双膦酸盐相关性颌骨坏死的CT诊断
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摘要
目的:分析双膦酸盐相关性颌骨坏死(BRONJ)的临床及CT表现,探讨CT对BRONJ的诊断价值。方法:搜集BRONJ患者5例,其中3例经手术病理证实,2例经临床及影像学证实,5例均有完整的临床及影像学资料,回顾性分析其临床及影像学表现特点。结果:5例BRONJ患者均有不同程度的颌骨硬化,4例位于下颌骨,1例位于上颌骨,骨质硬化均累及牙槽嵴及齿槽骨板。2例BRONJ患者颌骨硬化较广泛,导致邻近的下颌管狭窄。5例BRONJ患者同时伴有溶骨性骨质破坏。结论:BRONJ常伴颌骨骨质硬化,易累及牙槽嵴及齿槽骨板是其特征性表现,CT检查有助于早期、准确地诊断BRONJ,可为临床诊断、鉴别诊断和治疗提供可靠依据。
Objective:This study was performed to evaluate the clinical manifestations and imaging features of bisphosphonate-related osteonecrosis of the jaws(BRONJ).Methods:Five cases of BRONJ were included in this study for retrospective analysis:3 were confirmed by pathology,2 by imaging and clinical data.All had complete clinical and imaging data.Results:Osteosclerosis in the jaws were found in all 5 cases,four were located at the mandible,one in the maxilla all invading the alveolar ridge and alveolar plate.Diffuse osteosclerosis were found in 2 cases with narrowed mandibular canal.Osteolytic destruction of the jaws was found in 5 cases.Conclusions:The characteristic imaging findings in BRONJ was osteosclerosis of the jaws which commonly involved the alveolar ridge and the alveolar plate.CT examinations play an important role on diagnosis of BRONJ,which can provide robust clues in the clinical diagnosis,differential diagnosis and treatment.
Objective:This study was performed to evaluate the clinical manifestations and imaging features of bisphosphonate-related osteonecrosis of the jaws(BRONJ).Methods:Five cases of BRONJ were included in this study for retrospective analysis:3 were confirmed by pathology,2 by imaging and clinical data.All had complete clinical and imaging data.Results:Osteosclerosis in the jaws were found in all 5 cases,four were located at the mandible,one in the maxilla all invading the alveolar ridge and alveolar plate.Diffuse osteosclerosis were found in 2 cases with narrowed mandibular canal.Osteolytic destruction of the jaws was found in 5 cases.Conclusions:The characteristic imaging findings in BRONJ was osteosclerosis of the jaws which commonly involved the alveolar ridge and the alveolar plate.CT examinations play an important role on diagnosis of BRONJ,which can provide robust clues in the clinical diagnosis,differential diagnosis and treatment.
引文
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[2]Early Breast Cancer Trialists'Collaborative Group.Adjuvant bisphosphonate treatment in early breast cancer:meta-analyses of individual patient data from randomised trials[J].Lancet,2015,386(10001):1353-1361.
[3]Robichaux C,Ong M,Veillon D,et al.Bisphosphonate-related osteonecrosis of the jaw[J].J La State Med Soc,2014,166(5):200-202.
[4]Bisdas S,Chambron Pinho N,Smolarz A,et al.Biphosphonate-induced osteonecrosis of the jaws:CT and MRI spectrum of findings in 32patients[J].Clin Radiol,2008,63(1):71-77.
[5]Marx RE.Pamidronate(Aredia)and zoledronate(Zometa)induced avascular necrosis of the jaws:agrowing epidemic[J].J Oral Maxillofac Surg,2003,61(9):1115-1117.
[6]Mavrokokki T,Cheng A,Stein B,et al.Nature and frequency of bisphosphonate-associated osteonecrosis of the jaws in Australia[J].J Oral Maxillofac Surg,2007,65(3):415-423.
[7]Spanou A,Lyritis GP,Chronopoulos E,et al.Management of bisphosphonate-related osteonecrosis of the jaw:a literature review[J].Oral Dis,2015,21(8):927-936.
[8]杨万群,黄飚,梁长虹.双磷酸盐相关性颌骨坏死影像学研究进展[J].中国医学影像技术,2010,26(2):381-383.
[9]Ruggiero SL,Dodson TB,Fantasia J,et al.American association of oral and maxillofacial surgeons position paper on medication-related osteonecrosis of the Jaw-2014 Update[J].Oral Maxillofac Surg,2014,72(10):1938-1956.
[10]Pichardo SE,Van Merkesteyn JP.Bisphosphonate related osteonecrosis of the jaws:spontaneous or dental origin?[J].Oral Surg Oral Med Oral Pathol Oral Radiol,2013,116(3):287-292.
[11]Ozcan G,Sekerci AE,Gonen ZB.Are there any differences in mandibular morphology of patients with bisphosphonate-related osteonecrosis of jaws:a case-control study[J].Dentomaxillofac Radiol,2016,45(6):201600471.
[12]Zandi M,Dehghan A,Malekzadeh H,et al.Introducing aprotocol to create bisphosphonate-related osteonecrosis of the jaw in rat animal model[J].J Craniomaxillofac Surg,2016,44(3):271-278.
[13]Phal PM,Myall RW,Assael LA,et al.Imaging findings of bisphosphonate-associated osteonecrosis of the jaws[J].Am J Neuroradiol,2007,28(6):1139-1145.
[14]Popovic K,Kocar M.Imaging findings in bisphosphonate-induced osteonecrosis of the jaws[J].Radiol and Oncol,2010,44(4):215-219.
[15]徐向阳,周红梅.二膦酸盐相关性颌骨骨质坏死的影像学表现[J].放射学实践,2009,24(8):885-887.
[16]Torres SR,Chen CS,Leroux BG,et al.Fractal dimension evaluation of cone beam computed tomography in patients with bisphosphonate associated osteonecrosis[J].Dentomaxillofac Radiol,2011,40(8):501-505.
[17]Torres SR,Chen CS,Leroux BG,et al.Mandibular cortical bone evaluation on cone beam computed tomography images of patients with bisphosphonate-related osteonecrosis of the jaw[J].Oral Surg Oral Med Oral Pathol Oral Radiol,2012,113(5):695-703.
[18]Barragan-adjemian C,Lausten L,Ang DB,et al.Bisphosphonaterelated osteonecrosis of the jaw:model and diagnosis with cone beam computerized tomography[J].Cells Tissues Organs,2009,189(1-4):284-288.
[19]Guggenberger R,Fischer DR,Metzler P,et al.Bisphosphonateinduced osteonecrosis of the jaw:comparison of disease extent on contrast-enhanced MR imaging,18F-Fuoride PET/CT,and conebeam CT imaging[J].Am J Neuroradiol,2013,34(6):1242-1247.