title: Cone beam computed tomography for diagnosis of bisphosphonate-related osteonecrosis of the jaw: evaluation of quantitative and qualitative image parameters.
abstract: OBJECTIVE
  To assess the diagnostic performance of quantitative and qualitative image parameters in cone-beam computed tomography (CBCT) for diagnosis of bisphosphonate-related osteonecrosis of the jaw (BRONJ).
  
  
  METHODS
  A BRONJ (22 patients, mean age 70.0 years) group was age and gender matched to a healthy control group (22 patients, mean age 68.0 years). On CBCT images two independent readers performed quantitative bone density value (BDV) measurements with region and volume-of-interest (ROI and VOI) based approaches and qualitative scoring of BRONJ-associated necrosis, sclerosis and periosteal thickening (1 = not present to 5 = definitely present). Intraoperative and clinical findings served as standard of reference. Interreader agreements and diagnostic performance were assessed by intraclass correlation coefficients (ICC), kappa-statistics and receiver-operating characteristic (ROC) analysis.
  
  
  RESULTS
  Twenty-three regions in 22 patients were affected by BRONJ. ICC values for mean BDV VOI and mean BDV ROI were 0.864 and 0.968, respectively (p < 0.001). The area under the curve (AUC) for mean BDV VOI and mean BDV ROI was 0.58/0.83 with a sensitivity of 57/83% and specificity of 61/77% for diagnosis of BRONJ, respectively. Kappa values for presence of necrosis, sclerosis and periosteal thickening were 0.575, 0.617 and 0.885, respectively. AUC values for qualitative parameters ranged between 0.90-0.96 with sensitivity of 96% and specificities between 79-96% at respective cutoff scores.
  
  
  CONCLUSIONS
  BRONJ can be effectively diagnosed with CBCT. Qualitative image parameters yield a higher diagnostic performance than quantitative parameters, and ROI-based attenuation measurements were more accurate than VOI-based measurements.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland, Roman.guggenberger@usz.ch.
authors.forename: Roman
authors.initials: R
authors.lastname: Guggenberger
authors.forename: Emrah
authors.initials: E
authors.lastname: Koral
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Zemann
authors.forename: Christine
authors.initials: C
authors.lastname: Jacobsen
authors.forename: Gustav
authors.initials: G
authors.lastname: Andreisek
authors.forename: Philipp
authors.initials: P
authors.lastname: Metzler
mesh_terms: D000368:Aged; D019540:Area Under Curve; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000000981:diagnostic imaging*; D015519:Bone Density; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D007568:Jaw / Q000000981:diagnostic imaging; D008297:Male; D015588:Observer Variation; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors