Article Figures & Data
Figures
- Fig 1.
Transaxial images of the upper jaw from patient 9 with BONJ in the right maxilla (regions 14–15). A, Axial CT image in a bone window depicting osteolysis and fragmentation of bone in a BONJ focus (arrow). B, CT image with fused [18F] fluoride PET signal indicating increased [18F] fluoride uptake (arrow) overlapping the morphologic BONJ focus in A. C, Axial contrast-enhanced T1-weighted MR image with fat saturation shows slightly increased contrast uptake of the BONJ focus without marked soft-tissue involvement (arrow). D, CEMR image with fused [18F] fluoride PET signal indicates slightly larger BONJ extent than expected from the CEMR image alone (arrow). E, Clinical intraoperative examination confirms BONJ in regions 14–15 of the right maxilla (white arrow).
- Fig 2.
Location and extent of BONJ as marked on jaw schemes from contrast-enhanced MR imaging (blue), [18F] fluoride PET/CT (pink), clinical preoperative (red), and intraoperative examinations (striated areas) were graphically assembled in 1 image and related to delineations (white contours) on panoramic views from CBCT to compare the extent of BONJ among different modalities/examinations. A, In patient 9, only a small clinically suspicious area in the right maxilla was seen. PET/CT and CEMR imaging showed slightly larger areas of suspected BONJ than CBCT and intraoperative examinations in the right maxilla (regions 14–15). BONJ was histologically proved. B, In patient 2, BONJ was suspected preoperatively in the regions 44–46 of the right mandible. The actual extent of the BONJ was markedly larger than expected clinically and on CBCT in both CEMR imaging and PET/CT. This was confirmed intraoperatively, where only parts of the necrotic bone were removed.
- Fig 3.
Rankings of BONJ extent (0 = no sign of BONJ, 5 = maximal extent among modalities/examinations) in different modalities for each patient. Note in patient 10 that no abnormalities were seen in CEMR imaging due to artifacts and no intraoperative examination was performed.
- Fig 4.
Mean rankings of BONJ extent in different modalities/examinations (0 = no sign of BONJ, 5 = maximal extent among modalities/examinations). CEMR imaging and PET/CT ranked highest and showed the largest extent of BONJ of all modalities, being significantly higher than CBCT and clinical preoperative examinations. PET/CT ranked significantly higher than intraoperative examinations. The latter showed significantly larger extent of BONJ than clinical preoperative examinations but did not significantly differ from CEMR imaging and CBCT. Horizontal lines with stars indicate significant differences among modalities (P < .05). Note that patient 10 was excluded from statistical analysis because no histologic confirmation of BONJ was obtained.
Tables
Patient demographics with disease, type, and duration of prior bisphosphonate intake, histology, and location/region of BONJ
Patient Sex Age (yr) Disease Bisphosphonate Duration of Treatment Histology Region 1 F 56 Metastases, breast Ca Zoledronic acid (Zometa) 54 mo ON/OM 23–28 2 F 85 MM Zoledronic acid (Zometa) 48 mo ON/OM 44–46 3 F 64 MM Zoledronic acid (Zometa) 48 mo ON 34–37 4 F 60 Metastases, breast Ca Zoledronic acid (Zometa) 48 mo ON 35–36 and 45 5 F 59 Metastases, mamma Ca Zoledronic acid (Zometa) 36 mo ON 14–17 6 F 53 Osteoporosis Ibandronic acid (Bondronat oral) 12 mo ON 45–47 7 F 86 Osteoporosis Ibandronic acid (Bondronat oral) Not available ON 45–47 8 F 79 Metastases, breast Ca Zoledronic acid (Zometa) 7 mo ON 11–15 9 M 66 MM Zoledronic acid (Zometa) 60 mo ON 14–15 10 F 88 Metastases, breast Ca Zoledronic acid (Zometa) Not available Not operated 17–18 Note:—ON indicates osteonecrosis; OM, osteomyelitis; MM, multiple myeloma; Ca, cancer; Mamma, mammary.
