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Diagnostic Imaging – Conventional Radiology, Computed Tomography and Magnetic Resonance Imaging

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Osteomyelitis of the Jaws

Abstract

Imaging is a crucial diagnostic tool in the assessment of acute and chronic osteomyelitis of the jaws. Before any cross-sectional imaging modality is applied, the orthopanoramic view is the first image to assess the status of dentition, recognize direct radiographic signs of osteomyelitis, narrow the differential diagnosis, and depict potential predisposing conditions such as a fracture or systemic bone disease. The orthopanoramic view is furthermore the first-line image when follow-up examinations are performed. In acute osteomyelitis the higher sensitivity of magnetic resonance imaging (MRI), with respect to detection of intramedullary inflammation, advocates its use as the imaging modality of choice to confirm the diagnosis and provide an estimate of the intraosseous extent and soft tissue involvement. In case surgical treatment is planned, high-resolution computed tomography (CT) is required to specify the degree of cortical destruction, delineate the presence of sequestra, and to define the extent of osseous removal required. In chronic osteomyelitis the higher sensitivity of CT with respect to detection of sequester and sclerotic bone changes renders CT the examination of choice to distinguish the usually more uniform and extensive primary chronic osteomyelitis from the more localized type of secondary chronic osteomyelitis. Magnetic resonance imaging is superior to detect periosteal inflammation and soft tissue involvement and thus aids in determining the persistence or recurrence of infection. Following surgery, CT is preferred as follow-up examination for a period of 6 months to distinguish postoperative and reparative changes from recurrent or persistent infection. Complimentary information is gained in particular situations by a combination of imaging modalities adapted to the individual patient’s course of disease and the panoramic view findings. An overview of the diagnostic imaging pathway in patients with suspected osteomyelitis of the jaws is given in Fig. 3.1.

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Schuknecht, B. (2009). Diagnostic Imaging – Conventional Radiology, Computed Tomography and Magnetic Resonance Imaging. In: Baltensperger, M., Eyrich, G. (eds) Osteomyelitis of the Jaws. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-28766-7_3

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