ramus

- Multilocular

- Radiolucency

- #17 displaced distally

- Mandible is thin and expanded

- Resorption of root

- Expansion of external oblique ridge

Describe the characteristics of the lesion: (7)

- Right posterior mandible at #32

- Well-defined

- Corticated

- Radiopaque surrounded by radiolucent rim

- Displaced #32 distally/posteriorly

- External oblique branch expanded

- IAN canal displaced inferior

Describe the characteristics of the lesion: (7)

- Attached to #19 root

- Well-defined

- Oval shape

- Radiopaque with a radiolucent rim

- Non-corticated

- IAN canal displaced inferiorly

- Expansion of inferior border of mandible

- Sclerosis of bone

Describe the characteristics of the lesion: (7)