The usefulness of different imaging modalities in mandibular osteonecrosis and osteomyelitis diagnosis

Abstract To examine the CT-imaging features of subjects with bacterial osteomyelitis (OM), osteoradionecrosis (ORN), and medication-related osteonecrosis of the jaw (MRONJ) with histopathological confirmation, and to examine the diagnostic efficacy of panoramic radiography and MRI in detecting these...

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Main Authors: Masaya Kawasaki, Hiroaki Shimamoto, Danielle Ayumi Nishimura, Noriko Yamao, Naoko Takagawa, Yuka Uchimoto, Ami Takeshita, Tomomi Tsujimoto, Sven Kreiborg, Sanjay M. Mallya, Fan-pei Gloria Yang, Shumei Murakami
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Language:English
Published: Nature Portfolio 2025-04-01
Series:Scientific Reports
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Online Access:https://doi.org/10.1038/s41598-025-96910-x
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author Masaya Kawasaki
Hiroaki Shimamoto
Danielle Ayumi Nishimura
Noriko Yamao
Naoko Takagawa
Yuka Uchimoto
Ami Takeshita
Tomomi Tsujimoto
Sven Kreiborg
Sanjay M. Mallya
Fan-pei Gloria Yang
Shumei Murakami
author_facet Masaya Kawasaki
Hiroaki Shimamoto
Danielle Ayumi Nishimura
Noriko Yamao
Naoko Takagawa
Yuka Uchimoto
Ami Takeshita
Tomomi Tsujimoto
Sven Kreiborg
Sanjay M. Mallya
Fan-pei Gloria Yang
Shumei Murakami
author_sort Masaya Kawasaki
collection DOAJ
description Abstract To examine the CT-imaging features of subjects with bacterial osteomyelitis (OM), osteoradionecrosis (ORN), and medication-related osteonecrosis of the jaw (MRONJ) with histopathological confirmation, and to examine the diagnostic efficacy of panoramic radiography and MRI in detecting these disease features. 150 cases with preoperative CT data were selected: 61 bacterial OM, 19 ORN, and 70 MRONJ. 143 cases underwent panoramic X-ray examination, and 47 underwent MRI. The assessment criteria for imaging findings included: (1) bone resorption, (2) osteosclerosis, (3) clarity of the mandibular canal, (4) periosteal reactions, (5) cortical bone perforation, (6) sequestrum, and (7) pathological fractures. CT was considered the gold standard for assessing these features. Compared with CT, all panoramic radiographs were detectable for diagnostic features of the disease. Bone resorption was detected in 123 cases (sensitivity 91.1%), and osteosclerosis was detected in 131 cases (sensitivity 98.5%). With panoramic radiography, most changes to clarity of the mandibular canal and pathological fractures were detected (sensitivities of 87.8% and 68.8%, respectively). However, the sensitivities for detection of periosteal reactions, cortical bone perforation and sequestration were low (19.6%, 17.8% and 19.4%, respectively). Sensitivity of MRI for detecting periosteal reactions, cortical bone perforation, sequestration, and pathological fractures (27.3%, 73.5%, 35.7%, and 60.0%, respectively) was equivalent or superior to panoramic imaging. MR-specific characteristics of bone marrow edema were depicted on almost all examinations. Panoramic radiography may be adequate for identifying bone resorption and osteosclerosis. However, MRI provides more value than panoramic radiography in detecting periosteal reactions, cortical bone perforation, sequestration, and bone marrow edema.
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spelling doaj-art-4767d621dbc04b0ea55eaaa4bb58b12b2025-08-20T02:17:01ZengNature PortfolioScientific Reports2045-23222025-04-0115111810.1038/s41598-025-96910-xThe usefulness of different imaging modalities in mandibular osteonecrosis and osteomyelitis diagnosisMasaya Kawasaki0Hiroaki Shimamoto1Danielle Ayumi Nishimura2Noriko Yamao3Naoko Takagawa4Yuka Uchimoto5Ami Takeshita6Tomomi Tsujimoto7Sven Kreiborg8Sanjay M. Mallya9Fan-pei Gloria Yang10Shumei Murakami11Department of Oral and Maxillofacial Radiology, Graduate School of Dentistry, The University of Osaka Department of Oral and Maxillofacial Radiology, Graduate School of Dentistry, The University of Osaka Department of Oral and Maxillofacial Radiology, Graduate School of Dentistry, The University of Osaka Department of Oral and Maxillofacial Radiology, Graduate School of Dentistry, The University of Osaka Department of Oral and Maxillofacial Radiology, Graduate School of Dentistry, The University of Osaka Department of Oral and Maxillofacial Radiology, Graduate School of Dentistry, The University of Osaka Department of Oral and Maxillofacial Radiology, Graduate School of Dentistry, The University of Osaka Department of Oral and Maxillofacial Radiology, Graduate School of Dentistry, The University of Osaka Department of Pediatric Dentistry and Clinical Genetics, School of Dentistry, Faculty of Health and Medical Sciences, University of CopenhagenSection of Oral and Maxillofacial Radiology, UCLA School of DentistryDepartment of Oral and Maxillofacial Radiology, Graduate School of Dentistry, The University of Osaka Department of Oral and Maxillofacial Radiology, Graduate School of Dentistry, The University of Osaka Abstract To examine the CT-imaging features of subjects with bacterial osteomyelitis (OM), osteoradionecrosis (ORN), and medication-related osteonecrosis of the jaw (MRONJ) with histopathological confirmation, and to examine the diagnostic efficacy of panoramic radiography and MRI in detecting these disease features. 150 cases with preoperative CT data were selected: 61 bacterial OM, 19 ORN, and 70 MRONJ. 143 cases underwent panoramic X-ray examination, and 47 underwent MRI. The assessment criteria for imaging findings included: (1) bone resorption, (2) osteosclerosis, (3) clarity of the mandibular canal, (4) periosteal reactions, (5) cortical bone perforation, (6) sequestrum, and (7) pathological fractures. CT was considered the gold standard for assessing these features. Compared with CT, all panoramic radiographs were detectable for diagnostic features of the disease. Bone resorption was detected in 123 cases (sensitivity 91.1%), and osteosclerosis was detected in 131 cases (sensitivity 98.5%). With panoramic radiography, most changes to clarity of the mandibular canal and pathological fractures were detected (sensitivities of 87.8% and 68.8%, respectively). However, the sensitivities for detection of periosteal reactions, cortical bone perforation and sequestration were low (19.6%, 17.8% and 19.4%, respectively). Sensitivity of MRI for detecting periosteal reactions, cortical bone perforation, sequestration, and pathological fractures (27.3%, 73.5%, 35.7%, and 60.0%, respectively) was equivalent or superior to panoramic imaging. MR-specific characteristics of bone marrow edema were depicted on almost all examinations. Panoramic radiography may be adequate for identifying bone resorption and osteosclerosis. However, MRI provides more value than panoramic radiography in detecting periosteal reactions, cortical bone perforation, sequestration, and bone marrow edema.https://doi.org/10.1038/s41598-025-96910-xOsteomyelitisMRIPanoramic radiographyCT
spellingShingle Masaya Kawasaki
Hiroaki Shimamoto
Danielle Ayumi Nishimura
Noriko Yamao
Naoko Takagawa
Yuka Uchimoto
Ami Takeshita
Tomomi Tsujimoto
Sven Kreiborg
Sanjay M. Mallya
Fan-pei Gloria Yang
Shumei Murakami
The usefulness of different imaging modalities in mandibular osteonecrosis and osteomyelitis diagnosis
Scientific Reports
Osteomyelitis
MRI
Panoramic radiography
CT
title The usefulness of different imaging modalities in mandibular osteonecrosis and osteomyelitis diagnosis
title_full The usefulness of different imaging modalities in mandibular osteonecrosis and osteomyelitis diagnosis
title_fullStr The usefulness of different imaging modalities in mandibular osteonecrosis and osteomyelitis diagnosis
title_full_unstemmed The usefulness of different imaging modalities in mandibular osteonecrosis and osteomyelitis diagnosis
title_short The usefulness of different imaging modalities in mandibular osteonecrosis and osteomyelitis diagnosis
title_sort usefulness of different imaging modalities in mandibular osteonecrosis and osteomyelitis diagnosis
topic Osteomyelitis
MRI
Panoramic radiography
CT
url https://doi.org/10.1038/s41598-025-96910-x
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