Ami Kuribayashi

Bifid mandibular canals: cone beam computed tomography evaluation

OBJECTIVES For surgical procedures involving the posterior mandible, it is important to be familiar with the details of the bifid mandibular canal. To our knowledge, there have been no systematic studies evaluating the bifid mandibular canal using sectional imaging. The purpose of this study is to evaluate the incidence and configuration of the bifid mandibular canal using cone beam CT. METHODS 252 patients (301 mandible sides) underwent cone beam CT between October 2004 and September 2005 and were included in this study. The cone beam CT images were evaluated for the presence and configuration of the bifid mandibular canal. The patterns of bifurcation were classified into four types according to the classification of Nortjé et al (Variations in the normal anatomy of the inferior dental (mandibular) canal: a retrospective study of panoramic radiographs from 3612 routine dental patients. Br J Oral Surg 1977; 15: 55-63). The diameter of the accessory canal was classified into two categories: 50% or more and less than 50% of the diameter of the main mandibular canal. RESULTS Of the 301 subjects, 47 (15.6%) demonstrated a bifid mandibular canal. They were Type I in 2, Type II in 40, Type III in 0, and Type IV in 5 cases. The diameter of the accessory canal was greater than or equal to 50% of the main canal in 23, and less than 50% in 24 cases. CONCLUSIONS On the basis of the cone beam CT, a bifid mandibular canal was found in 15.6% of cases, a markedly higher proportion than found in previous reports using panoramic images. Cone beam CT is considered a suitable modality for detailed evaluation of bifid mandibular canals.

Usefulness of cone beam computed tomography in temporomandibular joints with soft tissue pathology

OBJECTIVE the aim of the study was to evaluate the usefulness of cone beam CT (CBCT) in temporomandibular joints (TMJs) with soft tissue pathology. METHODS 106 TMJs of 55 patients with temporomandibular disorder (TMD) were examined by MRI and CBCT. MR images were used for the evaluation of disc displacement, disc deformity, joint effusion and obscurity of temporal posterior attachment (TPA). CBCT images were evaluated for the presence or absence of osseous abnormalities. The chi(2) test was used to analyse the association between MRI and CBCT findings. RESULTS MRI of 106 TMJs revealed disc displacement, disc deformity, joint effusion and obscurity of the TPA in 68, 73, 28 and 27 joints, respectively. Of the 68 TMJs with disc displacement, anterior disc displacement without reduction (ADDWR) was seen most frequently (47/68). CBCT imaging found 65 TMJs were characterized by the presence of osseous abnormalities and were significantly associated with disc deformity and ADDWR (P < 0.05). There was no statistically significant association between the presence of joint effusion and obscurity of TPA and TMJ osseous abnormalities. CONCLUSIONS TMD patients with confirmed ADDWR or disc deformity on MRI are at risk of having osseous abnormalities in the TMJ and further examination with CBCT is recommended.

Bifid mandibular canal: confirmation of limited cone beam CT findings by gross anatomical and histological investigations

OBJECTIVES The aims of this study were (1) to assess the validity of limited cone beam CT (CBCT) in detecting the distribution of bifid mandibular canals in the retromolar region by comparing its findings with those of panoramic radiography and spiral CT imaging, and (2) to confirm the contents of such canals depicted on limited CBCT images by using gross anatomical and histological methods. METHODS Bilateral bifid mandibular canals of a Japanese cadaver were investigated. The canals depicted on panoramic radiography, spiral CT and limited CBCT images were compared. Cross-sectional limited CBCT images of these canals were compared with gross anatomical sections of the mandible and their contents were confirmed histologically. RESULTS The spiral CT and limited CBCT images showed the bilateral bifid mandibular canals in the retromolar region whereas the panoramic radiographs indicated the presence of only the left bifid mandibular canal. The canal distribution was more distinct in the limited CBCT images than in the spiral CT images and the cross-sectional limited CBCT images were consistent with the gross anatomical sections. Histologically, the canals contained several nerve bundles and arteries among which the largest nerve and artery were of a similar size. CONCLUSION Limited CBCT is valuable for assessing the distribution of bifid mandibular canals. It is clinically significant to accurately localize a bifid mandibular canal of the retromolar region because it contains a nerve bundle and artery.

Non-Hodgkin lymphoma involving the mandible: imaging findings

OBJECTIVE The aim of this study was to investigate the imaging findings of non-Hodgkin lymphoma (NHL) involving the mandible. STUDY DESIGN The imaging studies of 4 patients with NHL involving the mandible were retrospectively reviewed. Panoramic and computerized tomographic (CT) images were available for all patients. Magnetic resonance imaging (MRI) was available for 3 patients. RESULTS On panoramic images, an apparent radiolucent lesion was found in only 2 of 4 cases. However, in all cases careful observation demonstrated imaging findings suggesting malignancy. On CT and MRI, tumor replaced the bone marrow in all cases and spread to the surrounding soft tissue in 3 cases. Cortical bone destruction tended to be mild for the extent of tumor involvement. CONCLUSIONS NHL involving the mandible tended to show slight or mild cortical bone destruction relative to the extent of the tumor involvement. Careful observation was considered to be necessary when interpreting conventional images, because they might not clearly demonstrate bone destruction.

Application of diffusion kurtosis imaging to odontogenic lesions: Analysis of the cystic component.

To assess the feasibility of applying diffusion kurtosis imaging (DKI) to common odontogenic lesions and to compare its diagnostic ability versus that of the apparent diffusion coefficient (ADC) for differentiating keratocystic odontogenic tumors (KCOTs) from odontogenic cysts.

Mandibular lingual canals distribute to the dental crypts in prenatal stage

PurposeTo describe configurations of human prenatal mandibular, lingual canals using a limited-field cone beam computed tomography (CBCT) to examine their origin and anatomical significance.Materials and methodsNine fetal mandibles were examined using a CBCT. Mandibular maturity was assessed according to the mandibular size measured directly and image findings on development of dental crypts. Mandibular, lingual canals and the related foramina (mandibular, mental, and lingual foramina) were observed on axial, sagittal, and cross-sectional images. The horizontal position of mental and lingual foramina was assessed by direct observation using a loupe.ResultsIn all nine mandibles, CBCT images depicted three separate mandibular canals, which individually occurred at the ramus area. One was a short canal directly connecting to the permanent molar crypt. The other two showed a parallel course, following the mandibular corpus toward the frontal area; the upper one connected to the mental foramen, and the lower one distributed anterior area of canine and incisor crypts. Lingual foramina were observed bilaterally in eight of nine mandibles, whose horizontal position was lingual against the crypt of deciduous canine. The lingual canals occurred from lingual foramina, and connected to the close deciduous tooth crypt or the mandibular canal distributing in the frontal area.ConclusionsIt was suggested human dentition could be developed by plural mandibular and lingual canals.

USPIO-enhanced MRI of highly invasive and highly metastasizing transplanted human squamous cell carcinoma: an experimental study

OBJECTIVE The aim of this study was to investigate the signal intensity characteristics of highly invasive and highly metastasizing transplanted human squamous cell carcinoma using ultra-small super-paramagnetic iron oxide (USPIO)-enhanced MRI and to correlate them with USPIO distribution to tumour components revealed by histological examination. METHODS 13 nude mice with transplanted human squamous cell carcinoma in the oral cavity were imaged before and 24 hours after intravenous administration of USPIO. The difference in signal intensity between pre-contrast and post-contrast MR images was visually evaluated. For quantitative analysis, signal intensity within a region of interest was measured. Histological findings were correlated with MR findings. The approximate USPIO concentration was evaluated using USPIO phantoms. RESULTS Seven tumours had an area showing signal intensity increase on post-contrast T₁ weighted images. Histopathologically, six of those tumours contained a small amount of iron particles in the stroma. The USPIO concentration was presumed low. Two tumours had an area showing signal intensity decrease on post-contrast T₁ and T₂ weighted images. The areas had a large amount of iron particles in the stroma and the USPIO concentration was presumed high. There was a minimal amount of iron particles in tumour parenchymal cells. CONCLUSIONS The amount of USPIO accumulation into tumour stroma was considered to affect MR signal intensity. A small amount increases T₁ weighted signal intensity, whereas a large amount decreases T₁ and T₂ weighted intensity. The USPIO accumulation into the tumour parenchyma was not thought to affect MR signal intensity.

Resolution characteristics of optical coherence tomography for dental use

OBJECTIVES The purpose of this study was to clarify the resolution characteristics of optical coherence tomography (OCT) for dental use. METHODS Two types of swept-source optical coherence tomography machines were employed in this study. To clarify their resolution characteristics, we newly developed a glass chart device with a ladder pattern of wavelengths, which ranged from 4 × 2 μm to 1024 × 2 μm, as well as a star-target pattern, a grid pattern and a spatial frequency response pattern. The resolving powers and characteristics of the OCTs were subjectively evaluated. RESULTS The Santec OCT-2000™ (Santec Co., Komaki, Japan) had a resolving power of 64 μm in both the horizontal X and vertical Y directions, while the OCT from Yoshida had a resolving power of 64 μm in the horizontal X direction and 128 µm in the vertical Y direction. The resolving power of the depth Z direction could not be obtained from this study. With the Yoshida OCT, the star-target pattern seemed to be non-symmetrical, owing to an edge enhancement effect, which was revealed when the ladder patterns were placed in a horizontal direction. CONCLUSIONS This study successfully clarified the resolution characteristics of two types of OCTs. The obtained data may be useful for diagnostic purposes, and the glass chart device used in this study may be useful for OCT quality assurance programmes.

Imaging findings of childhood B-cell lymphoblastic lymphoma in the mental region: a case report

Lymphoblastic lymphoma (LBL) is an uncommon neoplasm that accounts for about 5% of all non-Hodgkins lymphomas. Approximately 90% of LBLs are of immature T-cell lineage, with B-cell lymphoblastic lymphoma (B-LBL) accounting for only about 10%. Owing to infrequency, the clinicopathological features and the imaging findings of B-LBL are not well defined. LBLs frequently affect extranodal sites. The most common site is the skin, followed by the bone, and the head and neck region is rarely involved. We report herein a case of childhood B-LBL occurring in the mental region, with emphasis on the findings of several imaging studies, including contrast-enhanced CT, MRI and fluorodeoxyglucose-positron emission tomography/CT.

Imaging findings of benign peripheral nerve sheath tumor in jaw

OBJECTIVE The aim of this study was to investigate the imaging characteristics of peripheral nerve sheath tumors (PNSTs) in the jaw. STUDY DESIGN Imaging studies of 6 patients were retrospectively reviewed. Conventional radiography, computed tomography, and magnetic resonance imaging were performed in all patients. RESULTS A fusiform lesion continuous with the nerve was observed in 2 cases, with the tumor arising within the inferior alveolar canal. In the other 4 cases, with the tumor arising outside the canal, the tumor had protruded and eroded into the bone. Protrusion was also present in 1 of the 2 cases, with the tumor arising within the canal. A target or fascicular sign was observed each in 1 case. CONCLUSIONS A fusiform lesion continuous with the nerve and a target or fascicular sign was only present in a few cases. The PNSTs, however, showed a tendency to protrude into the bone.