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Role of magnetic resonance imaging in diagnosis of bisphosphonate-related osteonecrosis of the jaw

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Abstract

Objectives

To clarify the magnetic resonance (MR) imaging features of bisphosphonate-related osteonecrosis of the jaw (BRONJ), particularly those in the early stage, through a literature review and case analysis.

Methods

Literature on MR imaging of BRONJ was collected, and the MR imaging features were summarized. On MR images of patients with BRONJ, the signal intensity of the bone marrow was evaluated quantitatively by means of the contrast-to-noise ratio (CNR). The relationships of the imaging features with the presence of exposed bone, types and administration routes of bisphosphonates (BP), and duration of symptoms were investigated.

Results

Fifteen articles were identified. In the early stages, the region of osteonecrosis displayed decreased signal intensity on T1-weighted images and normal signal intensity on T2-weighted images. In the late stages, the signal intensity of the bone marrow on T2-weighted images was variable: the exposed diseased bone displayed decreased signal intensity, and the unexposed diseased bone displayed increased signal intensity. These changes were also seen in BRONJ cases. There was a significant difference in the CNR between the exposed and unexposed diseased bones on STIR images. There were no significant differences in the CNR among the three groups by types and administration routes of BP, both on T1-weighted and STIR images. Changes in the signal intensity of bone marrow were seen at the early duration of symptoms. In the early stage, the CNR on T1-weighted images had a significant correlation with duration of symptoms.

Conclusion

MR imaging may provide visualization of useful features in the early stage of BRONJ.

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Acknowledgments

We are thankful to all of the dentists in the Departments of Oral and Maxillofacial Radiology, Oral and Maxillofacial Surgery, Maxillofacial Surgery, and Oral Pathology for participating in the diagnosis and medical treatment of patients. We also thank all staff members in the MRI laboratory section of Hachiya Orthopedic Hospital for performing MR examinations of patients. In addition, we thank Prof. Tanimoto (Editor-in-Chief of the journal), Prof. Shimizutani (President of the 17th Congress of Clinical Imaging for Oral and Maxillofacial Lesions in Japan), and Prof. Taguchi (Coordinator of Symposium) for giving us the opportunity to present our work and contribute our findings to the medical field.

Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Radiology, Aichi-Gakuin University School of Dentistry, 2-11 Suemori-dori, Chikusa-ku, Nagoya, 464-8651, Japan

    Yoshiko Ariji & Eiichiro Ariji

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  1. Yoshiko Ariji
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  2. Eiichiro Ariji
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Correspondence to Yoshiko Ariji.

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Ariji, Y., Ariji, E. Role of magnetic resonance imaging in diagnosis of bisphosphonate-related osteonecrosis of the jaw. Oral Radiol 29, 111–120 (2013). https://doi.org/10.1007/s11282-013-0124-6

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  • DOI: https://doi.org/10.1007/s11282-013-0124-6

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