Tc-99m hydroxymethylene diphosphonate scintigraphy, computed tomography, and magnetic resonance imaging of osteonecrosis in the mandible: Osteoradionecrosis versus medication-related osteonecrosis of the jaw

Abstract

Purpose To present characteristic findings of Tc-99m hydroxymethylene diphosphonate (HMDP) scintigraphy, computed tomography (CT), and magnetic resonance (MR) imaging for osteonecrosis in the mandible, especially osteoradionecrosis (ORN) and medication-related osteonecrosis of the jaw (MRONJ). Materials and Methods Thirteen patients with MRONJ and 7 patients with ORN in the mandible underwent Tc-99m HMDP scintigraphy, CT, and MR imaging (T1-weighted images [T1WI], T2-weighted images [T2WI], short inversion time inversion recovery images [STIR]), diffusion-weighted images [DWI], and apparent diffusion coefficient [ADC] mapping). The associations of scintigraphy, CT, and MR imaging findings with MRONJ and ORN were analyzed using the chi-square test with the Pearson exact test. Results Thirteen patients with MRONJ and 7 patients with ORN in the mandible showed low signal intensity on T1WI and ADC mapping, high signal intensity on STIR and DWI, and increased uptake on scintigraphy. Periosteal bone proliferation on CT was observed in 69.2% of patients with MRONJ (9 of 13) versus 14.3% of patients with ORN (1 of 7) ( P =0.019). Conclusion This study presented characteristic imaging findings of MRONJ and ORN on scintigraphy, CT, and MR imaging. Our results suggest that CT can be effective for detecting MRONJ and ORN.

Clinical and panoramic radiographic features of osteomyelitis of the jaw: A comparison between antiresorptive medication-related and medication-unrelated conditions

“…16 Several previous studies have attempted to identify pathognomonic imaging features of MRONJ; however, most of those studies used 3-dimensional (3D) imaging modalities. 15,17,18 As panoramic radiography is typically used as part of the basic examination performed in dental clinics, we hypothesized that the early detection of signs of MRONJ using panoramic radiography, along with medication history, could be extremely helpful in diagnosing MRONJ. In the present study, sequestrum and extraction socket were observed significantly more frequently in the medication-related group.…”

Clinical Diagnostic Imaging Study of Osteoradionecrosis of the Jaw: A Retrospective Study

“…Similar results were reported by Ogura et al, which could be distinguished from medication-related osteonecrosis of the jaw (MRONJ). MRONJ was often observed periosteum reaction and the periosteum condition of MRONJ is usually less damaged than that of ORN [37,38].…”

Quantitative Analysis of Multimodal Skeletal SPECT/CT Reconstructions in Diagnosing Medication-related Osteonecrosis of the Jaw

“…One particular limitation of our study was the very high probability of BRONJ in patients we selected, so the specificities cited herein must be interpreted with some caution. Clearly, other disorders of mandible and maxilla, such as osteomyelitis [26], radionecrosis [27], and severe periodontitis [28], may similarly exact marked increases in polyphosphonate uptake, making it difficult to diagnose MRONJ on the basis of bone scan only. However, Ogura et al recently published two papers on use of quantitative SPECT/CT to discriminate MRONJ from other disorders of the jaw, primarily chronic osteomyelitis and osteoradionecrosis [27,29].…”