Imaging Sci Dent.  2019 Mar;49(1):53-58. 10.5624/isd.2019.49.1.53.

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

• Ogura I
• Sasaki Y
• Sue M
• Oda T
• Kameta A
• Hayama K

• KMID: 2442109
• DOI: http://doi.org/10.5624/isd.2019.49.1.53

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.

Keyword

Osteonecrosis; Tomography, X-Ray Computed; Radionuclide Imaging; Magnetic Resonance Imaging

MeSH Terms

Diffusion
Humans
Jaw*
Magnetic Resonance Imaging*
Mandible*
Osteonecrosis*
Osteoradionecrosis*
Radionuclide Imaging*
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Medication-related osteonecrosis of the right side of the mandible in an 86-year-old woman. A. Axial bone tissue algorithm computed tomography shows an osteolytic lesion with sequestrum separation and periosteal bone proliferation in the right mandible (arrow). B. On magnetic resonance imaging, an axial T1-weighted image shows heterogeneous, low-signal intensity (arrow). C. An axial T2-weighted image shows heterogeneous, low-signal intensity (arrow). D. An axial short TI inversion recovery image shows heterogeneous, high-signal intensity (arrow). E. An axial diffusion-weighted image shows heterogeneous, high-signal intensity (arrow). F. An axial apparent diffusion coefficient map shows heterogeneous, low-signal intensity (arrow). G. A maximum intensity projection (diffusion-weighted image) shows the lesion in an improved way (arrow). H–J. Bone scintigraphy shows increased uptake in the mandible (arrow).

• 

  Fig. 2 Radiation-related osteonecrosis of the left side of the mandible in an 84-year-old man. A. Axial bone tissue algorithm computed tomography shows an osteolytic lesion with sequestrum separation in the left mandible (arrow). B. On magnetic resonance imaging, an axial T1-weighted image reveals heterogeneous, low-signal intensity (arrow). C. An axial T2-weighted image shows heterogeneous, high-signal intensity (arrow). D. An axial short TI inversion recovery image reveals heterogeneous, high-signal intensity (arrow). E. An axial diffusion-weighted image shows heterogeneous, high-signal intensity (arrow). F. An axial apparent diffusion coefficient map shows heterogeneous, low-signal intensity (arrow). G. A maximum intensity projection (diffusion-weighted image) shows the lesion in an improved way (arrow). H–J. Bone scintigraphy shows increased uptake in the mandible (arrow).

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