Bisdas S, Chambron Pinho N, Smolarz A, Sader R, Vogl T J, Mack M G
Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University Hospital, Frankfurt, Germany.
Clin Radiol. 2008 Jan;63(1):71-7. doi: 10.1016/j.crad.2007.04.023. Epub 2007 Oct 22.
To evaluate the computed tomography (CT) and magnetic resonance imaging (MRI) findings of biphosphonate therapy-associated changes of the mandible and maxilla.
Thirty-two patients with a clinical history of pain, purulent discharge, and swelling in the mandible or maxilla as well as non-healing dental extraction were examined. All patients had received biphosphonate medication for approximately 33 months. Non-contrast enhanced CT and contrast-enhanced MRI were performed and, subsequently, all patients underwent a surgical removal of the affected bone, the histological diagnosis of which confirmed osteonecrosis. The images were read by two head and neck radiologists in consensus.
Osteonecrosis with Actinomyces infection was identified in the mandible of 18 patients, in the maxilla of eight patients, and in both jaws in six patients. The CT images showed predominantly osteolytic lesions and sclerotic regions in the jaws with or without periostal bone proliferation. There was a reduction of the marrow space in the jaws. The T1-weighted MRI signal was hypointense in nearly all cases. The gadolinium-enhanced MRI images revealed intensity changes of the cortical and subcortical bone structures in all patients. The T2-weighted MRI signal was hypointense on the affected side in the majority of the cases (28/32). Pathological gadolinium enhancement was observed in the neighbouring soft tissues, including the masticator space in all patients. Reactive lymphadenopathy was found in all patients in submental and jugulodigastric areas.
Biphosphonate-induced osteonecrosis of the jaws presents a wide variety of CT and MRI features that are readily recognized and help to determine the extent of the disease; however, they are not specific for the disease.
评估双膦酸盐治疗相关的下颌骨和上颌骨改变的计算机断层扫描（CT）和磁共振成像（MRI）表现。
对32例有下颌骨或上颌骨疼痛、脓性分泌物、肿胀以及拔牙创口不愈合临床病史的患者进行检查。所有患者均接受了约33个月的双膦酸盐药物治疗。进行了非增强CT和增强MRI检查，随后所有患者均接受了受累骨的手术切除，组织学诊断证实为骨坏死。图像由两位头颈放射科医生共同解读。
18例患者下颌骨、8例患者上颌骨以及6例患者上下颌骨均发现伴有放线菌感染的骨坏死。CT图像主要显示颌骨的溶骨性病变和硬化区域，伴有或不伴有骨膜增生。颌骨髓腔减小。几乎所有病例T1加权MRI信号均为低信号。钆增强MRI图像显示所有患者皮质和皮质下骨结构的强化改变。大多数病例（28/32）患侧T2加权MRI信号为低信号。在所有患者的邻近软组织包括咀嚼肌间隙均观察到病理性钆强化。所有患者颏下和颈二腹肌区均发现反应性淋巴结病。
双膦酸盐诱导的颌骨骨坏死呈现出多种CT和MRI特征，易于识别并有助于确定疾病范围；然而，这些特征并非该疾病所特有。
