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MRI of Mandibular Osteonecrosis Secondary to Bisphosphonates

¹ Department of Radiology, Consorcio Hospital General, Universitario de Valencia, Valencia, Spain.
² Department of Stomatology, Consorcio Hospital General, Universitario de Valencia, Valencia, Spain.
³ CT and MR ERESA Unit, Consorcio Hospital General, Universitario de Valencia, Avida. Tres Cruces s/n, Valencia, Valencia, Spain 46014.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —55-year-old man with prostate cancer. T1-weighted image shows hypointense area in right mandible (white arrow) that corresponds to focal lesion of osteonecrosis and associated adenopathy (black arrow).

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —55-year-old man with prostate cancer. Photograph shows clinical lesion.

View larger version (112K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —62-year-old woman with breast cancer. Axial T1-weighted image shows mass of soft tissue (large arrow) that affects masseter muscle and internal pterygoid with extension reaching cheek. Small arrow indicates break of cortical bone in retromolar trigone area.

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —62-year-old woman with breast cancer. Photograph shows clinical lesion.

View larger version (185K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —70-year-old woman with breast cancer. Oblique sagittal T1-weighted image shows occupation of right maxillary sinus caused by hypointense lesion in upper right maxilla (white arrow), causing lysis of floor of maxillary sinus. Associated submaxillary adenopathy (black arrow) is seen.

View larger version (141K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —70-year-old woman with breast cancer. Photograph shows clinical lesion (arrow) of osteonecrosis of the jaw.

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —51-year-old woman with breast cancer. Oblique sagittal T1-weighted image shows focal lesion of osteonecrosis (arrow) affecting mandibular branch and involving mandibular canal.

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —51-year-old woman with breast cancer. Photograph shows clinical image.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —62-year-old woman with breast cancer. Typical behavior of osteonecrotic lesion on T1 (A), STIR (B), and contrast-enhanced T1 (C) sequences. Hypointense lesion with bright signal in STIR and contrast enhancement in quadrants 1 and 2 are seen. Arrows show focal lesions of osteonecrosis in quadrant 1 (black arrows) and quadrant 2 (white arrows).

View larger version (142K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —62-year-old woman with breast cancer. Typical behavior of osteonecrotic lesion on T1 (A), STIR (B), and contrast-enhanced T1 (C) sequences. Hypointense lesion with bright signal in STIR and contrast enhancement in quadrants 1 and 2 are seen. Arrows show focal lesions of osteonecrosis in quadrant 1 (black arrows) and quadrant 2 (white arrows).

View larger version (144K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —62-year-old woman with breast cancer. Typical behavior of osteonecrotic lesion on T1 (A), STIR (B), and contrast-enhanced T1 (C) sequences. Hypointense lesion with bright signal in STIR and contrast enhancement in quadrants 1 and 2 are seen. Arrows show focal lesions of osteonecrosis in quadrant 1 (black arrows) and quadrant 2 (white arrows).

View larger version (139K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5D —62-year-old woman with breast cancer. Photograph shows clinical lesion in quadrant 1.

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —59-year-old woman with multiple myeloma. T1 (A), STIR (B), and contrast-enhanced T1 (C) sequences show atypical behavior of osteonecrotic lesion (arrows). There is hypointense lesion with little brightness on STIR (B) and with no contrast enhancement (C).

View larger version (101K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —59-year-old woman with multiple myeloma. T1 (A), STIR (B), and contrast-enhanced T1 (C) sequences show atypical behavior of osteonecrotic lesion (arrows). There is hypointense lesion with little brightness on STIR (B) and with no contrast enhancement (C).

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —59-year-old woman with multiple myeloma. T1 (A), STIR (B), and contrast-enhanced T1 (C) sequences show atypical behavior of osteonecrotic lesion (arrows). There is hypointense lesion with little brightness on STIR (B) and with no contrast enhancement (C).

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