Objective: Bisphosphonates are a group of drugs used in the treatment of many common diseases, such as osteoporosis, bone metastasis, and multiple myeloma. Since 2003 an increasing number of cases of bisphosphonate-related osteonecrosis of the jaw (BRONJ) has been reported. BRONJ is a severe, challenging condition, characterized by bone exposure, pain, superinfection, and masticatory and speech disorders. Surgery is often the only possible treatment, but relapse is unfortunately common; this is probably due to an underestimation of the extent of the disease or to a late diagnosis. The aim of this study was to evaluate the role of MRI in the assessment of BRONJ lesions, considering the possible impact of MRI in the clinical and surgical management of patients. Materials and Methods: Twenty-eight patients (11 men, 17 women; mean age, 66.3 years; range, 49-75 years) with suspected BRONJ have been evaluated with clinical examination and MRI (1.5-T head array). Thirteen patients out of 28 (46.4%) had been treated with bisphosphonates for myeloma, 9/28 (32.1%) for bone metastasis, and 6/28 (21.4%) for osteoporosis. Results: Twenty-two patients out of 28 (78.6%) were found to have BRONJ, and 26 lesions were detected and confirmed by surgical inspection and histologic examination. Twenty-two of these lesions out of 26 (84.6%) developed in the lower jaw, while 4/26 (15.4%) were located in the upper jaw. MRI identified 23/26 lesions (88.5%), while clinical examination was able to detect 15/26 lesions (57.7%); one lesion out of the 15 detected by clinical examination was missed by MRI, whereas eight lesions was detected only with MRI (p = 0.039). MRI was able to detect medullary bone alteration and to assess the extension of the disease; this was in most cases larger than suspected with clinical examination. MRI also showed swelling of the soft tissue in 9/22 patients (40.9%), while fistulous tracts between the necrotic bone and the soft tissue were detected in 3/22 patients (13.6%). Conclusion: Our study confirmed that MRI has high sensitivity in the detection of BRONJ lesions. MRI allows evaluation of the extension of the disease assessing the area of medullary bone alteration as well as the involvement of the soft tissue. This may lead to an earlier diagnosis, to an improvement of surgery outcome, and may reduce the number of relapses and postoperative complications.

Bisphosfonate-Related Osteonecrosis of the Jaw: Role of MRI

FILONZI, GIACOMO;BAZZOCCHI, ALBERTO;SPINNATO, PAOLO;CICCARESE, FEDERICA;BAGLIVO, EMANUELA;SALIZZONI, EUGENIO
2012

Abstract

Objective: Bisphosphonates are a group of drugs used in the treatment of many common diseases, such as osteoporosis, bone metastasis, and multiple myeloma. Since 2003 an increasing number of cases of bisphosphonate-related osteonecrosis of the jaw (BRONJ) has been reported. BRONJ is a severe, challenging condition, characterized by bone exposure, pain, superinfection, and masticatory and speech disorders. Surgery is often the only possible treatment, but relapse is unfortunately common; this is probably due to an underestimation of the extent of the disease or to a late diagnosis. The aim of this study was to evaluate the role of MRI in the assessment of BRONJ lesions, considering the possible impact of MRI in the clinical and surgical management of patients. Materials and Methods: Twenty-eight patients (11 men, 17 women; mean age, 66.3 years; range, 49-75 years) with suspected BRONJ have been evaluated with clinical examination and MRI (1.5-T head array). Thirteen patients out of 28 (46.4%) had been treated with bisphosphonates for myeloma, 9/28 (32.1%) for bone metastasis, and 6/28 (21.4%) for osteoporosis. Results: Twenty-two patients out of 28 (78.6%) were found to have BRONJ, and 26 lesions were detected and confirmed by surgical inspection and histologic examination. Twenty-two of these lesions out of 26 (84.6%) developed in the lower jaw, while 4/26 (15.4%) were located in the upper jaw. MRI identified 23/26 lesions (88.5%), while clinical examination was able to detect 15/26 lesions (57.7%); one lesion out of the 15 detected by clinical examination was missed by MRI, whereas eight lesions was detected only with MRI (p = 0.039). MRI was able to detect medullary bone alteration and to assess the extension of the disease; this was in most cases larger than suspected with clinical examination. MRI also showed swelling of the soft tissue in 9/22 patients (40.9%), while fistulous tracts between the necrotic bone and the soft tissue were detected in 3/22 patients (13.6%). Conclusion: Our study confirmed that MRI has high sensitivity in the detection of BRONJ lesions. MRI allows evaluation of the extension of the disease assessing the area of medullary bone alteration as well as the involvement of the soft tissue. This may lead to an earlier diagnosis, to an improvement of surgery outcome, and may reduce the number of relapses and postoperative complications.
AJR
E493
E493
G. Filonzi; A. Bazzocchi; P. Spinnato; F. Ciccarese; E. Baglivo; E. Salizzoni.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11585/116309
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