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<meta name="DC.Title" content="Bisphosphonate-Induced Osteonecrosis of the Jaw: Comparison of Disease Extent on Contrast-Enhanced MR Imaging, [18F] Fluoride PET/CT, and Conebeam CT imaging" />
<meta name="DC.Identifier" content="10.3174/ajnr.A3355" />
<meta name="DC.Date" content="2012-12-06" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2013 American Society of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Imaging of bisphosphonate-induced osteonecrosis of the jaw is essential for surgical planning. We compared the extent of BONJ on contrast-enhanced MR imaging, [18F] fluoride PET/CT, and panoramic views derived from standard conebeam CT with clinical pre- and intraoperative examinations.

MATERIALS AND METHODS: Between February 2011 and January 2012, ten subjects with written informed consent (9 women; mean, 69.6 years; range, 53–88 years) were included in this prospective ethics-board-approved study. Patients underwent CEMR imaging, [18F] fluoride PET/CT, and CBCT and were clinically examined pre- and intraoperatively. Surgery was performed, and BONJ was histologically confirmed in 9 patients. Location and extent of BONJ on different modalities/examinations were graphically compared (0 = no pathologic finding, 1 = smallest, 5 = largest extent of BONJ). Rank tests were used to assess overall and paired differences of ratings in 9 patients. A P value &lt;.05 was considered statistically significant.

RESULTS: Significant differences in BONJ extent among different modalities and examinations were found ( P &lt; .001). The highest median rank was seen in PET/CT (4 ± 1.12) and CEMR imaging (4 ± 1.01), followed by intraoperative examinations (3 ± 0.71), CBCT (2 ± 0.33), and preoperative examinations (1 ± 0). No significant differences were found between PET/CT and CEMR imaging ( P = .23), except when comparing PET/CT to either CBCT, pre- and intraoperative examinations (all P &lt; .05). Preoperative examinations showed significantly less extensive disease than all other modalities/examinations (all P &lt; .05).

CONCLUSIONS: [18F] fluoride PET/CT and CEMR imaging revealed more extensive involvement of BONJ compared with panoramic views from CBCT and clinical examinations.

### Abbreviations

BONJ
:   bisphosphonate-induced osteonecrosis of the jaw
CBCT
:   conebeam CT
CEMR
:   contrast-enhanced MR
MDCT
:   multidetector CT
STIR
:   short τ inversion recovery" />
<meta name="DC.Contributor" content="R. Guggenberger" />
<meta name="DC.Contributor" content="D.R. Fischer" />
<meta name="DC.Contributor" content="P. Metzler" />
<meta name="DC.Contributor" content="G. Andreisek" />
<meta name="DC.Contributor" content="D. Nanz" />
<meta name="DC.Contributor" content="C. Jacobsen" />
<meta name="DC.Contributor" content="D.T. Schmid" />
<meta name="article:published_time" content="2012-12-06" />
<meta name="article:section" content="HEAD &amp;amp; NECK" />
<meta name="citation_title" content="Bisphosphonate-Induced Osteonecrosis of the Jaw: Comparison of Disease Extent on Contrast-Enhanced MR Imaging, [18F] Fluoride PET/CT, and Conebeam CT imaging" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Imaging of bisphosphonate-induced osteonecrosis of the jaw is essential for surgical planning. We compared the extent of BONJ on contrast-enhanced MR imaging, [&lt;sup&gt;18&lt;/sup&gt;F] fluoride PET/CT, and panoramic views derived from standard conebeam CT with clinical pre- and intraoperative examinations.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Between February 2011 and January 2012, ten subjects with written informed consent (9 women; mean, 69.6 years; range, 53–88 years) were included in this prospective ethics-board-approved study. Patients underwent CEMR imaging, [&lt;sup&gt;18&lt;/sup&gt;F] fluoride PET/CT, and CBCT and were clinically examined pre- and intraoperatively. Surgery was performed, and BONJ was histologically confirmed in 9 patients. Location and extent of BONJ on different modalities/examinations were graphically compared (0 = no pathologic finding, 1 = smallest, 5 = largest extent of BONJ). Rank tests were used to assess overall and paired differences of ratings in 9 patients. A &lt;i&gt;P&lt;/i&gt; value &amp;lt;.05 was considered statistically significant.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Significant differences in BONJ extent among different modalities and examinations were found (&lt;i&gt;P&lt;/i&gt; &amp;lt; .001). The highest median rank was seen in PET/CT (4 ± 1.12) and CEMR imaging (4 ± 1.01), followed by intraoperative examinations (3 ± 0.71), CBCT (2 ± 0.33), and preoperative examinations (1 ± 0). No significant differences were found between PET/CT and CEMR imaging (&lt;i&gt;P&lt;/i&gt; = .23), except when comparing PET/CT to either CBCT, pre- and intraoperative examinations (all &lt;i&gt;P&lt;/i&gt; &amp;lt; .05). Preoperative examinations showed significantly less extensive disease than all other modalities/examinations (all &lt;i&gt;P&lt;/i&gt; &amp;lt; .05).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;[&lt;sup&gt;18&lt;/sup&gt;F] fluoride PET/CT and CEMR imaging revealed more extensive involvement of BONJ compared with panoramic views from CBCT and clinical examinations.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
<meta name="citation_publisher" content="American Journal of Neuroradiology" />
<meta name="citation_publication_date" content="2012/12/06" />
<meta name="citation_mjid" content="ajnr;ajnr.A3355v1" />
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<meta name="citation_doi" content="10.3174/ajnr.A3355" />
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<meta name="citation_article_type" content="Research Article" />
<meta name="citation_section" content="HEAD &amp;amp; NECK" />
<meta name="citation_author" content="R. Guggenberger" />
<meta name="citation_author_institution" content="From the Departments of Diagnostic and Interventional Radiology (R.G., D.R.F., G.A., D.N.), Nuclear Medicine (D.R.F., D.T.S.), and Cranio-Maxillofacial and Oral Surgery (P.M., C.J.), University Hospital Zurich, Zurich, Switzerland." />
<meta name="citation_author" content="D.R. Fischer" />
<meta name="citation_author_institution" content="From the Departments of Diagnostic and Interventional Radiology (R.G., D.R.F., G.A., D.N.), Nuclear Medicine (D.R.F., D.T.S.), and Cranio-Maxillofacial and Oral Surgery (P.M., C.J.), University Hospital Zurich, Zurich, Switzerland." />
<meta name="citation_author" content="P. Metzler" />
<meta name="citation_author_institution" content="From the Departments of Diagnostic and Interventional Radiology (R.G., D.R.F., G.A., D.N.), Nuclear Medicine (D.R.F., D.T.S.), and Cranio-Maxillofacial and Oral Surgery (P.M., C.J.), University Hospital Zurich, Zurich, Switzerland." />
<meta name="citation_author" content="G. Andreisek" />
<meta name="citation_author_institution" content="From the Departments of Diagnostic and Interventional Radiology (R.G., D.R.F., G.A., D.N.), Nuclear Medicine (D.R.F., D.T.S.), and Cranio-Maxillofacial and Oral Surgery (P.M., C.J.), University Hospital Zurich, Zurich, Switzerland." />
<meta name="citation_author" content="D. Nanz" />
<meta name="citation_author_institution" content="From the Departments of Diagnostic and Interventional Radiology (R.G., D.R.F., G.A., D.N.), Nuclear Medicine (D.R.F., D.T.S.), and Cranio-Maxillofacial and Oral Surgery (P.M., C.J.), University Hospital Zurich, Zurich, Switzerland." />
<meta name="citation_author" content="C. Jacobsen" />
<meta name="citation_author_institution" content="From the Departments of Diagnostic and Interventional Radiology (R.G., D.R.F., G.A., D.N.), Nuclear Medicine (D.R.F., D.T.S.), and Cranio-Maxillofacial and Oral Surgery (P.M., C.J.), University Hospital Zurich, Zurich, Switzerland." />
<meta name="citation_author" content="D.T. Schmid" />
<meta name="citation_author_institution" content="From the Departments of Diagnostic and Interventional Radiology (R.G., D.R.F., G.A., D.N.), Nuclear Medicine (D.R.F., D.T.S.), and Cranio-Maxillofacial and Oral Surgery (P.M., C.J.), University Hospital Zurich, Zurich, Switzerland." />
<meta name="twitter:title" content="Bisphosphonate-Induced Osteonecrosis of the Jaw: Comparison of Disease Extent on Contrast-Enhanced MR Imaging, [18F] Fluoride PET/CT, and Conebeam CT imaging" />
<meta name="twitter:card" content="summary" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Imaging of bisphosphonate-induced osteonecrosis of the jaw is essential for surgical planning. We compared the extent of BONJ on contrast-enhanced MR imaging, [18F] fluoride PET/CT, and panoramic views derived from standard conebeam CT with clinical pre- and intraoperative examinations.

MATERIALS AND METHODS: Between February 2011 and January 2012, ten subjects with written informed consent (9 women; mean, 69.6 years; range, 53–88 years) were included in this prospective ethics-board-approved study. Patients underwent CEMR imaging, [18F] fluoride PET/CT, and CBCT and were clinically examined pre- and intraoperatively. Surgery was performed, and BONJ was histologically confirmed in 9 patients. Location and extent of BONJ on different modalities/examinations were graphically compared (0 = no pathologic finding, 1 = smallest, 5 = largest extent of BONJ). Rank tests were used to assess overall and paired differences of ratings in 9 patients. A P value &lt;.05 was considered statistically significant.

RESULTS: Significant differences in BONJ extent among different modalities and examinations were found ( P &lt; .001). The highest median rank was seen in PET/CT (4 ± 1.12) and CEMR imaging (4 ± 1.01), followed by intraoperative examinations (3 ± 0.71), CBCT (2 ± 0.33), and preoperative examinations (1 ± 0). No significant differences were found between PET/CT and CEMR imaging ( P = .23), except when comparing PET/CT to either CBCT, pre- and intraoperative examinations (all P &lt; .05). Preoperative examinations showed significantly less extensive disease than all other modalities/examinations (all P &lt; .05).

CONCLUSIONS: [18F] fluoride PET/CT and CEMR imaging revealed more extensive involvement of BONJ compared with panoramic views from CBCT and clinical examinations.

### Abbreviations

BONJ
:   bisphosphonate-induced osteonecrosis of the jaw
CBCT
:   conebeam CT
CEMR
:   contrast-enhanced MR
MDCT
:   multidetector CT
STIR
:   short τ inversion recovery" />
<meta name="og-title" property="og:title" content="Bisphosphonate-Induced Osteonecrosis of the Jaw: Comparison of Disease Extent on Contrast-Enhanced MR Imaging, [18F] Fluoride PET/CT, and Conebeam CT imaging" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2012/12/06/ajnr.A3355" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Imaging of bisphosphonate-induced osteonecrosis of the jaw is essential for surgical planning. We compared the extent of BONJ on contrast-enhanced MR imaging, [18F] fluoride PET/CT, and panoramic views derived from standard conebeam CT with clinical pre- and intraoperative examinations.

MATERIALS AND METHODS: Between February 2011 and January 2012, ten subjects with written informed consent (9 women; mean, 69.6 years; range, 53–88 years) were included in this prospective ethics-board-approved study. Patients underwent CEMR imaging, [18F] fluoride PET/CT, and CBCT and were clinically examined pre- and intraoperatively. Surgery was performed, and BONJ was histologically confirmed in 9 patients. Location and extent of BONJ on different modalities/examinations were graphically compared (0 = no pathologic finding, 1 = smallest, 5 = largest extent of BONJ). Rank tests were used to assess overall and paired differences of ratings in 9 patients. A P value &lt;.05 was considered statistically significant.

RESULTS: Significant differences in BONJ extent among different modalities and examinations were found ( P &lt; .001). The highest median rank was seen in PET/CT (4 ± 1.12) and CEMR imaging (4 ± 1.01), followed by intraoperative examinations (3 ± 0.71), CBCT (2 ± 0.33), and preoperative examinations (1 ± 0). No significant differences were found between PET/CT and CEMR imaging ( P = .23), except when comparing PET/CT to either CBCT, pre- and intraoperative examinations (all P &lt; .05). Preoperative examinations showed significantly less extensive disease than all other modalities/examinations (all P &lt; .05).

CONCLUSIONS: [18F] fluoride PET/CT and CEMR imaging revealed more extensive involvement of BONJ compared with panoramic views from CBCT and clinical examinations.

### Abbreviations

BONJ
:   bisphosphonate-induced osteonecrosis of the jaw
CBCT
:   conebeam CT
CEMR
:   contrast-enhanced MR
MDCT
:   multidetector CT
STIR
:   short τ inversion recovery" />
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      <h1 class="highwire-cite-title" id="page-title">Bisphosphonate-Induced Osteonecrosis of the Jaw: Comparison of Disease Extent on Contrast-Enhanced MR Imaging, [<sup>18</sup>F] Fluoride PET/CT, and Conebeam CT imaging</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">R. Guggenberger</span>, <span class="highwire-citation-author" data-delta="1">D.R. Fischer</span>, <span class="highwire-citation-author" data-delta="2">P. Metzler</span>, <span class="highwire-citation-author" data-delta="3">G. Andreisek</span>, <span class="highwire-citation-author" data-delta="4">D. Nanz</span>, <span class="highwire-citation-author" data-delta="5">C. Jacobsen</span> and <span class="highwire-citation-author" data-delta="6">D.T. Schmid</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">December 2012,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A3355 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-50126--6285282235" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">R. Guggenberger </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Diagnostic and Interventional Radiology (R.G., D.R.F., G.A., D.N.), Nuclear Medicine (D.R.F., D.T.S.), and Cranio-Maxillofacial and Oral Surgery (P.M., C.J.), University Hospital Zurich, Zurich, Switzerland.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.%2BGuggenberger%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Guggenberger%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AR.%2BGuggenberger%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">D.R. Fischer </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Diagnostic and Interventional Radiology (R.G., D.R.F., G.A., D.N.), Nuclear Medicine (D.R.F., D.T.S.), and Cranio-Maxillofacial and Oral Surgery (P.M., C.J.), University Hospital Zurich, Zurich, Switzerland.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.R.%2BFischer%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Fischer%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AD.R.%2BFischer%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">P. Metzler </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Diagnostic and Interventional Radiology (R.G., D.R.F., G.A., D.N.), Nuclear Medicine (D.R.F., D.T.S.), and Cranio-Maxillofacial and Oral Surgery (P.M., C.J.), University Hospital Zurich, Zurich, Switzerland.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=P.%2BMetzler%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Metzler%20P&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AP.%2BMetzler%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">G. Andreisek </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Diagnostic and Interventional Radiology (R.G., D.R.F., G.A., D.N.), Nuclear Medicine (D.R.F., D.T.S.), and Cranio-Maxillofacial and Oral Surgery (P.M., C.J.), University Hospital Zurich, Zurich, Switzerland.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=G.%2BAndreisek%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Andreisek%20G&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AG.%2BAndreisek%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">D. Nanz </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Diagnostic and Interventional Radiology (R.G., D.R.F., G.A., D.N.), Nuclear Medicine (D.R.F., D.T.S.), and Cranio-Maxillofacial and Oral Surgery (P.M., C.J.), University Hospital Zurich, Zurich, Switzerland.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.%2BNanz%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Nanz%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AD.%2BNanz%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">C. Jacobsen </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Diagnostic and Interventional Radiology (R.G., D.R.F., G.A., D.N.), Nuclear Medicine (D.R.F., D.T.S.), and Cranio-Maxillofacial and Oral Surgery (P.M., C.J.), University Hospital Zurich, Zurich, Switzerland.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.%2BJacobsen%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Jacobsen%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AC.%2BJacobsen%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">D.T. 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