Spread asymmetry to differentiate nasopalatine duct cysts from radicular cysts arising in the anterior maxilla on computed tomographic images

Objective: The aim of this study was to clarify numerical values for differentiating nasopalatine duct cysts (NPDCs) from radicular cysts (RCs) arising in the anterior maxilla on computed tomography (CT) or cone-beam CT (CBCT) images.

Methods: CT or CBCT images of histologically proven NPDCs (n = 30) and RCs (n = 33) beyond the midline of the maxilla were investigated to determine two asymmetry indices on axial images of the maximum lesion area. The lateral asymmetry index was calculated based on two distances from each of the lateral ends of the lesion to the midsagittal plane. The index was defined as the difference between the two distances divided by their sum. The labio-palatal asymmetry index was determined by the distance between the labial and palatal ends of the lesion and the coronal plane passing through the central incisor root apex. The performance of these indices was assessed by receiver operating characteristic (ROC) analysis. The cutoff values for differentiating NPDCs from RCs were determined with the Youden procedure on the ROC curve.

Results: The area under the ROC curve was 0.97 for the lateral asymmetry index and 0.88 for the labio-palatal asymmetry index. The cutoff values for differentiation were 0.36 and 0.68 for the lateral and labio-palatal asymmetry indices, respectively.

Conclusion: The lateral asymmetry index appeared to be an effective reference for differentiating NPDCs from RCs on CT or CBCT images. When the index was less than the cutoff value, a diagnosis of NPDC was strongly suggested.