This study evaluated the diagnostic ability to differentiate between ameloblastoma and odontogenic keratocyst using different imaging modalities and observers with varying levels of experience. Six oral radiologists diagnosed 83 cases using panoramic radiograph only, CT only, or both combined. Their ability to differentiate the lesions was assessed using ROC analysis. Experienced observers performed best when using both panoramic and CT images together, followed by CT only, and worst with panoramic only. Less experienced observers performed worst with CT only. Combining imaging modalities and experience level of observers can improve accurate differentiation of these lesions.
Dr. Ahmed M. Adawy
Professor Emeritus, Dep. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine
Al-Azhar University. By definition, a cyst is a “pouch” or sac without an opening, provided with a distinct membrane, and containing fluid or semifluid material, abnormally developed in one of the natural cavities or in the substance of an organ. Cysts of the oral region may be epithelial or non-epithelial, odontogenic or non-odontogenic, developmental, or inflammatory in origin. The distribution of jaw cysts according to diagnosis in a general population is given. The treatment of choice is dependent on the size and localization of the lesion, the bone integrity of the cystic wall, its proximity to vital structures and patient age.Treatment modalities are discussed.
Odontogenic keratocyst involving maxillary antrum / dental coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Keratocystic odontogenic tumors(KCOT) or Odontogenic Keratocyst(OKC)OKCMohamadreza Lalegani
Keratocystic odontogenic tumors or KERATOCYSTIC ODONTOGENIC TUMOR is a distinctive form of developmental odontogenic cyst. in this presentation we will examine pathological , clinical and Especially it's radiographical features. at the end we will investigate a number of case reports from literature.
Dr. Ahmed M. Adawy
Professor Emeritus, Dep. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine
Al-Azhar University. By definition, a cyst is a “pouch” or sac without an opening, provided with a distinct membrane, and containing fluid or semifluid material, abnormally developed in one of the natural cavities or in the substance of an organ. Cysts of the oral region may be epithelial or non-epithelial, odontogenic or non-odontogenic, developmental, or inflammatory in origin. The distribution of jaw cysts according to diagnosis in a general population is given. The treatment of choice is dependent on the size and localization of the lesion, the bone integrity of the cystic wall, its proximity to vital structures and patient age.Treatment modalities are discussed.
Odontogenic keratocyst involving maxillary antrum / dental coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Keratocystic odontogenic tumors(KCOT) or Odontogenic Keratocyst(OKC)OKCMohamadreza Lalegani
Keratocystic odontogenic tumors or KERATOCYSTIC ODONTOGENIC TUMOR is a distinctive form of developmental odontogenic cyst. in this presentation we will examine pathological , clinical and Especially it's radiographical features. at the end we will investigate a number of case reports from literature.
An overview of various pathological processes affecting the Jaw Bones- Maxilla and Mandible including odontogenic cysts and tumours including their radiological findings!
Odontogenic cysts i / dental implant courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Surgical Management of Jaw Tumors and Other Oral Cavity TumorsHermie Culeen Flores
Powerpoint presentation by Ma. Hermie Culeen F. Barapon
Download the following fonts to view original format:
- Daddy Longlegs
- Angelina
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After download, right click zip file then choose 'Extract Here'. Then right click the font file and choose 'Install'
This presentation covers routinely used intraoral & extraoral plain radiographs used in assessment of maxillofacial trauma patients with extended coverage on occlusal radiographs. This PPT is echanced with addition of images for all radiographs
An overview of various pathological processes affecting the Jaw Bones- Maxilla and Mandible including odontogenic cysts and tumours including their radiological findings!
Odontogenic cysts i / dental implant courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Surgical Management of Jaw Tumors and Other Oral Cavity TumorsHermie Culeen Flores
Powerpoint presentation by Ma. Hermie Culeen F. Barapon
Download the following fonts to view original format:
- Daddy Longlegs
- Angelina
You can download fonts for free from: www.1001fonts.com
After download, right click zip file then choose 'Extract Here'. Then right click the font file and choose 'Install'
This presentation covers routinely used intraoral & extraoral plain radiographs used in assessment of maxillofacial trauma patients with extended coverage on occlusal radiographs. This PPT is echanced with addition of images for all radiographs
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Ameloblastoma is benign slow-growing but locally invasive neoplasm of odontogenic origin. In 2005, the WHO has classified ameloblastomas into multi cystic, unicystic and peripheral subtypes. The clinical picture, radiographic findings and differential diagnosis are presented. Treatment of ameloblastomas is primarily surgical. There has been some debate regarding the most appropriate method for removing. These range from conservative to radical modes. Some authors advocate conservative approach and thought that ameloblastoma are essentially benign in nature and should be treated as such. However, this conservative approach result in recurrence rates of 55% to 90%of the cases. Currently, the standard of care for ameloblastoma includes en bloc resection with 1-2 combine margin and immediate bone reconstruction. Despite the medical nature of a surgical resection, it may actually involve less morbidity than extensive hard and soft tissue resection with associated extensive morbidity that may be warranted in case of recurrence following inadequate primary treatment.
Clinical study of impacted maxillary canine in the Arab population in IsraelAbu-Hussein Muhamad
The objective of the present study was to determine the prevalence of impacted maxillary canine in patients in Arabs
Community in Israel (ARAB48,Israel) visiting our Center For Dentistry,Research & Aesthetics,Jatt,Almothalath,Israel,
4250 patients . This study comprises data from patients who attended the O.P.D.2200 patients between Jun. 2006 to Dec
2013. Patients were examined in order to detect the impacted maxillary canines by intraoral examination, palpation, dental
records and followed by radiographs. It was found that the prevalence of canine impaction was 0,8 % (N=4250), 1,6
(N=2200), 43,9 (N-82) in males and 1,1% (N=4250), 2,1 (N=2200), 56,1 (N-82) in females suggesting that prevalence of
impacted maxillary canines is more in females than males and it is statistically significant. The overall prevalence for
maxillary impacted canines was found to be 3,7 % (N=2200) which suggested that it is much higher than previous studies.
The results of this study were slightly different than other studies, while the dissimilarities may be attributed to the sample
selection, method of the study and area of patient selection, which suggest racial and genetic differences.
Clinical study of impacted maxillary canine in the Arab population in IsraelAbu-Hussein Muhamad
The objective of the present study was to determine the prevalence of impacted maxillary canine in patients in Arabs Community in Israel (ARAB48,Israel) visiting our Center For Dentistry,Research & Aesthetics,Jatt,Almothalath,Israel, 4250 patients . This study comprises data from patients who attended the O.P.D.2200 patients between Jun. 2006 to Dec 2013. Patients were examined in order to detect the impacted maxillary canines by intraoral examination, palpation, dental records and followed by radiographs. It was found that the prevalence of canine impaction was 0,8 % (N=4250), 1,6 (N=2200), 43,9 (N-82) in males and 1,1% (N=4250), 2,1 (N=2200), 56,1 (N-82) in females suggesting that prevalence of impacted maxillary canines is more in females than males and it is statistically significant. The overall prevalence for maxillary impacted canines was found to be 3,7 % (N=2200) which suggested that it is much higher than previous studies. The results of this study were slightly different than other studies, while the dissimilarities may be attributed to the sample selection, method of the study and area of patient selection, which suggest racial and genetic differences.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Mandibular Radiolucencies; A Systematic Approach to DiagnosisAhmed Adawy
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty
of Dental Medicine, Al-Azhar University. Conventional radiography may revel a variety of
radiolucent legions in the mandible. Interpretation of such radiolucencies can be challenging either
because the clinical presentation may be non specific or because the ;legion is detected
incidentally. Further, interpretation may vary from one examiner to another. thus, systemic
approach is necessary to diagnose the legion or at least provide a meaningful deferential
diagnosis. This approach should focus on specific radiographic parameters. Initially, the legion
should be placed in the category of either normal or abnormal. The presented parameters includes
describing the legion in terms of: 1- Location, 2- Margins, 3- Size and shape, 4- Effect on
surrounding structures. Obviously, however diagnosis of a legion should never be made
exclusively on the bases of radiographic interpretation. Radiographic interpretation should be used
along with clinical information and other tests to formulate a deferential diagnosis.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Diagnostic ability of differential diagnosis in ameloblastoma and odontogenic keratocyst by imaging modalities and observers
1. Korean Journal of Oral and Maxillofacial Radiology 2006; 36 : 177-82
Diagnostic ability of differential diagnosis in ameloblastoma and
odontogenic keratocyst by imaging modalities and observers
Tae-In Gang, Kyung-Hoe Huh, Won-Jin Yi**, Min-Suk Heo**, Sam-Sun Lee*,
Jeong-Hwa Kim, Je-Woon Moon, Soon-Chul Choi*
Department of Oral and Maxillofacial Radiology
*Department of Oral and Maxillofacial Radiology, Dental Research Institute
**Department of Oral and Maxillofacial Radiology, Dental Research Institute, and BK21
School of Dentistry, Seoul National University
ABSTRACT
Purpose : To evaluate the diagnostic ability in differentiating between ameloblastoma and odontogenic keratocyst
according to the imaging modalities and observers.
Materials and Methods : We evaluated thirty-six cases of ameloblastomas and forty-seven cases of odontogenic
keratocysts all histologically confirmed. Six oral and maxillofacial radiologists diagnosed the lesions by 3 methods:
using panoramic radiograph, using computed tomograph (CT), and using panoramic radiograph and CT. The
observers were classified by 3 groups: group 1 had experienced over 10 years in oral and maxillofacial radiologic
field, group 2 had experienced for 3-4 years, and group 3 was in the process of residentship. After over 2 weeks, the
observers diagnosed them by the same methods.
Results : The ROC curve areas except for group 3 were the highest with interpretation using panoramic radiograph
and CT, followed by interpretation using CT only, and the lowest with interpretation using panoramic radiograph
only. The overall difference was not found in diagnostic ability among groups in using panoramic radiograph only,
but there was difference in diagnostic ability of group 1 and 2 vs 3 in using CT only, and combination panoramic
radiograph and CT.
Conclusions : To differentiate between ameloblastoma and odontogenic keratocyst more accurately, the
experienced oral and maxillofacial radiologist should diagnose with combination of panoramic radiograph and CT.
(Korean J Oral Maxillofac Radiol 2006; 36 : 177-82)
KEY WORDS : Diagnostic Ability; Ameloblastoma; Odontogenic Keratocyst
lingual cortical expansion is frequently present. Root resorp-
Introduction
tion of adjacent teeth to the tumor is common.1
Ameloblastomas are tumors of odontogenic epithelial Odontogenic keratocysts arise from cell rests of the dental
origin. Theoretically, they may arise from cell rests of the lamina and make up 10 to 12 percent of all developmental
enamel organ, from a developing enamel organ, from the odontogenic cysts.1 Histopathologically, they typically show a
epithelial lining of an odontogenic cyst, or from the basal cells thin, friable wall, which is often difficult to enucleate from the
of the oral mucosa.1 They make up 1% of all tumors of the bone in one piece, and have small satellite cysts within fibrous
jaws,2 and 11% of odontogenic tumors.3 Although ameloblas- wall. Therefore odontogenic keratocysts often tend to recur
tomas are histopathologically benign, they have been charac- after treatment.7 Radiographically odontogenic keratocysts
terized as a tumor with marked tendency to recur.2,4 Radio- demonstrate a well-defined unilocular or multilocular radiolu-
graphically ameloblastomas show an expansile unilocular or cency with smooth and often corticated margins. 1 Odonto-
multilocular lesion with a “honeycomb or soap bubble” genic keratocysts tend to grow in and anteroposterior direction
appearance and a sharp scalloping border. 5,6 Buccal and within the medullary cavity of the bone without causing obvi-
ous bone expansion.1 Displacement of teeth adjacent to the
Received October 4, 2006; accepted November 6, 2006
Correspondence to : Prof. Soon-Chul Choi cyst occurs more frequently than resorption.6
Department of Oral and Maxillofacial Radiology School of Dentistry, Seoul The surgical treatment of ameloblastomas is marginal or
National University 28, Yeongeon-dong, Jongno-gu, Seoul, 110-749, Korea
Tel) 82-2-2072-2622, Fax) 82-2-744-3919, E-mail) raychoi@snu.ac.kr block resection, but most odontogenic keratocysts are treated
─ 177 ─
2. Diagnostic ability of differential diagnosis in ameloblastoma and odontogenic keratocyst by imaging modalities and observers
by enucleation and curretage.8,9 The preoperative differential keratocyst. The purpose of the present study is to assess the
diagnosis between ameloblastoma and odontogenic keratocyst diagnostic ability, intra- and interobserver agreement on
is important to establish appropriate treatment planning, but radiologic differential diagnosis in ameloblastoma and
ameloblastoma and odontogenic keratocyst are not much odontogenic keratocyst by imaging modalities and observers.
different in development age or site, and sometimes they are
radiologically similiar, which makes it not easy to differenti-
Materials and Methods
ate between them.
The studies of the preoperative differential diagnosis 1. Materials
between ameloblastoma and odontogenic keratocyst have
We examined histopathologically confirmed cases, taken
been reported over years. Tanimoto et al.10 reported that buc-
preoperative panoramic radiograph and CT (IQ scanner,
colingual expansion of the ramus caused by odontogenic
Picker International, USA), from January 1997 to July 2003 in
keratocysts was smaller than that caused by ameloblastomas.
Seoul National University Dental Hospital. Thirty-six cases of
Choi11 reported that lesional outline, the root resorption of
ameloblastomas and forty-seven cases of odontogenic kerato-
adjacent teeth, tooth displacement, and the loss of lamina dura
cysts were selected. The cases showing the typical multilo-
could be the parameters to differentiate odontogenic kerato-
cular characteristics of the ameloblastoma and recurrent cases
cyst and unilocular ameloblastoma. Minami et al.12 reviewed
were not included.
the magnetic resonance findings in patients with odontogenic
keratocysts or ameloblastomas, and proposed that from the
2. Methods
magnetic resonance (MR) findings of the walls, solid com-
ponents, and the fluid contents, odontogenic keratocysts could 1) Observers
be differentiated from ameloblastomas. Jeong13 et al. describ- The six observers who participated in the study were
ed that maxillary lesions were more common in odontogenic divided three groups. Group 1 was composed of the two
keratocyst, multilocular lesions were seen more frequently in observers (observer A, B), having experience over 10 years in
ameloblastoma, and the external root resorption of adjacent oral and maxillofacial radiologic field. Group 2 was com-
teeth showed more frequently in ameloblastoma. Tozaki et posed of the two observers (observer C, D), having experience
al.14 reported that a rapidly enhancing area was detected in 4-5 years in oral and maxillofacial radiologic field. Group 3
cases of ameloblastoma, while no apparent rapid enhancement was composed of the two observers (observer E, F), in the
was seen in the other cystic lesions, including odontogenic process of residentship.
keratocyst on dynamic multislice helical computed tomograph
2) Diagnostic method
(CT). Soh et al.15 described that the root resorption of the
Each one of the six observers diagnosed the 83 randomly
adjacent teeth, mandibular canal displacement, and the impac-
selected cases by 3 methods: 1. panoramic radiograph only, 2.
tion of teeth were seen more frequently in ameloblastoma than
CT only, 3. panoramic radiograph and CT simultaneously.
in odontogenic keratocyst, and cortical expansion showed
The diagnoses were classified on 5-grade semiquantitative
more severely in ameloblastoma.
= =
scales: 1=must be odontogenic keratocyst; 2=may be odonto-
The reliable interpretation of dental radiographs may be
=
genic keratocyst; 3= odontogenic keratocyst or amelobla-
affected by a variety of biases, including the education, train-
= =
stoma; 4=may be ameloblastoma; 5=must be ameloblastoma.
ing, and experience of the observer,16 which makes the obser-
All observers were blinded to their own results and those of
ver difference in radiologic diagnosis. Choi et al.17 examined
the other observers. After over 2 weeks, the observers dia-
the accuracy and inter- and intraobserver agreement in the
gnosed them by same methods.
radiologic diagnosis of ameloblastoma and odontogenic
keratocyst on panoramic radiograph. They reported that 3) Statistical analysis
experienced observer could differentiate more accurately than Receiver operating characteristic (ROC) curves for each
inexperienced observer, and that the diagnostic accuracy observers and groups were analysized and areas under the
highly correlated to the intraobserver agreement. curve were calculated. Intra- and interobserver agreement was
But we didn’t find the studies about the difference of effec- determined by using the kappa statistics with 95% confidence
tiveness by imaging modalities and observers in the differen- intervals for each pairs of observers and groups. All statistical
tial diagnosis between ameloblastoma and odontogenic analysis were performed by the statistical software package
─ 178 ─
3. Tae-In Gang, Kyung-Hoe Huh, Won-Jin Yi, Min-Suk Heo, Sam-Sun Lee, Jeong-Hwa Kim, Je-Woon Moon, Soon-Chul Choi
SPSS, release 10.0. (SPSS Inc., Chicago, USA). (0.751), followed with panoramic radiograph only (0.748),
and was the lowest with CT only (0.672) (Fig. 4). When
observers diagnosed using panoramic radiograph only, the
Results
areas under the curve were 0.765 for group 1, 0.763 for group
1. ROC analysis 2, and 0.748 for group 3. When observers interpreted using
CT only, the areas under the curve were 0.812 for group 1,
The overall areas under the curve were the highest with
0.801 for group 2, and 0.672 for group 3. When observers
panoramic radiograph and CT (0.825), followed with CT only
examined using panoramic radiograph and CT simultane-
(0.758), and was the lowest with panoramic radiograph only
ously, the areas under the curve were 0.870 for group 1 and 2,
(0.757) (Fig. 1). The ROC curve areas of group 1 and 2 were
and 0.751 for group 3 (Fig. 5).
the highest with panoramic radiograph and CT (0.870, both),
followed with CT only (0.812 and 0.801, respectively), and
2. Intraobserver agreement
was the lowest with panoramic radiograph only (0.765 and
0.763, respectively) (Figs. 2, 3). The ROC curve areas of We found the various kappa values of 0.27 to 0.76 for the
group 3 were the highest with panoramic radiograph and CT intraobserver agreement. The kappa values varied between
1 1
0.75 0.75
Sensitivity
Sensitivity
0.5 0.5
0.25 0.25
Panoramic radiograph; area=0.757 Panoramic radiograph; area=0.763
CT; area=0.758 CT; area=0.801
Panoramic radiograph and CT; area=0.825 Panoramic radiograph and CT; area=0.870
Reference Reference
0 0
0 0.25 0.5 0.75 1 0 0.25 0.5 0.75 1
1-Specificity 1-Specificity
Fig. 1. ROC curve of all observers. Fig. 3. ROC curve of group 2.
1 1
0.75 0.75
Sensitivity
Sensitivity
0.5 0.5
0.25 0.25
Panoramic radiograph; area=0.765 Panoramic radiograph; area=0.748
CT; area=0.812 CT; area=0.672
Panoramic radiograph and CT; area=0.870 Panoramic radiograph and CT; area=0.751
Reference Reference
0 0
0 0.25 0.5 0.75 1 0 0.25 0.5 0.75 1
1-Specificity 1-Specificity
Fig. 2. ROC curve of group 1. Fig. 4. ROC curve of group 3.
─ 179 ─
4. Diagnostic ability of differential diagnosis in ameloblastoma and odontogenic keratocyst by imaging modalities and observers
0.90
Discussion
0.80
0.70 Frame and Wake18 reviewed the value of CT as an aid to
0.60 diagnosis and treatment planning in selected conditions affec-
0.50 ting the jaws and related structures, and many features of CT
0.40 which are helpful in diagnosis were demonstrated: 1. It is the
0.30 technique that provides an axial view of the tissue. In addi-
0.20 tion, coronal scans of the jaw can also be obtained to give
0.10 greater clarity; 2. A good display of the soft tissue is obtained,
0.00 both the normal anatomy such as muscles, and pathologic
Panoramic radiograph CT Panoramic radiograph
and CT lesions where extension into the adjacent tissues can be seen;
Group 1 Group 2 Group 3
3. An assessment of tissue density is possible by determining
the absorption values of the lesions. This indicates the possi-
Fig. 5. Areas under curve of individual groups. ble make-up or contents of a structure or tumor as to whether
it is predominantly fluid, cellular, or vascular; 4. A clearer
picture is produced than with conventional radiographs, where
Table 1. Intraobserver agreement (kappa values) there is often blurring because of superimposition of struc-
Panoramic Panoramic tures outside the plane of interest. Mackenzie et al.19 reported
Group Observer CT
radiograph radiograph and CT
limitations of CT, which were possibility of failure of coronal
A 0.61 0.49 0.76
1 CT and streak artifacts on the scans by high density objects.
B 0.59 0.56 0.72
C 0.47 0.62 0.57 Cohen et al.20 reported that the soft tissue mass, destruction of
2
D 0.50 0.44 0.67 cortical bone, and extension of tumor into adjacent structures
E 0.39 0.27 0.48 of mandibular ameloblastoma were clearly visualized using
3
F 0.32 0.52 0.47 CT. Abrahams and Oliverio21 reported that dental CT could
provide a better means of assessing odontogenic cysts than
conventional techniques (orthopantomographic, intraoral, and
Table 2. Interobserver agreement (kappa values)
mandibular films), which are of limited usefulness because of
Panoramic Panoramic radiograph
Group
radiograph
CT
and CT the curved configuration of the mandible. Kawai et al.22 made
a comparative evaluation of the conventional radiography,
Group 1 and 2 0.42 0.49 0.64
Group 2 and 3 0.38 0.43 0.42 CT, magnetic resonance (MR) imaging of maxillary amelobla-
Group 1 and 3 0.34 0.37 0.50 stoma, and reported that CT and MR imaging were superior to
conventional radiography, that CT may be superior to MR
imaging in the lesions bound by outlining bony tissues, but
0.49 and 0.76 for group 1, between 0.44 and 0.67 for group 2,
that MR imaging was the best way of imaging in the recurrent
and between 0.27 and 0.52 for group 3. The kappa values
lesions, which might not always be outlined by bony tissues.
varied between 0.32 and 0.61 for interpreting panoramic
Iko et al.23 proposed that CT was the most sensitive imaging
radiograph only, between 0.27 and 0.62 for interpreting CT
technique for detecting ameloblastomas, and Kurabayashi24
only, and between 0.47 and 0.76 for interpreting panoramic
emphasized that CT was useful in demonstrating the extent of
radiograph and CT (Table 1).
maxillofacial mass lesions in children and for surgical treat-
ment planning. So the many studies about the utility of CT in
3. Interobserver agreement
diagnosis and treatment planning of ameloblastoma and
Interobserver kappa values ranged from 0.34 to 0.64. The odontogenic keratocyst have been reported. But the difference
kappa values varied between 0.34 and 0.42 for using pano- of effectiveness by imaging modalities and observers in the
ramic radiograph only, between 0.37 and 0.49 for using CT differential diagnosis between ameloblastoma and odonto-
only, and between 0.42 and 0.64 for using panoramic radio- genic keratocyst does not appear to have been discussed suf-
graph and CT (Table 2). ficiently. We examined the diagnostic ability of each obser-
vers and groups by image modalities. Diagnostic ability is
─ 180 ─
5. Tae-In Gang, Kyung-Hoe Huh, Won-Jin Yi, Min-Suk Heo, Sam-Sun Lee, Jeong-Hwa Kim, Je-Woon Moon, Soon-Chul Choi
measured by the area under the ROC curve. The closer the good intraobserver agreement. The overall kappa values were
curve follows the left-hand border and then the top border of fair-to-good interobserver agreement. The kappa values
the ROC space, the more accurate the test. The closer the between group 1 and 2 were moderate-to-good interobserver
curve comes to the 45-degree diagonal of the ROC space, the agreement, but the other kappa values were fair-to-moderate
less accurate the test.25 In this study, the ROC curve areas interobserver agreement. The kappa values of using pano-
except for group 3 were the highest with interpretation using ramic radiograph only and using CT only were fair-to-
panoramic radiograph and CT, followed by interpretation moderate interobserver agreement, and those of using pano-
using CT only, and was the lowest with interpretation using ramic radiograph and CT were moderate-to-good interobse-
panoramic radiograph only. As a result, in differential diagno- rver agreement. As a general, when the observers who had
sis between ameloblastoma and odontogenic keratocyst the experienced interpretation of CT over years diagnosed by
diagnostic ability of CT was superior to that of panoramic using panoramic radiograph and CT simultaneously, it was a
radiograph, and combination of panoramic radiograph and CT tendency to show higher intra- and interobserver agreement.
could increase the diagnostic ability more. Conclusionally, when making a differential diagnosis
The overall difference was not found in diagnostic ability between ameloblastoma and odontogenic keratocyst, com-
among groups in using panoramic radiograph only, but there bination of panoramic radiograph and CT increases the
was difference in diagnostic ability of group 1 and 2 vs 3 in diagnostic ability and the intra- and interobserver agreement,
using CT only, and combination panoramic radiograph and especially in the experienced oral and maxillofacial radio-
CT. The group 1 and 2 were composed of the experienced logists.
observers of CT, but group 3 was composed of the observers
who had not experienced with interpretation of CT. Although
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