Evaluation of the Role of Contrast Enhanced Computed Tomography Imaging in the Spectrum of Oral Masses: A Review of Benign and Malignant Lesions

Abstract

Background: Radiological assessment of oral masses is challenging owing to the compact anatomy of the oral cavity and the wide pathological spectrum. Contrast-enhanced computed tomography (CECT) offers rapid, high-resolution characterization that can guide early triage, staging, and treatment planning. Aim: To evaluate the role and diagnostic performance of CECT across the spectrum of oral masses (benign and malignant), with emphasis on reproducible imaging criteria and lesion distribution in routine practice. Methods: In this prospective cross-sectional study conducted at a tertiary centre (March-July 2025), 30 consecutive patients presenting with an oral mass/lump/swelling or pain and referred for CECT neck were enrolled after ethics approval and consent. Scans were acquired on a 128-slice MDCT using intravenous non-ionic iodinated contrast with standard multiplanar reconstructions. Two radiologists (consensus, blinded to histology) recorded site, margins, enhancement pattern, internal composition, adjacent invasion (soft tissue/bone), perineural/perivascular features, and nodal status. Where available, CECT impressions were correlated with histopathology/cytology. Descriptive statistics summarized distributions and feature–outcome associations. Results: Tongue (26.6%) and buccal mucosa (16.6%) were the most frequent subsites; malignant-prone lesions clustered in older adults (≥60 years). Imaging features strongly associated with malignancy included: irregular/ill-defined margins (present in 70% overall; malignant in 85% of such cases), heterogeneous enhancement (73%; malignant in 81%), necrotic cervical lymph nodes (60%; malignant in 94%), involvement of adjacent soft tissues/bone (76%; malignant in 95%), and intralesional necrosis/cystic change (80%; malignant in 83%). Smooth, well-defined margins (benign in 78%) and homogeneous enhancement (benign in 63%) favored benignity. Category-level concordance between CECT impression and histopathology was 100% in this cohort. Conclusions: CECT provides fast, actionable characterization of oral masses with excellent category-level agreement with histopathology. A concise checklist margins, enhancement pattern, intra-lesional necrosis/cystic change, adjacent invasion, and nodal necrosis yields high specificity for malignancy and streamlines biopsy targeting, staging, and operative planning. Larger multicentre studies should validate these predictors and standardize CECT-based reporting pathways.

Keywords: oral cavity, floor of mouth, contrast-enhanced CT, squamous cell carcinoma, lymph node necrosis, mandibular invasion, staging, head and neck imaging