Application of radiomics features in differential diagnosis of odontogenic cysts

Objectives: Cysts in jaws may have similar radiographic features. However, it is important to clarify the diagnosis prior to surgery. The aim of this study was to compare the radiomic features of radicular cysts (RCs), dentigerous cysts (DCs), and odontogenic keratocysts (OKCs) as a non-invasive diagnostic alternative to biopsy. Methods: In total, 161 odontogenic cysts diagnosed histopathologically (55 RCs, 53 DCs, and 53 OKCs) were included in the present study. Each cyst was semi-automatically segmented on CBCT images, and radiomic features were extracted by an observer. A second observer repeated 20% of the evaluations and the radiomic features. Those achieving an inter-observer agreement level above 0.850 were included in the study. Consequently, five shape-based and 22 textural features were investigated in the study. Statistical analysis was performed comparing both three cyst features and making pairwise comparisons. Results: All features included in the study showed statistical differences between cysts, with the exception of one textural feature (NGTDM coarseness) (P <. 05). However, only one shape-based feature (shericity) and one textural feature (GLSZM large area emphasis) were statistically different in pairwise comparisons of all three cysts (P <. 05). Conclusion: Radiomics features of the RCs, DCs, and OKCs showed significant differences, and may have the potential to be used as a non-invasive method in the differential diagnosis of cysts.