An increased attenuation area (IAA) is sometimes seen in the cystic cavity of odontogenic keratocysts (OKCs) on CT scans. The significance of IAA was compared radiologically and histologically in 26 cysts in which a provisional diagnosis of OKC had been made. First, the presence of IAA in the cystic cavity was assessed. Then, relationship between the presence of IAA and data obtained from the cysts, including the CT and histological findings and the visual appearance of the cyst contents, was evaluated. An IAA was frequently seen in large multilocular cysts. There was no relationship between the presence of IAA and aggressive features of the cyst on CT or the cyst contents. Histologically, subepithelial inflammation was often observed in the cysts with IAA. In order to ascertain whether the IAA was due to the keratin mass, a CT scan of a bundle of hair in a water bath was performed and shown to have a similar density. Our study demonstrated that IAA in cystic cavities results from desquamated keratin. Since this seems to occur in long-standing or inflamed multilocular OKCs, it could be used as a significant finding in the diagnosis of OKC.
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