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

• Published in: American journal of neuroradiology : AJNR Vol. 34; no. 6; pp. 1242 - 1247
• Main Authors: Guggenberger, R., Fischer, D.R., Metzler, P., Andreisek, G., Nanz, D., Jacobsen, C., Schmid, D.T.
• Format: Journal Article
• Language: English
• Published: United States American Society of Neuroradiology 01.06.2013
• Subjects: Aged; Aged, 80 and over; Bisphosphonate-Associated Osteonecrosis of the Jaw - diagnostic imaging; Bisphosphonate-Associated Osteonecrosis of the Jaw - pathology; Bone Density Conservation Agents - adverse effects; Diphosphonates - adverse effects; Female; Fluorodeoxyglucose F18; Head & Neck; Humans; Magnetic Resonance Imaging - methods; Male; Middle Aged; Multimodal Imaging - methods; Positron-Emission Tomography; Prospective Studies; Radiopharmaceuticals; Tomography, X-Ray Computed - methods
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A3355

Imaging of bisphosphonate-induced osteonecrosis of the jaw is essential for surgical planning. We compared the extent of BONJ on contrast-enhanced MR imaging, [(18)F] fluoride PET/CT, and panoramic views derived from standard conebeam CT with clinical pre- and intraoperative examinations. Between February 2011 and January 2012, ten subjects with written informed consent (9 women; mean, 69.6 years; range, 53-88 years) were included in this prospective ethics-board-approved study. Patients underwent CEMR imaging, [(18)F] fluoride PET/CT, and CBCT and were clinically examined pre- and intraoperatively. Surgery was performed, and BONJ was histologically confirmed in 9 patients. Location and extent of BONJ on different modalities/examinations were graphically compared (0 = no pathologic finding, 1 = smallest, 5 = largest extent of BONJ). Rank tests were used to assess overall and paired differences of ratings in 9 patients. A P value <.05 was considered statistically significant. Significant differences in BONJ extent among different modalities and examinations were found (P < .001). The highest median rank was seen in PET/CT (4 ± 1.12) and CEMR imaging (4 ± 1.01), followed by intraoperative examinations (3 ± 0.71), CBCT (2 ± 0.33), and preoperative examinations (1 ± 0). No significant differences were found between PET/CT and CEMR imaging (P = .23), except when comparing PET/CT to either CBCT, pre- and intraoperative examinations (all P < .05). Preoperative examinations showed significantly less extensive disease than all other modalities/examinations (all P < .05). [(18)F] fluoride PET/CT and CEMR imaging revealed more extensive involvement of BONJ compared with panoramic views from CBCT and clinical examinations.