Comparison of radiographical characteristics and diagnostic accuracy of intraosseous jaw lesions on panoramic radiographs and CBCT

Abstract

Objective: To investigate the differences in imaging characteristics and the diagnostic accuracy of 225 intraosseous jaw lesions on panoramic radiographs (PAN) versus cone beam computed tomography (CBCT). Methods: 225 sets of PAN and CBCT images with biopsy-proven histopathological diagnoses were retrospectively compared in terms of radiographic features and diagnostic accuracy. The imaging characteristics of PAN and CBCT were independently evaluated by two oral and maxillofacial radiologists who were required to answer 12 questions and provided up to three differential diagnoses with their confidence scores. Results: Odds ratios (ORs) were statistically significant for border cortication (OR = 1.521; p = .003) and border continuity (OR = 0.421; p = .001), involvement on neurovascular canals (OR = 2.424; p < .001), expansion (OR = 7.948; p < .001), cortical thinning (OR = 20.480; p < .001) as well as its destruction (OR = 25.022; p < .001) and root resorption (OR = 2.477; p < .001). Furthermore, imaging features in the posterior and mandibular regions showed better agreement than those in the anterior and maxillary regions, respectively. The diagnostic accuracy of the first differential diagnosis was higher on CBCT than on PAN (Observer 1:78.7 vs 64.4%; Observer 2: 78.7 vs 70.2% (p < .001)). The observers’ confidence scores were also higher at CBCT interpretation compared with PAN. Conclusions: CBCT demonstrated a greater number of imaging characteristics of intraosseous jaw lesions compared with PAN, especially in the anterior regions of both jaws and in the maxilla. Diagnostic accuracy is improved with CBCT compared to PAN, especially for lesions in the maxilla. Radiologists have greater confidence when using CBCT.