Computed tomography and magnetic resonance imaging characteristics of giant cell tumors in the temporomandibular joint complex

Abstract

Purpose: This study aimed to investigate the computed tomography and magnetic resonance imaging features of giant cell tumors in the temporomandibular joint region to facilitate accurate diagnoses.

Materials and methods: From October 2007 to June 2020, 6 patients (2 men and 4 women) at Yonsei University Dental Hospital had histopathologically proven giant cell tumors in the temporomandibular joint. Their computed tomography and magnetic resonance imaging findings were reviewed retrospectively, and the cases were classified into 3 types based on the tumor center and growth pattern observed on the radiologic findings.

Results: The age of the 6 patients ranged from 25 to 53 years. Trismus was found in 5 of the 6 cases. One case recurred. The mean size of the tumors, defined based on their greatest diameter, was 32 mm (range, 15-41 mm). The characteristic features of all cases were a heterogeneously-enhancing tumorous mass with a lobulated margin on computed tomographic images and internal multiplicity of signal intensity on T2-weighted magnetic resonance images. According to the site of origin, 3 tumors were bone-centered, 2 were soft tissue-centered, and 1 was peri-articular.

Conclusion: Computed tomography and magnetic resonance imaging yielded a tripartite classification of giant cell tumors of the temporomandibular joint according to their location on imaging. This study could help clinicians in the differential diagnosis of giant cell tumors and assist in proper treatment planning for tumorous diseases of the temporomandibular joint.

Keywords: Diagnostic Imaging; Giant Cell Tumors; Magnetic Resonance Imaging; Temporomandibular Joint.

Fig. 1. Giant cell tumors in the temporomandibular joint region are categorized as bone-centered (A), soft tissue-centered (B), or peri-articular (C) according to the tumor's center and growth pattern. The right and left figures indicate a tumor mass on magnetic resonance imaging and computed tomography. Bone-centered type (A) shows a lobulated tumorous mass with internal high attenuation portion (white arrow). Peri-articular type (C) presents bony destruction by infiltrative tumorous mass (white asterisk).

Fig. 2. A. A bone-centered giant cell tumor is observed as a lobulated hyperdense tumorous mass on the left condylar head. B. At the periphery, a low signal intensity on T2-weighted magnetic resonance imaging is detected (white arrow).

Fig. 3. A. The soft tissue-centered type of giant cell tumor, shown as a heterogeneously enhancing tumorous mass, is located in the masticatory space on computed tomography. B. The tumor is observed as iso or slightly high signal intensity compared to the masticatory muscle on coronal T1-weighted magnetic resonance imaging with intracranial extension (white arrow).

Fig. 4. A. The peri-articular type of giant cell tumor presents bony remodeling of the left condyle's anterior border on a panoramic radiograph (white triangle). B. On axial contrast-enhanced T1-weighted magnetic resonance imaging, the tumorous mass shows an infiltrative growth pattern into the condylar head with heterogeneous enhancement (white arrow).