Imaging findings of bisphosphonate-related osteonecrosis of the jaw with emphasis on early magnetic resonance imaging findings.
OBJECTIVE
To describe the imaging findings of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with emphasis on early magnetic resonance imaging (MRI) findings.


METHODS
The medical records and computed tomography, MRI, and bone scintigraphy images of 5 female and 1male patients (n = 6) between the ages of 49 and 79 years (mean age, 70 years) who had a diagnosis of BRONJ were retrospectively reviewed, and temporal changes in imaging features were noted.


RESULTS
The earliest MRI finding was the loss of the normal T1 hyperintensity of fatty marrow in the mandible and maxilla. The MRI findings of more advanced BRONJ included bone destruction, soft tissue edema and enhancement, inferior alveolar nerve thickening, and pterygoid muscle swelling and enhancement. On computed tomography, sclerosis and subtle lucencies (widening) of the periodontal ligament and cortex and around the apices of the teeth in the early stage, and osteolytic bone lesions, cortical disruption, and frank bone fragmentation in the later stages were observed. Bone scintigraphy showed increased uptake early in the disease.


CONCLUSIONS
Osteonecrosis of the mandible and maxilla occurs as a complication of bisphosphonate treatment of bone metastasis and osteoporosis and typically manifests after a dental procedure. Magnetic resonance imaging and bone scintigraphy findings may precede clinical symptoms and mimic metastatic disease.
William Beaumont Hospital, Royal Oak, MI 48073, USA. akrishnan@beaumont.edu
Anant
A
Krishnan
Atilla
A
Arslanoglu
Nadir
N
Yildirm
Richard
R
Silbergleit
Nafi
N
Aygun
D000368:Aged; D019386:Alendronate / Q000009:adverse effects* / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000009:adverse effects; D001943:Breast Neoplasms / Q000188:drug therapy; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects*; D007571:Jaw Diseases / Q000139:chemically induced* / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000139:chemically induced* / Q000175:diagnosis*; D010024:Osteoporosis / Q000188:drug therapy; D019048:Prostatic Intraepithelial Neoplasia / Q000188:drug therapy; D012189:Retrospective Studies; D000077211:Zoledronic Acid
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D019386:Alendronate