Department of Radiology, University of Michigan Hospital, Taubman Floor 2, Room 2910F, Ann Arbor, MI 48109-5326, USA.
Radiographics. 2009 Nov;29(7):1971-84. doi: 10.1148/rg.297095050.
Bisphosphonate-related osteonecrosis of the jaw (ONJ) is characterized by nonhealing exposed bone in the maxillofacial region in patients who have undergone bisphosphonate treatment. The underlying etiology is unclear and may be multifactorial. The diagnosis is primarily clinical. Diagnostic tissue sampling may exacerbate the process and is typically avoided, necessitating other diagnostic approaches. The appearance of ONJ at diagnostic imaging is variable and includes sclerotic, lytic, or mixed lesions with possible periosteal reaction, pathologic fractures, and extension to soft tissues. There is a spectrum of signal intensity changes on T1- and T2-weighted magnetic resonance (MR) images with variable enhancement, findings that may correspond to the clinical and histopathologic stage of the process. Bone scintigraphy is sensitive with increased uptake in the area of the lesion. Although the imaging findings are nonspecific, there appears to be a role for imaging in the management of ONJ. Radiography is relatively insensitive but typically employed as the first line of radiologic investigation. Computed tomography and MR imaging are more precise in demonstrating the extent of the lesion. A number of imaging modalities have revealed lesions that may be associated with bisphosphonate exposure in asymptomatic individuals or in the context of nonspecific symptoms. The risk of these lesions advancing to overt clinical disease is unknown at this time. The radiologist should be aware of ONJ and include it in the differential diagnosis when evaluating patients with a history of bisphosphonate therapy without jaw irradiation, so as to avoid potentially harmful biopsies.
双膦酸盐相关性下颌骨坏死（ONJ）的特征是接受双膦酸盐治疗的患者的颌面区域出现无法愈合的暴露骨。其潜在病因尚不清楚，可能是多因素的。诊断主要基于临床。诊断性组织采样可能会加重病情，通常会避免进行，因此需要其他诊断方法。ONJ 在诊断性影像学上的表现多样，包括硬化性、溶骨性或混合性病变，可能伴有骨膜反应、病理性骨折和软组织扩展。T1 和 T2 加权磁共振（MR）图像上存在信号强度变化的谱，增强程度不同，这些发现可能与病变的临床和组织病理学阶段相对应。骨闪烁显像具有较高的摄取率，对病变区域敏感。尽管影像学表现是非特异性的，但影像学在 ONJ 的治疗管理中似乎具有一定作用。X 线摄影相对不敏感，但通常作为一线影像学检查。计算机断层扫描和磁共振成像在显示病变范围方面更精确。一些影像学方法已经揭示了与双膦酸盐暴露相关的病变，这些病变可能在无症状个体或非特异性症状的情况下出现。这些病变进展为明显临床疾病的风险目前尚不清楚。放射科医生应意识到 ONJ，并在评估无颌骨放疗且有双膦酸盐治疗史的患者时将其纳入鉴别诊断，以避免进行可能有害的活检。
