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.
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.
Stockmann
Philipp
P
Department of Oral and Maxillofacial Surgery, University Hospital of Erlangen, Glueckstrasse 11, 91054 Erlangen, Germany. philipp.stockmann@uk-erlangen.de
Hinkmann
Fabian M
FM
Lell
Michael M
MM
Fenner
Matthias
M
Vairaktaris
Eleftherios
E
Neukam
Friedrich-Wilhelm
FW
Nkenke
Emeka
E
D000368:Aged; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D001853:Bone Marrow / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D003287:Contrast Media; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005682:Gadolinium; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects; D007571:Jaw Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008336:Mandibular Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D008439:Maxillary Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D009942:Organometallic Compounds; D010014:Osteolysis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D010020:Osteonecrosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D000077268:Pamidronate; D011862:Radiography, Panoramic; D014057:Tomography, X-Ray Computed; D000077211:Zoledronic Acid
D050071:Bone Density Conservation Agents; D003287:Contrast Media; D004164:Diphosphonates; D007093:Imidazoles; D009942:Organometallic Compounds; C090600:gadobutrol; D000077211:Zoledronic Acid; D005682:Gadolinium; D000077268:Pamidronate