Panoramic radiograph, computed tomography or magnetic resonance imaging. Which imaging technique should be preferred in bisphosphonate-associated osteonecrosis of the jaw? A prospective clinical study

Abstract

It was the aim of the present study to find out which radiological imaging techniques allow assessing the extent of bisphosphonate-associated osteonecrosis of the jaw (BONJ) in an adequate way. Twenty-four patients suffering from BONJ were included in the study. Before surgery, each patient was examined with panoramic radiograph, contrast-enhanced magnetic resonance imaging (MRI) and non-enhanced computed tomography. The detectability of BONJ was assessed for the three imaging techniques. The extent of the jaw region affected by BONJ was determined in MRI and CT scans and compared to the intra-operative situation. The detectability of BONJ lesions was 54% for panoramic radiographs, 92% for MRI scans and 96% for computed tomography (CT) scans. The intra-operatively assessed extent of BONJ correlated significantly with the measurements on CT scans (p = 0.0004) but did not correlate significantly with the measurements in MRI scans (p = 0.241). The intra-operatively measured extent of BONJ differed significantly from the CT measurements (p = 0.00003) but not from the MRI data (p = 0.137). Although MRI as well as CT have a high detectability for BONJ lesions that exceeds that of panoramic radiographs by far, both techniques show problems with the exact assessment of the extent of BONJ lesions in the individual patients. Therefore, the relevance of MRI and CT for the preoperative assessment of the extent of BONJ lesions is limited. Future research should focus on the identification of imaging techniques that allow assessing the extent of BONJ lesions with a higher accuracy.

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

“…Soft-tissue involvement can be detected with increased sensitivity by intravenous contrast administration, either in contrast-enhanced MDCT or in CEMR imaging. 6,11,18 Although only affected bone tissue was quantified, our results showed significantly larger disease extent in CEMR imaging compared with the widely used reference CBCT and clinical examination. This finding corroborates the notion of the additive value of intravenous contrast for disease quantification.…”

“…This problem has been shown in a previous study, where MR imaging and CT provided high detectability for BONJ lesions that exceeded that of panoramic radiographs by far, but both techniques had limitations concerning the exact assessment of the extent of BONJ lesions in individual patients. 18 The same observation may apply to [ 18 F] fluoride PET/CT imaging. [ 18 F] fluoride is a radioactive tracer that is incorporated in hydroxyapatite by osteoblasts during bone neoformation.…”

Do CBCT scans alter surgical treatment plans? Comparison of preoperative surgical diagnosis using panoramic versus cone-beam CT images

“…In contrast, several authors have stated that 3D analysis is superior to 2D imaging with respect to osteomyelitis (Bianchi et al, 2007, Stockmann et al, 2010, Treister et al, 2010. However, this might be explained by the relatively small sample size in this study.…”

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

“…Other reports point to CT as the best examination for diagnosing BRONJ at early stages, since it has a higher definition and better performance than panoramic radiography. 27,30,36,38,42,43 Nevertheless, according to some authors, all patients under bisphosphonate therapy should initially undergo panoramic radiography and afterwards further examinations if needed. 37,44 For the early detection of BRONJ, Hamada et al 38 recommend CT analysis of cancellous bone radiodensity.…”

“…Considering these properties in BRONJ evaluation, it seems that CBCT gives a precise analysis of bone lesion extent within the jaws and its relationship with structures such as the inferior alveolar nerve and teeth, whereas CT can give more information about the soft tissues involved, including cervical lymphadenopathy, and also the involvement of nasal and maxillary sinus cavities. 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.…”