Bisphosphonate-Induced Osteonecrosis of the Jaw: Comparison of Disease Extent on Contrast-Enhanced MR Imaging, [¹⁸F] Fluoride PET/CT, and Conebeam CT imaging

Abstract

BACKGROUND AND PURPOSE:Imaging of bisphosphonate-induced osteonecrosis of the jaw is essential for surgical planning. We compared the extent of BONJ on contrast-enhanced MR imaging, [18 F] fluoride PET/CT, and panoramic views derived from standard

Cone beam computed tomography for diagnosis of bisphosphonate-related osteonecrosis of the jaw: evaluation of quantitative and qualitative image parameters

“…However, major issues were discovered when research studies were performed comparing radiography, CT, MRI, scintigraphy, SPECT-CT and positron emission tomography. Several studies revealed substantial differences in interpretation of disease extent based Regions: right hemibandible: condylar process=region 1, coronoid process=region 2, ramus=region 3, posterior mandible=region 4, anterior mandible=region 5; left hemibandible: condylar process=region 6, coronoid process=region 7, ramus=region 8, posterior mandible=region 9, anterior mandible=region 10 Scores:1=not present, 2=probably present, 3=slightly present, 4=mod-erately present and 5=markedly present upon the imaging modality used [12][13][14]. These variances hindered clear-cut definition of disease borders and straightforward therapy planning.…”

“…Different radiological examinations have been applied in cases of BRONJ but no gold standard has been agreed upon [12][13][14]. However, conventional radiography and CT scans are widely used and may show periosteal reaction, sclerotic lesions and also mixed bone changes with ill-defined areas of lucency potentially leading to formations of a sequestrum.…”

Bisphosphonate-related osteonecrosis of the jaw: from the sine qua non condition of bone exposure to a non-exposed BRONJ entity

“…56 Meanwhile, this examination is not able to show the destruction of the cortical bone 37,45 and can overestimate the dimension of the necrotic lesion, where it is not recommended to determine BRONJ extent. 43,55 Another limitation in MRI is the artefact generated from the dental casting alloys. 58 Bisdas et al 47 reported that the T 1 weighted MRI signal was hypointense in nearly all BRONJ cases evaluated.…”

“…52 Nevertheless, CBCT attenuation analysis is not as reliable as that in CT, showing a lower soft-tissue contrast. 55 CBCT has a limitation in image quality related to noise and contrast resolution because of large amounts of scattered radiation. This is an important disadvantage of CBCT and occurs especially with larger fields of view.…”

“…57 MRI provides an adequate evaluation of bone involvement, 43 excellent contrast detail of the soft tissue and three-dimensional reconstruction, without exposing the patient to ionizing radiation. 55 It represents an interesting option to examine BRONJ, allowing assessment of bone marrow involvement 57 and improved softtissue observation, 37 including neurovascular bundles and lymphadenopathy. 57 BRONJ involvement of the cancellous bone can be detected as a low signal intensity on T 1 weighted images and a mild hyperintensity on T 2 weighted and turbo short tau inversion-recovery images.…”