Ultrasound real‐time imaging in the differential diagnosis of periapical lesions

TLDR

Ultrasound real‑time imaging may have further applications in diagnosing other jaw lesions. The study aimed to determine whether real‑time ultrasound combined with Colour Power Doppler could differentiate periapical cysts from granulomas based on lesion contents. Eleven patients scheduled for endodontic surgery were examined with ultrasound and Colour Power Doppler to assess lesion size, content, and vascularity, and tentative diagnoses were made, then compared with histopathology from surgically removed lesions. Ultrasound‑based differential diagnoses of cysts versus granulomas were confirmed by histopathology in all 11 cases, with four granulomas and seven cysts correctly identified.

Abstract

Abstract Aim To assess whether the use of real‐time ultrasound imaging (echography), together with the application of ‘Colour Power Doppler’, can help the differential diagnosis of periapical lesions based on their contents. Methodology Eleven patients diagnosed with periapical lesions using conventional clinical and radiographic findings and who had been scheduled for endodontic surgery were examined using ultrasound imaging and Colour Power Doppler at the site of the lesions. Lesions were described in each case by an expert echographist, together with an endodontist, according to a scheme described previously. Information on the size of each lesion, its content and its vascular supply was gained and recorded by means of the ultrasound images; then, a tentative differential diagnosis between a cyst and a granuloma was made. The lesions obtained during endodontic surgery were processed and examined with a light microscope. The results from the biopsies were compared with the descriptions made with the ultrasound images. Results The differential diagnoses between periapical granulomas and cystic lesions, which were based on the echograpic findings, were confirmed by the results of the histopathologic examination in all the 11 cases: four being granulomas and seven being cystic lesions. Conclusions Ultrasound real‐time imaging is a technique that may help make a differential diagnosis between cysts and granulomas by revealing the nature of the content of a bony lesion. This technique may have further applications in the study of other lesions of the jaws.