Zhou Yu-Qiong, Son Gee-Hun, Shi Yue-Qi, Yu Ye-Jia, Li Meng-Yu, Zhang Qin, Zou Duo-Hong, Zhang Zhi-Yuan, Yang Chi, Wang Shao-Yi
Shanghai Ninth People's Hospital, Collage of Stomatology, Shanghai Jiao Tong University School of Medicine (200011); National Clinical Research Center of Oral Disease; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Department of Oral Surgery.
Int J Med Sci. 2021 Mar 24;18(10):2209-2216. doi: 10.7150/ijms.56408. eCollection 2021.
Medication-related osteonecrosis of the jaw (MRONJ) severely impairs patients' quality of life and is remarkably refractory to treatment. There are lots of studies about identification of the radiographic features of MRONJ, yet reports about quantitative radiographic analysis for the risk assessment of the severity and recurrence of MRONJ are rarely heard. The aim of this study was to investigate the volumes of osteolytic lesions and radiodensity values of osteosclerotic lesions in MRONJ patients by using ITK-SNAP for severity prediction and prognosis evaluation. Of 78 MRONJ patients (78 lesions) involved in this retrospective study, 53 were presented as osteolytic lesions and 25 were presented as osteosclerotic changes alone. Comprehensive CBCT images, demographics and clinical data of patients were investigated. The volumetric analysis and radiodensity measurement were performed by ITK-SNAP. SPSS 25.0 were used for statistical analysis. The osteolytic lesion volumes in MRONJ patients receiving intravenous bisphosphonates (P=0.004) and patients without osteoporosis (P=0.027) were significantly large. No significant correlation between the volumes and bisphosphonates duration was found (P=0.094). The radiodensity values of osteosclerotic lesions was significantly correlated with bisphosphonates duration (P=0.040). The surrounding area of post-surgical lesions in MRONJ patients with recurrence showed significantly great radiodensity values (P=0.025). No significant correlation between the radiodensity values and the transformation from osteosclerotic lesions to osteolytic lesions was observed (P=0.507). MRONJ patients receiving intravenous bisphosphonates develop into large volumes of osteolytic lesions more easily. Long-term bisphosphonates duration is possibly related with higher bone density of osteosclerotic lesions, while higher density is not associated with the transformation from osteosclerotic lesions to osteolytic lesions. A rise of bone mineral density nearby post-surgical lesions is probably a predictor for MRONJ recurrence.
药物相关性颌骨坏死（MRONJ）严重损害患者的生活质量，且治疗极具挑战性。关于MRONJ影像学特征识别的研究众多，但关于MRONJ严重程度和复发风险评估的定量影像学分析报道却很少。本研究旨在通过使用ITK-SNAP软件研究MRONJ患者溶骨性病变的体积和骨硬化性病变的骨密度值，以进行严重程度预测和预后评估。在这项回顾性研究纳入的78例MRONJ患者（78处病变）中，53例表现为溶骨性病变，25例仅表现为骨硬化性改变。研究了患者的综合CBCT图像、人口统计学和临床数据。通过ITK-SNAP进行体积分析和骨密度测量。使用SPSS 25.0进行统计分析。接受静脉注射双膦酸盐治疗的MRONJ患者（P = 0.004）和无骨质疏松症的患者（P = 0.027）的溶骨性病变体积明显更大。未发现病变体积与双膦酸盐使用时长之间存在显著相关性（P = 0.094）。骨硬化性病变的骨密度值与双膦酸盐使用时长显著相关（P = 0.040）。复发的MRONJ患者术后病变周围区域的骨密度值显著更高（P = 0.025）。未观察到骨密度值与骨硬化性病变向溶骨性病变转变之间存在显著相关性（P = 0.507）。接受静脉注射双膦酸盐治疗的MRONJ患者更容易发展为大面积溶骨性病变。双膦酸盐长期使用可能与骨硬化性病变的骨密度较高有关，而较高的骨密度与骨硬化性病变向溶骨性病变的转变无关。术后病变附近骨密度的升高可能是MRONJ复发的一个预测指标。
