Describing radiographic lesions can be a tricky thing at first, but with practice and radiographic examples it starts to become second nature. The acronym below I created for my students when teaching them how to describe radiographic lesions. The entire acronym applies to intraosseous (within bone) lesions. Not all the letters/topics apply to all radiographic lesions
L – Location
E – Edge
S – Shape
I – Internal
O – Other Structures
N – Number
L – Location
Position in the Jaws
A) Identify the loca'tion in the jaws ie – maxilla versus mandible and anterior versus posterior
Localized or Generalized
A) If an abnormal appearance affects all the osseous structures of the mandible or maxilla of both jaws the entity is generalized
B) If the entity is confined to one quadrant or area, it is localized. It may be unilateral orbilateral
E – Edge
Identify whether the edge of the abnormality is well-defined, ill-defined or well-localized
A- A well-defined entity has a sharp boundary that allows the entire edge of the lesion to be traced. The surrounding bone of a well-defined lesion appears normal up to the edge of the abnormality. Some well-defined borders have a radiopaque border and are classified ascorticated. A corticated border can be thin to thick
B- An ill-defined entity is a gradual transition between normal appearing bone and the abnormal bone of the lesion. The border of the lesion cannot be traced and the boundaries of the lesion are not clear
C- A well-localized entity is visible in a specific area but the borders may not be clearly identified around the entire lesion.
S – Shape
Identify the general shape of the abnormality. Common shapes include circular, ovoid, linear or scalloped
I – Internal structure
Radiolucent
Identify if the entire internal aspect of the abnormality is completely radiolucent. Further classification includes unilocular versus multilocular
A- Unilocular is completely radiolucent
B- Multilocular has bony septum within the entity
Radiopaque
A) Identify if the entire internal aspect of the abnormality is completely radiopaque
B) Determine the radiopacity of the interanal aspect. For example – similar radiopaicyt to tooth structure, bone, etc
Mixed Radiolucent/Radiopaque
Identify if the internal aspect is a mixture of radiolucent and radiopaque areas
O – Other structures
Teeth
Identify if the adjacent teeth are being displaced or resorbed
Evaluate which direction the teeth are displaced
Evaluate where the resorption is occurring – ie midroot or apex
Inferior Alveolar Nerve Canal
A) Identify any changes to the course of the canal. Note if the canal being displaced inferiorly or superiorly
B) Identify if there are changes to the size of the canal. Is it being enlarged or smaller than what is within the range of normal
Cortical Bone
A) Identify any changes in the thickness of the cortical bone. Is there thinning or the cortical bone in the area of the abnormality
B) Identify any changes in the loca'tion of the cortical bone. Is the cortical bone being displaced inferiorly, superiorly, lingually or facially
N – Number
Single or Multiple
A) If there is one abnormality, it is a single entity
B) If there is more than one site throughout the jaws, it is multiple
L – Location
E – Edge
S – Shape
I – Internal
O – Other Structures
N – Number
L – Location
Position in the Jaws
A) Identify the loca'tion in the jaws ie – maxilla versus mandible and anterior versus posterior
Localized or Generalized
A) If an abnormal appearance affects all the osseous structures of the mandible or maxilla of both jaws the entity is generalized
B) If the entity is confined to one quadrant or area, it is localized. It may be unilateral orbilateral
E – Edge
Identify whether the edge of the abnormality is well-defined, ill-defined or well-localized
A- A well-defined entity has a sharp boundary that allows the entire edge of the lesion to be traced. The surrounding bone of a well-defined lesion appears normal up to the edge of the abnormality. Some well-defined borders have a radiopaque border and are classified ascorticated. A corticated border can be thin to thick
B- An ill-defined entity is a gradual transition between normal appearing bone and the abnormal bone of the lesion. The border of the lesion cannot be traced and the boundaries of the lesion are not clear
C- A well-localized entity is visible in a specific area but the borders may not be clearly identified around the entire lesion.
S – Shape
Identify the general shape of the abnormality. Common shapes include circular, ovoid, linear or scalloped
I – Internal structure
Radiolucent
Identify if the entire internal aspect of the abnormality is completely radiolucent. Further classification includes unilocular versus multilocular
A- Unilocular is completely radiolucent
B- Multilocular has bony septum within the entity
Radiopaque
A) Identify if the entire internal aspect of the abnormality is completely radiopaque
B) Determine the radiopacity of the interanal aspect. For example – similar radiopaicyt to tooth structure, bone, etc
Mixed Radiolucent/Radiopaque
Identify if the internal aspect is a mixture of radiolucent and radiopaque areas
O – Other structures
Teeth
Identify if the adjacent teeth are being displaced or resorbed
Evaluate which direction the teeth are displaced
Evaluate where the resorption is occurring – ie midroot or apex
Inferior Alveolar Nerve Canal
A) Identify any changes to the course of the canal. Note if the canal being displaced inferiorly or superiorly
B) Identify if there are changes to the size of the canal. Is it being enlarged or smaller than what is within the range of normal
Cortical Bone
A) Identify any changes in the thickness of the cortical bone. Is there thinning or the cortical bone in the area of the abnormality
B) Identify any changes in the loca'tion of the cortical bone. Is the cortical bone being displaced inferiorly, superiorly, lingually or facially
N – Number
Single or Multiple
A) If there is one abnormality, it is a single entity
B) If there is more than one site throughout the jaws, it is multiple
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