Imaging findings of bisphosphonate-related osteonecrosis of the jaw with emphasis on early magnetic resonance imaging findings

Anant Krishnan, Atilla Arslanoglu, Nadir Yildirm, Richard Silbergleit, Nafi Aygun

Research output: Contribution to journalArticle

Abstract

PURPOSE: To describe the imaging findings of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with emphasis on early magnetic resonance imaging (MRI) findings. MATERIALS AND 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.

Original languageEnglish (US)
Pages (from-to)298-304
Number of pages7
JournalJournal of Computer Assisted Tomography
Volume33
Issue number2
DOIs
StatePublished - Mar 2009

Fingerprint

Bisphosphonate-Associated Osteonecrosis of the Jaw
Magnetic Resonance Imaging
Bone and Bones
Radionuclide Imaging
Maxilla
Mandible
Pterygoid Muscles
Tooth Apex
Tomography
Mandibular Nerve
Periodontal Ligament
Osteonecrosis
Diphosphonates
Sclerosis
Osteoporosis
Medical Records
Edema
Tooth
Bone Marrow
Neoplasm Metastasis

Keywords

  • Bisphosphonate
  • CT
  • Jaw
  • Mandible
  • MRI
  • Osteonecrosis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Imaging findings of bisphosphonate-related osteonecrosis of the jaw with emphasis on early magnetic resonance imaging findings. / Krishnan, Anant; Arslanoglu, Atilla; Yildirm, Nadir; Silbergleit, Richard; Aygun, Nafi.

In: Journal of Computer Assisted Tomography, Vol. 33, No. 2, 03.2009, p. 298-304.

Research output: Contribution to journalArticle

Krishnan, Anant ; Arslanoglu, Atilla ; Yildirm, Nadir ; Silbergleit, Richard ; Aygun, Nafi. / Imaging findings of bisphosphonate-related osteonecrosis of the jaw with emphasis on early magnetic resonance imaging findings. In: Journal of Computer Assisted Tomography. 2009 ; Vol. 33, No. 2. pp. 298-304.
@article{ee0f2fdf4f94473ba5b14de8732ab646,
title = "Imaging findings of bisphosphonate-related osteonecrosis of the jaw with emphasis on early magnetic resonance imaging findings",
abstract = "PURPOSE: To describe the imaging findings of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with emphasis on early magnetic resonance imaging (MRI) findings. MATERIALS AND 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.",
keywords = "Bisphosphonate, CT, Jaw, Mandible, MRI, Osteonecrosis",
author = "Anant Krishnan and Atilla Arslanoglu and Nadir Yildirm and Richard Silbergleit and Nafi Aygun",
year = "2009",
month = "3",
doi = "10.1097/RCT.0b013e31817e4986",
language = "English (US)",
volume = "33",
pages = "298--304",
journal = "Journal of Computer Assisted Tomography",
issn = "0363-8715",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Imaging findings of bisphosphonate-related osteonecrosis of the jaw with emphasis on early magnetic resonance imaging findings

AU - Krishnan, Anant

AU - Arslanoglu, Atilla

AU - Yildirm, Nadir

AU - Silbergleit, Richard

AU - Aygun, Nafi

PY - 2009/3

Y1 - 2009/3

N2 - PURPOSE: To describe the imaging findings of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with emphasis on early magnetic resonance imaging (MRI) findings. MATERIALS AND 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.

AB - PURPOSE: To describe the imaging findings of bisphosphonate-related osteonecrosis of the jaw (BRONJ) with emphasis on early magnetic resonance imaging (MRI) findings. MATERIALS AND 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.

KW - Bisphosphonate

KW - CT

KW - Jaw

KW - Mandible

KW - MRI

KW - Osteonecrosis

UR - http://www.scopus.com/inward/record.url?scp=64749113650&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=64749113650&partnerID=8YFLogxK

U2 - 10.1097/RCT.0b013e31817e4986

DO - 10.1097/RCT.0b013e31817e4986

M3 - Article

C2 - 19346864

AN - SCOPUS:64749113650

VL - 33

SP - 298

EP - 304

JO - Journal of Computer Assisted Tomography

JF - Journal of Computer Assisted Tomography

SN - 0363-8715

IS - 2

ER -