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Cone beam computed tomography for diagnosis of bisphosphonate-related osteonecrosis of the jaw: evaluation of quantitative and qualitative image parameters

Guggenberger, Roman ; Koral, Emrah ; Zemann, Wolfgang ; Jacobsen, Christine ; Andreisek, Gustav ; Metzler, Philipp

In: Skeletal Radiology, 2014, vol. 43, no. 12, p. 1669-1678

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    Title
    • Cone beam computed tomography for diagnosis of bisphosphonate-related osteonecrosis of the jaw: evaluation of quantitative and qualitative image parameters
    Author
    • Guggenberger, Roman. Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    • Koral, Emrah. Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    • Zemann, Wolfgang. Department of Cranio-Maxillofacial and Oral Surgery, University Hospital Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland
    • Jacobsen, Christine. Department of Cranio-Maxillofacial and Oral Surgery, University Hospital Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland
    • Andreisek, Gustav. Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    • Metzler, Philipp. Department of Cranio-Maxillofacial and Oral Surgery, University Hospital Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland
    Document Type
    • Postprint
    OAI-PMH Identifier
    • oai:doc.rero.ch:325853
    Summary
    Objective: To assess the diagnostic performance of quantitative and qualitative image parameters in cone-beam computed tomography (CBCT) for diagnosis of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Materials and methods: A BRONJ (22 patients, mean age 70.0years) group was age and gender matched to a healthy control group (22 patients, mean age 68.0years). On CBCT images two independent readers performed quantitative bone density value (BDV) measurements with region and volume-of-interest (ROI and VOI) based approaches and qualitative scoring of BRONJ-associated necrosis, sclerosis and periosteal thickening (1 = not present to 5 = definitely present). Intraoperative and clinical findings served as standard of reference. Interreader agreements and diagnostic performance were assessed by intraclass correlation coefficients (ICC), kappa-statistics and receiver-operating characteristic (ROC) analysis. Results: Twenty-three regions in 22 patients were affected by BRONJ. ICC values for mean BDV VOI and mean BDV ROI were 0.864 and 0.968, respectively (p < 0.001). The area under the curve (AUC) for mean BDV VOI and mean BDV ROI was 0.58/0.83 with a sensitivity of 57/83% and specificity of 61/77% for diagnosis of BRONJ, respectively. Kappa values for presence of necrosis, sclerosis and periosteal thickening were 0.575, 0.617 and 0.885, respectively. AUC values for qualitative parameters ranged between 0.90-0.96 with sensitivity of 96% and specificities between 79-96% at respective cutoff scores. Conclusions: BRONJ can be effectively diagnosed with CBCT. Qualitative image parameters yield a higher diagnostic performance than quantitative parameters, and ROI-based attenuation measurements were more accurate than VOI-based measurements.