Magnetic resonance imaging and cone beam computed tomography fordifferential diagnosis between periapical cysts and granulomas:integrative review

Abstract

The differential diagnosis between radicular cysts and periapical granulomas is of clinical importance, as it guides distinct therapeutic approaches. This integrative review aimed to synthesize the applicability of cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI)—including radiomic texture analysis and weighted sequences (T1w, T1wFS, T2wFS)—in the preoperative distinction of these lesions, as well as to assess their potential to reduce reliance on invasive histopathological examination. A total of 33 articles published between 2014 and 2024 were selected from the PubMed and Lilacs databases. Conventional CBCT, based on morphological descriptors (such as shape, borders, and volume), showed heterogeneous results, whereas radiomic approaches achieved areas under the curve (AUC) ranging from 76% to 86.4%. MRI demonstrated high sensitivity for soft tissue evaluation and differentiated cysts from granulomas using multiple criteria, despite the variability in protocols and high operational costs. It is worth noting that the clinical applicability of these imaging techniques remains partial, as the definitive differentiation between true apical cysts and pocket cysts—which is critical for determining the appropriate treatment—still requires histopathological confirmation. It is concluded that CBCT with radiomics and sequential MRI protocols are safe and effective tools for preoperative diagnosis. However, multicenter standardization of technical parameters and imaging analysis protocols is necessary to ensure consistent application and to potentially reduce the reliance on biopsy.

Keywords: Radicular Cyst; Periapical Granuloma; Magnetic Resonance; Cone-Beam Computed Tomography; Differential Diagnosis.