European Journal of Radiology 43 (2002) 37 41

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Application of dynamic MRI to differentiating odontogenic

myxomas from ameloblastomas
Jun-ichi Asaumi *, Hidenobu Matsuzaki, Miki Hisatomi, Hironobu Konouchi,
Hiroshi Shigehara, Kanji Kishi
Department of Oral and Maxillofacial Radiology, Field of Tumor Biology, Graduate School of Medicine and Dentistry,
Okayama Uni6ersity Graduate Schools, 2 -5 -1 Shikata-cho, Okayama 700 -8525, Japan
Received 30 July 2001; received in revised form 8 October 2001; accepted 10 October 2001

Abstract
It is often difficult to radiographically distingush odontogenic myxomas from ameloblastomas. In the present study, we tried
to differentiate odontogenic myxomas from ameloblastomas using dynamic magnetic resonance imaging (dynamic MRI). Two
cases of ameloblastoma with cystic companents and two cases of odontogenic myxoma were compared by dynamic MRI. The
dynamic MRI features of solid areas of ameloblastomas showed a rapid enhancement, reaching maximum contrast at 4560 s,
and maintained these enhancement levels or showed a gradual wash-out to 600 s thereafter; in contrast, those of the cystic areas
of ameloblastomas showed no enhancement. The dynamic MRI features of the whole area of odontogenic myxomas (we
considered the whole area to be the tumor substance in the odontogenic myxomas, as based on histopathological examinations)
showed a gradual increase in enhancement at 500600 s. The central portions of the odontogenic myxomas, which did not appear
to be enhanced on Gd-T1 weighted images also showed a gradual increase in enhancement at 500 600 s, though the increase was
minimal. These results indicate that the dynamic MRI features of odontogenic myxomas are different from those of ameloblastomas. Therefore, dynamic MRI may be a useful tool for diagnosis of myxoma. 2002 Elsevier Science Ireland Ltd. All rights
reserved.
Keywords: Dynamic MRI; Odontogenic myxoma; Ameloblastoma

1. Introduction
Myxoma is a relatively rare tumor of mesenchymal
origin [1,2]. Radiographically, the odontogenic myxoma
commonly shows multiple radiolucent areas of varying
size separated by straight or curved bony septa (soapbubble appearance) [3,4]. Computed tomography (CT)
also shows a multilocular soft tissue mass with bone
destruction and thinning as well as strands of a fine,
lacelike density [5]. The above appearance may be
indistinguishable from that of an ameloblastoma, especially when the bony septa of odontogenic myxoma are
of the curved type rather than the straight type. Therefore, it may often be difficult to radiographycally distinguish odontogenic myxomas from ameloblastomas,
* Corresponding author. Tel.: +81-86-235-6705; fax: + 81-86-2356709.
E-mail address: asaumi@md.okayama-u.ac.jp (J. Asaumi).

even if CT was performed. Recently, magnetic resonance imaging (MRI) has been used in diagnosing and
defining soft tissue lesions in the oral and maxillofacial
region because it is the most useful modality for analyzing the internal structures of lesions with its superior
soft tissue contrast and multiplanar facility [68]. We
have previously described the characteristic MR features of odontogenic myxoma [5], noting that although
both the gross and microscopic features are visible by
MRI, the signal intensities are not characteristic of
odontogenic myxomas alone. It is only the ability of
MRI to clearly show the erosive extension into adjacent
structures and invasion into the interroots of the teeth
[5] that makes it possible to confirm that these lesions
are not consistent mass lesions such as ameloblastomas,
as these lesions do not absorb or move the roots of the
teeth. However, this type of erosion and invasions
occurs only in relatively advanced lesions of the maxillary sinus. As such, it may be difficult to confirm this

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J. Asaumi et al. / European Journal of Radiology 43 (2002) 3741

characteristic feature in small lesions of odontogenic

myxoma.
There have been many reports that dynamic MRI is
useful for differential diagnosis of some tumors [912],
and many investigators have attempted to differentiate
benign from malignant tumors and to assess malignancy
with dynamic MRI [9,12]. Dynamic MRI may be useful
in predicting the biological behavior of some tumors and
in making a diagnosis. However, to our knowledge there
have been no reports of the use of dynamic MRI with
myxomas. The purpose of the present study was to
compare the dynamic MRI of odontogenic myxoma to
that of ameloblastoma in order to distinguish odontogenic myxomas from ameloblastomas.

2. Materials and methods

2.1. Cases
Two cases of ameloblastoma with cystic lesions and
two cases of odontogenic myxoma.

2.2. Dynamic MRI

The MR examinations were carried out with a 1.5 tesla
unit (Magnetom Vision; Siemens, Erlangen, Germany)
with a CP head coil. Dynamic MRI was performed using
three-dimensional fast imaging with a steady-state procession sequence (TR/TE =5/2 ms). Gd DTPA (Magnevist; Nihon Schering, Osaka, Japan) was injected as a
bolus at approximately 2 ml/s. The beginning of the first
scan was designated as time 0, and the administration of
Gd DTPA was started at 6 s before the second scan.
Dynamic MRI were acquired from 20 consecutive scans
at 1-s intervals (14 s/scan).

Fig. 1. The region of interest (ROI) in case 1 (odontogenic myxoma)

whole area; large area, central portion; small area.

CI =(signal intensity (postcontrast) signal intensity

(precontrast))/signal intensity (precontrast). The time
course of the CI (CI curves) was obtained by plotting the
CI on a time course.

3. Results
The CI curves, which were calculated from dynamic series, are shown in Fig. 5. The whole area of
both cases of odontogenic myxomas showed a gradual
increase of enhancement at 500600 s (case 1:
, case
2: ). The central portions of both cases of odontogenic

2.3. Image analysis

The region of interest (ROI) was drawn in the two
patterns of each lesion using the elective cursor on the
monitor (Figs. 14). In the odontogenic myxoma, the
ROI was drawn to include the whole area, as we
considered the whole area to be tumor substance in these
two cases of odontogenic myxoma based on histopathological examinations. Another ROI was drawn to include
only the central portion, as only the peripheral portion
was strongly enhanced and the central portion appeared
to be no enhancement because the central portion was
weakly enhanced compared with the peripheral portion
on Gd-T1 weighted images (WI) (Figs. 1 and 2). In the
ameloblastomas, the ROI was drawn to include the solid
area or the cystic area, which were proved histopathologically (Figs. 3 and 4). The mean signal intensity on the
ROI of each lesion was calculated using a workstation
(Siemens). The contrast index (CI) was calculated from:

Fig. 2. The ROI in case 2 (odontogenic myxoma) whole area; large

area, central portion; small area.

J. Asaumi et al. / European Journal of Radiology 43 (2002) 3741

Fig. 3. The ROI in case 3 (ameloblastoma) solid area; large area,

cystic area; small area.

myxoma showed a gradual increase in enhancement

to 500 600 s, though the increase was minimal (case
1: , case 2: "). The solid area in a case of
ameloblastoma showed a rapid enhancement, reaching
maximum CI at 45 s, and exhibiting a gradual washout thereafter (case 3: ). The solid area of another
case of ameloblastoma showed rapid enhancement,
reaching a plateau at 60 s, and then maintaining the
enhancement level at 600 s (case 4: ). The cystic
areas of both cases of ameloblastoma showed no enhancement (case 3: , case 4: 2).

4. Discussion
Dynamic MRI may be useful in predicting the biological behavior of some tumors and in making a

Fig. 4. The ROI in case 4 (ameloblastoma) solid area; large area,

cystic area; small area.

39

diagnosis. However, there have been few reports of

the use of dynamic MRI in the head and neck regions. The CI curves represent the blood behavior,
therefore the enhancement pattern of dynamic MRI
may reflect the intratumoral angiogenesis [1316]. It
has been reported that the CI curves of benign tumors increase gradually, while those of malignant tumors increase rapidly [17]. The dynamic MRI features
of some tumors in the salivary glands have been reported previously [10,12,18,19]. The CI curve of
pleomorphic adenomas shows a gradual increased enhancement [10,12], and those of Warthins tumors
show rapid enhancement, reaching a maximum CI,
decreasing rapidly, and then undergoing a gradual
wash-out [10,11,19]. These dynamic MRI features
have characteristic features, and they may useful in
making a differential diagnosis. In the present study,
we examined the dynamic MRI features of ameloblastoma and odontogenic myxoma, which are difficult to
differentiate using radiographic examinations. The
solid areas of ameloblastoma show an earlier enhancement than whole areas of odontogenic myxoma
(we considered the whole area to be tumor substance
in the odontogenic myxoma). The solid areas of
ameloblastoma showed a gradual wash-out or maintained enhancement levels at 600 s after reaching the
maximum enhancement levels, while the whole areas
of both cases of odontogenic myxomas showed a
gradual increase of enhancement at 500600 s. These
results indicate that the dynamic MRI features of the
tumor substance of ameloblastoma differs from those
of odontogenic myxomas. Moreover, we compared
dynamic MRI features in the cystic area of
ameloblastoma and those in the central portions of
odontogenic myxoma, which did not appear to be
enhanced on Gd-enhanced MRI. The cystic areas of
both cases of ameloblastoma showed no enhancement, while the central portion of both cases, which
appeared to be the cyst-like area in the odontogenic
myxomas, showed a gradual increase in enhancement
at 500600 s, though the increase was minimal. These
results indicate that the dynamic MRI features of the
cystic area of ameloblastomas differ from the central
cyst-like area of odontogenic myxomas. Thus, dynamic MRI features can differentiate ameloblastomas
from odontogenic myxomas in both solid and cystic
areas of ameloblastomas or cyst-like areas of odontogenic myxomas, making the use of dynamic MRI for
this purpose clinically useful. Minami et al. reported
that Gd-enhanced MRI of ameloblastomas shows
strong enhancement in the solid portions of the tumor, including papillary projections, walls, and septa,
but it shows no enhancement in the fluids, which are
not hemorrhagic but soft and gelatinous [20]. This
report suggested our dynamic MRI findings of
ameloblastomas. Kawai et al. reported that Gd-en-

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J. Asaumi et al. / European Journal of Radiology 43 (2002) 3741

Fig. 5. The contrast index curves on the two cases of odontogenic myxoma and two cases of ameloblastoma in the ROIs shown in Figs. 1 4.
Symbols; case 1 (myxoma) whole portion:
, central portion: , case 2 (myxoma) whole portion: , central portion: ", case 3 (ameloblastoma)
solid area: , cystic area: , case 4 (ameloblastoma) solid area: , cystic area: 2.

hanced MRI of the odontogenic myxoma shows homogeneous high signal intensity although their case of
myxoma consists of two parts histopathologically,
which are a small amount of collagen and fibroblastic
proliferation and a scarcely cellular mucoid matrix
which spindle-shaped and stellate cells are sparsely
scattered [21]. On the other hand, we reported previously that in the Gd-enhanced MRI of the odontogenic myxoma, the peripheral portion of the lesion
with a relatively large quantity of collagen bundles
was slowly enhanced, while the central portion with
only mucoid component was not. It was considered
that the central portion of the odontogenic myxomas
appeared the cyst-like area because the mucoid component showed slow and weak enhancement. In
odontogenic myxoma, it might take longer time in
the large lesion than in the small lesion because the
contrast agent invaded from the peripheral region of
the lesion. This may be the reason of the discrepancy
between Kawais case and our previous case of the
odontogenic myxoma
In the present study, we tried to differentiate odontogenic myxomas from ameloblastomas using dynamic
MRI. In the ameloblastoma, Gd DTPA, the contrast
agent, did not enter the cystic part of the tumor, but
rapidly entered into the tumor substance. While in
the odontogenic myxoma, the Gd DTPA entered the
central portion, which appeared to be the cyst-like
areas, as well as the peripheral portion, which was
strongly enhanced on the Gd-enhanced MRI. This
finding indicates that dynamic MRI can distinguish
ameloblastomas from odontogenic myxomas and may
be a useful tool for diagnosis of myxoma.

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