Odontogenic Sclerotic Lesions on CT: A Pictorial Review for Practicing Radiologists

Abstract

Abstract

Due to the ubiquity of head CT, radiologists frequently encounter odontogenic lesions incidentally, as the teeth often appear within the FOV. Although histology remains the reference standard for diagnosis, imaging can serve as an important diagnostic discriminator. Radiologic features such as lesion location relative to the tooth, inferred tooth vitality, margin definition, root interface, and expansile behavior, particularly when considered along with patient demographics, can substantially narrow the differential diagnosis. In fact, the new 2022 WHO classification of odontogenic lesions emphasizes the importance of imaging, underscoring the need for radiologists to recognize characteristic features of these entities. This Pictorial Essay highlights the key imaging features of entities that should be considered in the differential diagnosis of odontogenic sclerotic lesions on CT, including true odontogenic lesions, inflammatory processes, nonodontogenic mimics, and additional odontogenic tumors that may show overlapping imaging characteristics. The goal of this article is to provide a concise reference and practical framework to assist radiologists in evaluating odontogenic sclerotic lesions on CT and improve diagnostic confidence.