An imaging‑based diagnostic approach to vascular anomalies of the oral and maxillofacial region

Al-Hammad,Wlla E.; Fujikura,Mamiko; Hisatomi,Miki; Okada,Shunsuke; Munhoz,Luciana; Kawazu,Toshiyuki; Takeshita,Yohei; Fujita,Mariko; Yanagi,Yoshinobu; Asaumi,Jun-Ichi

doi:10.3892/ol.2023.13980

An imaging‑based diagnostic approach to vascular anomalies of the oral and maxillofacial region

Authors:
- Wlla E. Al-Hammad
- Mamiko Fujikura
- Miki Hisatomi
- Shunsuke Okada
- Luciana Munhoz
- Toshiyuki Kawazu
- Yohei Takeshita
- Mariko Fujita
- Yoshinobu Yanagi
- Jun-Ichi Asaumi
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Affiliations: Department of Oral and Maxillofacial Radiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700‑8558, Japan, Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, Okayama 700‑8558, Japan, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo 05508‑000, Brazil, Department of Oral and Maxillofacial Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700‑8558, Japan, Department of Dental Informatics, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700‑8525, Japan
Published online on: July 27, 2023 https://doi.org/10.3892/ol.2023.13980
Article Number: 394
Copyright: © Al-Hammad et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The accurate diagnosis of vascular anomalies (VAs) is considered a challenging endeavor. Misdiagnosis of VAs can lead clinicians in the wrong direction, such as the performance of an unnecessary biopsy or inappropriate surgical procedures, which can potentially lead to unforeseen consequences and increase the risk of patient injury. The purpose of the present study was to develop an approach for the diagnosis of VAs of the oral and maxillofacial region based on computed tomography (CT), magnetic resonance imaging (MRI) and dynamic contrast‑enhanced MRI (DCE‑MRI). In the present study, the CT and MR images of 87 VAs were examined, and the following imaging features were evaluated: Detectability of the lesion, the periphery of the lesion, the inner nature of the lesion, the density of the lesion on CT, the signal intensity of the lesion on MRI, the detectability of phleboliths and the shape of the lesion. A total of 29 lesions were further evaluated using the contrast index (CI) curves created from the DCE‑MRI images. A diagnostic diagram, which is based on the imaging features of VAs and CI curve patterns, was subsequently extrapolated. The results obtained demonstrated that the VAs were detected more readily by MRI compared with CT, whereas the detectability of phleboliths was superior when using CT compared with MRI. VAs showed a propensity for homogeneous isodensity on CT, whereas, by contrast, they exhibited a propensity for heterogeneous hyperdensity on CE‑CT. VAs also showed a propensity for homogeneous intermediate signal intensity when performing T1‑weighted imaging (T1WI), heterogeneous high signal intensity when performing short tau inversion recovery MRI, and heterogeneous high signal intensity when performing fat‑saturated CE‑T1WI. The CI curves of VAs were found to exhibit a specific pattern: Of the 29 CI curves, 23 (79.3%) showed early weak enhancement, followed by a plateau leading up to 400‑600 sec. An imaging‑based diagnostic diagram was ultimately formulated. This diagram can act as an aid for radiologists when they are expecting to find a VA, and hopefully serve the purpose of simplifying the diagnostic process. Taken together, the findings of the present study indicated that DCE‑MRI may be considered a useful tool for the diagnosis of VAs.

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