Potential relationship among CT and MRI imaging, histological findings, and treatment outcomes in patients with medication-related osteonecrosis of the jaw undergoing segmental mandibulectomy–A retrospectives study

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Background/purpose: Surgical treatment has recently been recommended as a standard therapy for medication-related osteonecrosis of the jaw (MRONJ). However, no established methods exist for determining the extent of bone resection. We aimed to compare preoperative computed tomography (CT) and magnetic resonance imaging (MRI) findings with the histopathological findings of resection materials in patients with MRONJ undergoing surgery. Materials and methods: This was a retrospective, observational study. We analyzed the preoperative CT and MRI findings, histopathological characteristics of the resected materials, and treatment outcomes of 14 patients with MRONJ who underwent segmental mandibulectomy at Department of Oral and Maxillofacial Surgery, Nagasaki University Hospital. Results: Areas showing osteolysis, gap-type or irregular-type periosteal reactions, and mixed-type osteosclerosis on CT were histologically confirmed to contain osteomyelitis or necrotic bone. On MRI, MRONJ lesions exhibited low signal intensity on T1-weighted images (T1WI) and variable signal intensities on T2-weighted images (T2WI). The extent of MRONJ lesions was difficult to delineate using T1WI and T2WI. In contrast, high signal intensity on short tau inversion recovery (STIR) images accurately reflected the extent of histologically confirmed osteomyelitis. Conclusion: Osteomyelitis is present in areas with osteolysis, gap-type or irregular-type periosteal reactions, mixed-type osteosclerosis on CT, and high STIR signal intensity on MRI features. These findings may serve as reliable references for determining the extent of bone resection during surgery.