Skeletal Radiology

, Volume 43, Issue 12, pp 1669–1678 | Cite as

Cone beam computed tomography for diagnosis of bisphosphonate-related osteonecrosis of the jaw: evaluation of quantitative and qualitative image parameters

  • Roman Guggenberger
  • Emrah Koral
  • Wolfgang Zemann
  • Christine Jacobsen
  • Gustav Andreisek
  • Philipp Metzler
Scientific Article



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).

Materials and 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.


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.


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.


Cone beam CT Bisphosphonate Bisphosphonate-related osteonecrosis of the jaw (BRONJ) Diagnostic performance 


Conflict of interest statement

The authors declare that they have no conflict of interest.


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Copyright information

© ISS 2014

Authors and Affiliations

  • Roman Guggenberger
    • 1
  • Emrah Koral
    • 1
  • Wolfgang Zemann
    • 2
  • Christine Jacobsen
    • 2
  • Gustav Andreisek
    • 1
  • Philipp Metzler
    • 2
  1. 1.Department of Diagnostic and Interventional RadiologyUniversity Hospital ZurichZurichSwitzerland
  2. 2.Department of Cranio-Maxillofacial and Oral SurgeryUniversity Hospital ZurichZurichSwitzerland

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