Dentomaxillofacial Radiology (2021) 50, 20200384

© 2021 The Authors. Published by the British Institute of Radiology

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RESEARCH ARTICLE
Primary clinical study of radiomics for diagnosing simple bone
cyst of the jaw
1,2
Zhe-­Yi Jiang, 1,2Tian-­Jun Lan, 1,2Wei-­Xin Cai and 1,2Qian Tao

Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-­sen
1

University, Guangzhou, China; 2Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China

Objective:  To screen the radiomic features of simple bone cysts of the jaws and explore the
potential application of radiomics in pre-­operative diagnosis of jaw simple bone cysts.
Methods:  The investigators designed and implemented a case–control study. 19 patients with
simple bone cysts who were admitted to the Department of Maxillofacial Surgery, Sun Yat-­
sen University Affiliated Stomatology Hospital from 2013 to 2019 were included in this study.
Their clinical data and cone-­beam computed tomography (CBCT) images were examined. The
control group consisted of patients with odontogenic keratocyst. CBCT imaging features were
analyzed and compared between the patient and control groups.
Results:  Overall, 10,323 image features were extracted through feature analysis. A subset of
25 radiomic features obtained after feature selection were analyzed further. These 25 features
were significantly different between the 2 groups (p < 0.05). The absolute value of correlation
coefficient was 0.487–0.775. Gray-­level co-­occurrence matrix (GLCM) contrast, neighbor-
hood gray tone difference matrix (NGTDM) contrast, and GLCM variance were the features
with the highest correlation coefficients.
Conclusions:  Pre-­operative radiomics analysis showed the differences between simple bone
cysts and odontogenic keratocysts, can help to diagnose simple bone cysts. Three specific
texture features—GLCM contrast, NGTDM contrast, and GLCM variance—may be the
characteristic imaging features of simple bone cysts of the jaw.
Dentomaxillofacial Radiology (2021) 50, 20200384. doi: 10.1259/dmfr.20200384

Cite this article as:  Jiang Z-­Y, Lan T-­J, Cai W-­X, Tao Q. Primary clinical study of radiomics
for diagnosing simple bone cyst of the jaw. Dentomaxillofac Radiol 2021; 50: 20200384.

Keywords:  Simple bone cyst; Odontogenic keratocyst; Cone-­beam computed tomography;

Radiomics; Diagnosis

Introduction

Simple bone cyst (SBC) of the jaw is a rare non-­
odontogenic cyst in the oral cavity, accounting for
about 1% of all oral cysts.1 It is a non-­neoplastic bone
lesion without an epithelial lining and soft tissue, which
is empty or filled with fluid, and without evidence of
infection.2 SBC usually progresses slowly or does not
progress, without swelling, pain, and other functional
signs. Therefore, we often diagnose SBC incidentally
during imaging examinations.3 Majority of SBCs show
homogeneous osteolysis surrounded in a single cavity
Correspondence to: Dr Qian Tao, E-mail: ​taoqian@​mail.​sysu.​edu.​cn
Received 11 August 2020; revised 27 March 2021; accepted 30 March 2021
The authors Zhe-­Yi Jiang and Tian-­Jun Lan contributed equally to the work.
on panoramic radiograph, surrounded by narrow
conical bony condensation. Some cases present multi-
locular with septum-­like images, can be misdiagnosed
with other maxillary cystic lesions such as odonto-
genic keratocyst (OKC).4 OKC grows through the bone
marrow tissue without causing expansion, resulting in a
similar imaging features with SBC. Due to the aggres-
sive behavior and high recurrence rate, OKC requires
more radically surgical treatment, such as curettage,
mandibular segmental resection and so on. The diag-
nosis of OKC depended on microscopic examination,
while SBCs need to be confirmed via surgical explo-
ration.5 Since 1955, surgical intervention has been the
first choice for the diagnosis and treatment of SBC.6,7

An in-­depth study of SBC showed that SBC can resolve
spontaneously.8 If we can diagnose SBC accurately
before surgery, then conservative treatment can be the
first choice. An invasive surgery can be avoided, if the
condition of the cyst needs to be assessed regularly.
However, there are no effective pre-­operative diagnostic
methods. Thus, an accurate non-­invasive approach that
can diagnose SBC pre-­operatively is urgently needed to
help surgeons make precise treatment decisions.
Recently, there has been an increasing interest in
extracting quantitative features from medical images
to improve clinical diagnosis and treatment. Radiomics
is a new medical frontier based on the idea that micro-
scopic gene or protein pattern changes are expressed
on macroscopic images, and through in-­depth mining
of image features, it can identify the changes of human
tissue, cell and gene level. Specifically, radiomics mainly
focuses on improving image analysis by using high-­
throughput extraction of large amounts of features
from radiographic images.9 For example, the features of
chest X-­ray images have been applied in the diagnosis
of pediatric pneumonia and pulmonary tuberculosis.10
Radiomics is also used to predict the histologic grade
of oral squamous cell carcinoma.11 Although radiomics
has not been applied in jaw diseases, it may be used as an
accurate non-­invasive approach to diagnose SBC.
The present study aims to explore the application
of radiomics in distinguish SBC and other maxillary
cystic lesions (OKC). Extracting the radiomics features
between SBC and OKC, and identifying the specific
features of SBC, which are helpful to the the pre-­
operatively accurate diagnosis of SBC.
Patients and methods
Patients selection
A retrospective, case–control study was conducted to
address the research purpose. The study was approved
by the Institutional Ethics Board of the Hospital of
Stomatology, Sun Yat-­ sen University, and patient
informed consent was waived. In the present study,
we enrolled 38 patients, including 19 patients with
SBC and 19 with OKC, who had completed treatment
between 2013 and 2019. All patients with OKC were
diagnosed by pathological examination according
to the World Health Organization histologic clas-
sification.2 The OKC patients with nevoid basal cell
carcinoma syndrome were excluded in the study. The
diagnosis of SBC was confirmed by surgery explo-
ration based on the presence of a cavity, which may
contain blood or blood-­carrying fluid, and surrounded
by a hard capsule.12 The clinical and imaging data of
those patients were retrospectively retrieved from
the archive of Hospital of Stomatology, Sun Yat-­sen
University. The following data were collected: (1) clin-
ical data: gender, age, pain, bulging of the jaw, and
history of trauma; (2) imaging data: pre-­ operative
panoramic radiographs and CBCT images. All
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panoramic radiography images were taken on the same
Promax Digital Panoramic X-­ ray Machine (Plan-
meca, Finland). The following imaging parameters
were used: resolution ratio 2500*1244 pixels, Gray-
scale 4096, grayscale resolution 12 bits, panoramic
image area ≥15*30 cm, image amplification factor 1.27
times. All CBCT images were obtained using a CBCT
scanner (DCTPRO, VATECH, Yongin-­Si, Republic of
Korea) with a field of view of 16 × 7 cm and a voxel
size of 0.16 mm. The operating parameters were set at
90.0 kV and 9 mA with a scanning time of 24 s.
Methods and materials
Extraction of the region of interest (ROI) area
The CBCT data of patients with SBC and OKC were
imported into the image processing software, ITK-­
SNAP 3.2 (​www.​itksnap.​org).13 ITK-­SNAP program is
a free, open-­source, and multiplatform image analysis
tool. It provides semi-­ automatic segmentation using
active contour methods, as well as manual delineation
and image navigation and supports for many different
3D image formats, including NIfTI and DICOM. One
dentomaxillofacial radiologist then manually outlined
and segmented the area of the cystic lesions along their
edges, layer by layer, to generate ROIs. The CBCT image
and the corresponding segmentation results are shown
in Figure 1.
Feature extraction
In the present study, we computed the extracted 43
types of texture features using 240 different combina-
tions of extraction parameters. These texture features
consisted of 3 first-­order statistical features, 9 gray-­level
co-­occurrence matrix (GLCM) features, 13 gray-­level
run-­length matrix (GLRLM) features, 13 gray-­ level
size zone matrix (GLSZM) features, and 5 neighbor-
hood gray tone difference matrix (NGTDM) features
(Table  1). The four following extracted parameters
were applied for extracting texture features: wavelet
band-­ pass filtering, isotropic resampling, grayscale
quantization algorithm, and quantization level.14 Their
corresponding values are: (1/2, 2/3, 1, 3/2, 2), [pixelW
(Original image resolution), 1 mm, 2 mm, 3 mm, 4 mm,
5 mm], (Equal-­probability, Lloyd-­Max) and (8, 16, 32,
64). Based on( their corresponding) values (n = 5, 6, 2, 4),
1,0324 (‍4 + 3 + 9 + 13 + 13 + 5 × 5 × 6 × 2 × 4 = 10324)‍
features were extracted.
Feature selection
To screen for features that correlate with SBCs, we used
the sequence forward selection (SFS) method15 to opti-
mize the useful features and filter the redundant ones.
A feature subset containing 25 features with the highest
correlation was then selected.
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Figure 1  ROI segmentation results from CBCT images. (A) A ROI was manually outlined from CBCT, (B) Axial plane, (C) sagittal plane and
(D) coronal plane. The cyst is marked in red. CBCT, cone-­beam computed tomography; ROI, region of interest.
Statistical analyses
All statistical analyses were performed using the IBM
SPSS 20.0 (SPSS Inc., Chicago, IL) statistical software.
Spearman rank correlation analysis was performed on
the data of each feature to compare the correlation
between the features and categories. p values < 0.05 were
regarded as indicating statistical significance.
Results
General case information
Clinical data of the SBC and OKC groups are shown
in Table 2. In the present study, there were 19 patients
with SBC with an average age of 17.0 years, of which
8 (42.1%) were males and 11 (57.9) were females. Six
(31.6%) patients with SBC showed mandibular expan-
sion, while the other patients had no symptoms. There
were 19 patients with OKC with an average age of
29.1 years, of which 7 were males and 12 were females.
Compared to patients with SBC, patients with OKC
had a higher incidence of mandibular expansion; 17
(89.5%) patients with OKC had mandibular expansion.
Moreover, unlike patients with SBC, seven patients
with OKC experienced pain and four patients had tooth
mobility.
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Jiang et al
Imaging performance
Panoramic radiography:  The average maximum diam-
eter of SBC was 28.08 mm (Table 3). Of the 19 cases of
SBC, most of them originated from the posterior teeth
and ascending branch area of the mandible (73.7%),
and a small portion of the cases occurred in the ante-
rior teeth area (26.3%). Eight cases (42.1%) of SBC
appeared cone-­shaped, and the rest of the cases had an
irregular shape. 15 patients (78.9%) with SBC showed
scalloping on the panoramic radiograph; the upper
boundary of the cyst extended till the root of the tooth,
and it was fan-­shaped with hard bone lines and resem-
bled the shape of a shell (Figure  2). The pagination
notches on the lower margin was observed in five cases.
All patients with SBC did not have teeth displaced and
roots absorbed.
Of the 19 patients with OKC, the average maximum
diameter was 47.06 mm, which was larger than SBC.
Similar to SBCs, 18 OKCs (94.7%) originated from
the posterior teeth and ascending branch area of the
mandible, and only 1 case (5.3%) occurred in the ante-
rior teeth. Seven cases (36.8%) of OKC presented
scalloping. Nine cases (47.4%) showed pagination
notches on the lower margin and five cases showed root
resorption.
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Table 1  Characteristics of the imaging group used in this study

Feature type Feature name
Non-­texture Volume
Size
Solidity
Eccentricity
Texture  
First-­order statistics feature Variance
Skewness
Kurtosis
GLCM (Gray-­level co-­occurence matrix) Energy
Contrast
Correlation
Sum-­average
Homogeneity
Entropy
Variance
Dissimilarity
Auto-­Correlation
GLRLM (Gray-­level run-­length matrix) Short Run Emphasis(SRE)
Long Run Emphasis(LRE)
Gray-­Level Non-­uniformity(GLN)
Run-­Length Non-­uniformity(RLN)
Gray-­Level Variance(GLV)
Run-­Length Variance(RLV)
Run Percentage(RP)
Low Gray-­Level Run Emphasis(LGRE)
High Gray-­Level Run Emphasis(HGRE)
Short Run Low Gray-­Level Emphasis(SRLGE)
Short Run High Gray-­Level Emphasis(SRHGE)
Long Run Low Gray-­Level Emphasis(LRLGE)
Long Run High Gray-­Level Emphasis(LRHGE)
GLSZM (Gray-­level run-­length matrix) Small Zone Emphasis(SZE)
Large Zone Emphasis(LZE)
Gray-­Level Non-­uniformity(GLN)
Zone-­Size Non-­uniformity(ZSN)
Gray-­Level Variance(GLV)
Zone-­Size Variance(ZSV)
Zone Percentage(ZP)
Low Gray-­Level Zone Emphasis(LGZE)
High Gray-­Level Zone Emphasis(HGZE)
Small Zone Low Gray-­Level Emphasis(SZLGE)
Small Zone High Gray-­Level Emphasis(SZHGE)
Large Zone Low Gray-­Level Emphasis(LZLGE)
Large Zone Low Gray-­Level Emphasis(LZHGE)
NGTDM (Neighborhood gray tone difference matrix) Coarseness
Contrast
Busyness
Complexity
Strength

CBCT in SBC cases, there was only cortical bone thinning and
Via CBCT, we observed cortical bone perforation in no perforation (Figure 3a). Three relationships between
36.8% of OKCs and bone thinning in 89.5% of cases; cysts and the mandibular canal could be found: (1)

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 study of radiomics for diagnosing simple bone cyst of the jaw
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Table 2  Clinical data of the SBC and OKC groups

Average Mandibular Tooth Past
Group Male Female age Pain expansion mobility trauma
 SBC 8 11 17.0 0 6 0 0
 OKC 7 12 29.1 7 17 4 0
OKC, Odontogenic keratocyst;SBC, Simple bone cyst.

31.6% of SBCs and 15.8% of OKCs were located far

away from the mandibular canal; (2) 31.6% of SBCs and
36.8% of OKCs squeezed the canal; (3) 47.4% of OKCs
destroyed the bone around the canal (Figure  4), but
this did not occur in any of the SBC cases. Moreover, Figure 2  Panoramic radiograph revealing the scalloping at the root
in SBC cases, most cysts (73.7%) showed bony ridges of 47 (arrow).
protruding into the lumen at the edge of the cyst wall
(Figure  3b). However, in OKC cases, we observed this Results of radiomic feature selection
characteristic only in two cases (Table 3). As a result of feature extraction, a total of 10 324
radiomic features were obtained from ROI, which
Table 3  Imaging findings of the SBC and OKC groups consist of non-­ texture features and texture features.
Variables SBC OKC Through feature selection, we obtained a feature
subset containing 23 texture features and 2 non-­texture
Location, n (%) features. Table 4 presented Spearman’s rank correlation
 Anterior teeth region 5 (26.3) 1 (5.3) (Rs) and the corresponding p-­value of 25 features in the
 Posterior teeth region 12 (63.2) 13 (68.4) feature subset. The two non-­texture features (volume
 Mandibular ramus region 2 (10.5) 5 (26.3) and size) were significantly different between the OKC
 Average size, (mm) 28.08 47.06 and SBC groups. Among the texture features, GLCM
Cone shape, n (%) contrast, NGTDM contrast, and GLCM variance had
 Yes 8 (42.1) 3 (15.8) the highest correlation coefficients.
 No 11 (57.9) 16 (84.2)
Scalloping, n (%)
Discussion
 Yes 15 (78.9) 7 (36.8)
 No 4 (21.1) 12 (63.2)
SBC is a pseudocyst without a lining epithelium and
Pagination notch
often needs to be distinguished from true cysts because
 Yes 5 (26.3) 9 (47.4) different treatments are required for these conditions.16
 No 14 (73.7) 10 (52.6) However, some unilocular and multilocular SBCs are
Tooth displacement, n (%) difficult to distinguish from true cysts. In the present
 Yes 0 (0) 4 (21.1) study, we compared the panoramic radiograph and CBCT
 No 19 (100) 15 (78.9) scans of 19 SBCs and 19 OKCs to identify the diagnostic
Tooth root resorption, n (%) radiographic findings. There is a great difference in radio-
 Yes 0 (0) 5 (26.3) graphic findings between SBCs and OKCs. We then
 No 19 (100) 14 (73.7) extracted 10,324 features from every CBCT image in the
Cortical bone perforation, n (%)
 Yes 0 (0) 7 (36.8)
 No 19 (100) 12 (63.2)
Cortical bone thinning, n (%)
 Yes 17 (89.5) 17 (89.5)
 No 2 (10.5) 2 (10.5)
Relationships between cysts and the mandibular canal, n (%)
 Cyst away from the canal 6 (31.6) 3 (15.8)
 Cyst squeezed the canal 6 (31.6) 7 (36.8)
 Cyst destroyed the bone around the 0 (0) 9 (47.4)
canal
Bone ridges protruding into the cavity, n (%) Figure 3  CBCT manifestation of simple bone cyst. (A) A CBCT
 Yes 14 (73.7) 2 (10.5) scan showed only a thinning cortical bone between simple bone
 No 5 (26.3) 17 (89.5) cyst and mandibular canal, (B) A CBCT scan showed a bony ridge
protruding into the lumen at the edge of the cyst wall. CBCT, cone-­
SBC, Simple bone cyst; OKC, odontogenic keratocyst beam computed tomography.

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Figure 4  CBCT manifestation of OKC. A CBCT scan showed part of the bone around the mandibular canal is destroyed by the cyst. (A) sagittal
plane, (B) coronal plane, (C) Axial plane. CBCT, cone-­beam computed tomography; OKC, odontogenic keratocyst.

SBC and OKC groups. Finally, 2 non-­texture features and

23 texture features that had the distinguishable power
Table 4  The results of correlation tests of 25 features in the feature
subset were obtained by feature selection.
In the present study, some radiographic features of
Features R Scale Algorithm Ng Rs p value SBC were found. Scalloping is one of the typical features,
GLCM contrast 1.00 3 Lloyd 16 0.775 <0.0001 wherein the upper boundary of the cyst extends until the
GLCM variance 0.50 4 Lloyd 8 0.706 <0.0001 root of the tooth, thereby having the shape of a fan. A
GLCM dissimilarity 0.50 4 Lloyd 64 0.692 <0.0001 previous study reviewed 1253 patients with SBC, about
GLCM homogeneity 0.67 4 Lloyd 8 −0.567 0.000312
40% of whom showed scalloping.17 Similarly, Sabino-­
Bezerra18 et al described six patients with SBC, three of
GLCM energy 2.00 5 Equal 16 0.631 <0.0001
whom had marginal scallop-­like lesions. In our study, we
NGTDM contrast 0.50 4 Lloyd 8 0.713 <0.0001
observed scalloping on the panoramic radiograph of 15
NGTDM strength 0.67 1 Lloyd 16 0.647 <0.0001
patients with SBC (78.9%). It may be related to the epide-
NGTDM coarseness 2.00 2 Equal 64 0.636 <0.0001 miological differences between different regions or the
NGTDM busyness 2.00 2 Equal 8 −0.620 <0.0001 small sample size. Interestingly, Damante et al19 reported
GLSZM GLV 0.67 2 Lloyd 16 0.690 <0.0001 that in 10 cases of SBC with scalloping, 6 cases remod-
GLSZM ZSN 0.50 4 Lloyd 8 0.653 <0.0001 eled and 1 case spontaneously resolved. It suggested that
GLSZM SZE 1.50 5 Equal 32 0.650 <0.0001 the scalloping may be related to the prognosis of SBC.
GLSZM ZP 1.00 5 Equal 8 0.639 <0.0001 However, 36.8% patients with OKC showed scalloping
GLSZM LZE 0.50 5 Equal 8 −0.638 <0.0001 on the panoramic radiographs in the present study. A
GLSZM ZSV 1.50 5 Equal 64 0.634 <0.0001 previous study reported that the scalloping was more
GLRLM SRE 1.50 5 Equal 32 0.672 <0.0001 frequently observed in the posterior segment of OKCs
GLRLM RLN 1.50 5 Equal 16 0.666 <0.0001 than in SBCs on the panoramic radiographs.19 Therefore,
GLRLM LRE 1.00 5 Equal 8 −0.664 <0.0001 the radiographic features of SBC are not diagnostic and
GLRLM RLV 2.00 5 Lloyd 64 0.636 <0.0001
may be confused with a variety of odontogenic cysts.
CBCT was also applied for three-­dimensional visualiza-
GLRLM RP 1.50 5 Equal 32 0.635 <0.0001
tion of SBCs. Using CBCT, we observed that SBC showed
GLRLM GLN 2.00 5 Equal 64 0.629 <0.0001
a lower boundary that was flat and there were high-­density
Global variance 0.50 4 Equal 8 0.652 <0.0001
irregular osteoporotic images or bony crests protruding
Global kurtosis 1.00 5 Equal 16 −0.556 0.000428 into the lumen at the margin of the capsule wall. However,
Volume – – – – −0.540 0.000673 CBCT also cannot provide enough diagnostic informa-
Size – – – – −0.487 0.002615 tion. The radiomic features consisted of the information
GLCM, Gray-­level co-­occurrence matrix; GLRLM GLN, Gray-­level about mandibular cystic lesions’ gray shadow, shape,
run-­length matrix gray-­level non-­uniformity; GLSZM GLV, Gray-­ intensity, texture, as well as spatial relationship. According
level size zone matrix gray-­level variance; GLRLM LRE, gray-­level to the radiomics hypothesis, the genomic heterogeneity
run-­length matrix Long run emphasis; GLSZM LZE, Gray-­level size
zone matrix Large zone emphasis; NGTDM, Neighborhood gray
may translate to expression in a disease intra heteroge-
tone difference matrix; GLRLM RLN, gray-­level run-­length matrix neity that can be assessed through imaging.20 With regard
Run-­ length non-­uniformity; GLRLM RLV, gray-­ level run-­
length to gross observation and histopathological examination,
matrix Run-­ length variance; GLRLM RP, gray-­ level run-­
length the tissue composition of lesions from jaw SBC and OKC
matrix Run percentage; Rs, Spearman rank correlation coefficients; differs greatly. Maxillary SBCs may be empty or blood/
GLRLM SRE, Gray-­level run-­length matrix Short run emphasis;
GLSZM SZE, gray-­ level size zone matrix Small zone emphasis; fluid-­filled and occasionally have a fibrous capsule wall,
GLSZM ZP, gray-­level size zone matrix Zone percentage; GLSZM with the bone crest protruding into the cavity, or bone
ZSN, gray-­level size zone matrix Zone-­size variance. fragments scattered into the fluid. The cyst sac of OKCs

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have fluid and keratosis, and the sac wall thickens during
infection. Therefore, radiomic features can reflect the
difference between OKC and SBC.
In the present study, 10,324 texture features were
extracted, including information such as gray shadow,
intensity, texture, and spatial relationship of cystic lesions.
According to the correlation between features and cate-
gories, some feature organization methods are applied to
remove irrelevant, redundant, and noisy information from
the data, and select the optimal features to further improve
the differentiation performance.15 25 features that have the
ability to distinguish SBC and OKC were identified.
Two non-­texture features, namely, volume and size were
identified to have the ability to discriminate between SBC
and OKC. Volume refers to the product of the number
of pixels extracted and the dimension of the pixel, and
size refers to the maximum diameter of the lesion area
extracted from the CBCT image.21 Both these features
correlated negatively, indicating that the larger the range
of the maxillary cystic lesion, the lower the probability of
it being an SBC. However, when the OKC is small and its
image is similar to the jawbone SBC image, it cannot be
distinguished by its size alone.
Among the texture features, GLCM contrast,
NGTDM contrast, and GLCM variance had the highest
correlation coefficients (Rs). GLCM is a matrix whose
number of rows and columns represents the gray value,
and the cell contains the number of times the gray value
has a certain relationship (angle, distance, etc.). It is also
known as a second-­order histogram, and describes the
two-­by-­two arrangement of voxels. GLCM not only
reflects the distribution of brightness, but also reflects the
distribution of position between pixels with the same or
near-­same brightness.22 Contrast refers to a measure of
the local intensity change. A large contrast indicates that
the intensity values between adjacent voxels have a large
difference and that the visual effect is apparent. Variance
reflects the measurement of pixel values and mean devia-
tion. When the grayscale in the image changes greatly, the
variance and standard deviation are large. In OKCs, the
contents of the cyst cavity have a small difference in gray-
scale, and the change is relatively uniform. In contrast,
SBCs contain blood or air, bone crest, bone fragments,
and so on, and thus, the grayscale changes greatly because
of which the texture features such as GLCM contract and
GLCM variance are high.
NGTDM describes the difference between each voxel
and the adjacent voxel.23 Contrast reflects the change
of spatial brightness. High contrast indicates that the
image has a larger grayscale range and that there is more
change in gray values around a certain point. The SBC
sac cavity may have air density, blood or fluid density, and
the density of bone crests or scattered bone fragments.
These three types of densities have large differences, and
so does the gray value changes. In OKCs, the gray values
of keratin, sac fluid, and the sac wall are largely different.
This observation explains that there is more gray value
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Jiang et al
change around a certain point in SBC; therefore, the value
of contrast is higher than that of OKC.
In order to obtain more comprehensive and accu-
rate experimental results, we generated ROI along the
boundary of the lesion, so that as many features as possible
can be obtained. When the manual delineation was on the
inter side-­of the cyst, part of the information of cyst wall
and shape would be lost, making the result inaccurate. On
the other hand, excess bone tissue information would be
brought into the margin if we outlined on the intra side,
which may also interfere with the results. Precisely, the
radiomics features of the boundary are important for they
reflecting the difference between OKC and SBC, due to
their distinctly histological characteristics. Therefore, we
segmented just along the boundary of the cystic lesion in
this study. To take a more comprehensive consideration of
all the features of the image under various parameters, the
four commonly parameters R, Scale, Algo and Ng were
also used in extracting texture features in present study.
This study aimed to screen the radiomic features of
simple bone cysts of the jaws. These features may help
us explore new strategies for diagnosis. However, several
limitations of the study have to be addressed. First, this
was a single-­center retrospective study. Second, SBC is
a rare non-­odontogenic cyst. Therefore, a small sample
data set was applied in the study. A prospective random-
ized study with a larger data set to improve the proposed
prediction model is needed in further studies.
In conclusion, this study primarily showed the
potential ability of radiomics to differentiate SBCs and
other odontogenic cysts. The texture features of radio-
mics quantitatively described the differences between
SBC and OKC, and the three texture features (GLCM
contrast, NGTDM contrast, and GLCM variance)
showed the highest correlation coefficients, which were
candidate radiomic features for diagnosing SBC.
Contributors
Conception and design of study: Tao Qian, Jiang Zhe-­
Yi. Acquisition of data: Jiang Zhe-­Yi, Cai Wei-­Xin.
Analysis and interpretation of data: Lan Tian-­ Jun,
Jiang Zhe-­Yi. Drafting the manuscript: Jiang Zhe-­Yi,
Lan Tian-­ Jun. Revising the manuscript critically for
important intellectual content: Tao. Qian, Cai Wei-­
Xin. Approval of the version of the manuscript to be
published (the names of all authors must be listed):
Jiang Zhe-­Yi, Lan Tian-­Jun, Cai Wei-­Xin, Tao Qian.
Funding
This work was supported by the Science and Tech-
nology Planning Project of Guangdong Province (No.
2017A020211025), the Natural Science Foundation of
Guangdong Province (No. 2017A030313891).
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Jiang et al
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