Volumetric analysis of MRONJ lesions by semiautomatic segmentation of CBCT images
- 25 Downloads
The purpose of this study was to evaluate potential differences in volumes of areas of osteolysis caused by medication-related osteonecrosis of the jaw (MRONJ) between the upper and lower jaw. We aim to analyze the clinical relevance of volumetric measurement of osteolytic lesions for surgical planning of MRONJ patients.
Sixty-seven patients who were clinically and histopathologically diagnosed with MRONJ were retrospectively included in this study. Cone beam computed tomography (CBCT) images were evaluated according to localization, affected anatomical structures, and volumetric measurement of osteolytic lesions caused by MRONJ in appliance of CBCT datasets by using ITK-SNAP.
The most frequently affected localization is the mandible, whereas female patients show significantly more often lesions of the maxilla. The cortical bone was predominantly affected. Furthermore, the affection of teeth, sinus floor, inferior alveolar nerve canal, or even a pathological fracture of the mandible are infrequently existing. The volumetric measurements revealed a statistically significant greater absolute osteolysis volume in males.
Image analysis and volumetric measurements of osteolytic lesions of MRONJ patients is a helpful tool to further understand the clinical appearance and identify compromised anatomic landmarks. Volumetric analysis aids in pre-surgical planning and visualizes the individual extent of the disease for each patient.
Keywords:MRONJ Osteonecrosis of the jaws Volumetric parameters Pre-surgical planning Jaw’s anatomy
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
For this type of study (retrospective study), formal consent is not required.
- 1.Dreiseidler T, Lentzen MP, Zirk M, Safi AF, Zoeller JE, Kreppel M (2017) Systematic three-dimensional analysis of wafer-based maxillary repositioning procedures in orthognathic surgery. Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery 45(11):1828–1834CrossRefGoogle Scholar
- 2.Gurani SF, Di Carlo G, Thorn JJ, Ingerslev J, Cattaneo PM, Pinholt EM (2019) Two-year postoperative upper airway cone-beam computed tomographic outcomes based on a verified upper airway analysis following bimaxillary orthognathic surgery. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 77:1435–1445CrossRefGoogle Scholar
- 5.Safi AF, Richter MT, Rothamel D, Nickenig HJ, Scheer M, Zoller J, Kreppel M (2016) Influence of the volume of soft tissue herniation on clinical symptoms of patients with orbital floor fractures. Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery 44(12):1929–1934CrossRefGoogle Scholar
- 8.Baba A, Goto TK, Ojiri H, Takagiwa M, Hiraga C, Okamura M, Hasegawa S, Okuyama Y, Ogino N, Yamauchi H, Kobashi Y, Yamazoe S, Munetomo Y, Mogami T, Nomura T (2018) CT imaging features of antiresorptive agent-related osteonecrosis of the jaw/medication-related osteonecrosis of the jaw. Dento maxillo facial radiology 47(4):20170323CrossRefGoogle Scholar
- 11.Dastidar P, Heinonen T, Numminen J, Rautiainen M, Laasonen E (1999) Semi-automatic segmentation of computed tomographic images in volumetric estimation of nasal airway. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 256(4):192–198Google Scholar
- 14.Zirk M, Kreppel M, Buller J, Pristup J, Peters F, Dreiseidler T, Zinser M, Zoller JE (2017) The impact of surgical intervention and antibiotics on MRONJ stage II and III - retrospective study. Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery 45(8):1183–1189CrossRefGoogle Scholar
- 15.Hadaya D, Soundia A, Freymiller E, Grogan T, Elashoff D, Tetradis S, Aghaloo TL (2018) Nonsurgical management of medication-related osteonecrosis of the jaws using local wound care. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 76(11):2332–2339CrossRefGoogle Scholar
- 16.Saad F, Brown JE, Van Poznak C, Ibrahim T, Stemmer SM, Stopeck AT, Diel IJ, Takahashi S, Shore N, Henry DH et al (2012) Incidence, risk factors, and outcomes of osteonecrosis of the jaw: integrated analysis from three blinded active-controlled phase III trials in cancer patients with bone metastases. Annals of oncology : official journal of the European Society for. Med Oncol 23(5):1341–1347Google Scholar
- 18.Khan AA, Morrison A, Hanley DA, Felsenberg D, McCauley LK, O'Ryan F, Reid IR, Ruggiero SL, Taguchi A, Tetradis S et al (2015) Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research 30(1):3–23CrossRefGoogle Scholar
- 19.Khan AA, Morrison A, Kendler DL, Rizzoli R, Hanley DA, Felsenberg D, McCauley LK, O'Ryan F, Reid IR, Ruggiero SL, Taguchi A, Tetradis S, Watts NB, Brandi ML, Peters E, Guise T, Eastell R, Cheung AM, Morin SN, Masri B, Cooper C, Morgan SL, Obermayer-Pietsch B, Langdahl BL, Dabagh RA, Davison KS, Sándor GK, Josse RG, Bhandari M, el Rabbany M, Pierroz DD, Sulimani R, Saunders DP, Brown JP, Compston J, International Task Force on Osteonecrosis of the Jaw (2017) Case-based review of osteonecrosis of the jaw (ONJ) and application of the international recommendations for management from the international task force on ONJ. J Clin Densitom 20(1):8–24CrossRefGoogle Scholar
- 20.Walton K, Grogan TR, Eshaghzadeh E, Hadaya D, Elashoff DA, Aghaloo TL, Tetradis S (2018) Medication related osteonecrosis of the jaw in osteoporotic vs oncologic patients-quantifying radiographic appearance and relationship to clinical findings: Dentomaxillofac Radiol https://doi.org/10.1259/dmfr.20180128 CrossRefGoogle Scholar
- 21.Troeltzsch M, Pache C, Troeltzsch M, Kaeppler G, Ehrenfeld M, Otto S, Probst F (2015) Etiology and clinical characteristics of symptomatic unilateral maxillary sinusitis: a review of 174 cases. Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery 43(8):1522–1529CrossRefGoogle Scholar
- 23.De Ceulaer J, Tacconelli E, Vandecasteele SJ (2014) Actinomyces osteomyelitis in bisphosphonate-related osteonecrosis of the jaw (BRONJ): the missing link? European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology 33(11):1873–1880CrossRefGoogle Scholar
- 24.Heim N, Warwas FB, Wilms CT, Reich RH, Martini M (2017) Vitamin D (25-OHD) deficiency may increase the prevalence of medication-related osteonecrosis of the jaw. Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery 45(12):2068–2074CrossRefGoogle Scholar
- 25.Torres SR, Chen CS, Leroux BG, Lee PP, Hollender LG, Santos EC, Drew SP, Hung KC, Schubert MM (2012) Mandibular cortical bone evaluation on cone beam computed tomography images of patients with bisphosphonate-related osteonecrosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol 113(5):695–703CrossRefGoogle Scholar
- 28.Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, O'Ryan F (2014) American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 72(10):1938–1956CrossRefGoogle Scholar
- 29.Ruggiero SL, Kohn N (2015) Disease stage and mode of therapy are important determinants of treatment outcomes for medication-related osteonecrosis of the jaw. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 73(12 Suppl):S94–S100CrossRefGoogle Scholar
- 30.Fleisher KE, Pham S, Raad RA, Friedman KP, Ghesani M, Chan KC, Amintavakoli N, Janal M, Levine JP, Glickman RS (2016) Does fluorodeoxyglucose positron emission tomography with computed tomography facilitate treatment of medication-related osteonecrosis of the jaw? Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 74(5):945–958CrossRefGoogle Scholar
- 31.Wilde F, Heufelder M, Winter K, Hendricks J, Frerich B, Schramm A, Hemprich A (2011) The role of surgical therapy in the management of intravenous bisphosphonates-related osteonecrosis of the jaw. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics 111(2):153–163CrossRefGoogle Scholar