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Identifying MRONJ-affected bone with digital fusion of functional imaging (FI) and cone-beam computed tomography
Gayathri Subramanian1, Evelyne Kalyoussef2, Meredith Blitz-Goldstein3
1Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Newark, NJ, USA.
Abstract:
Surgical debridement of medication-related osteonecrosis of the jaw (MRONJ) lesions is far less predictable than lesion resection. Margins for surgical debridement are guided by surrogate markers of bone viability, such as bleeding and bone fluorescence, which limit debridement to visibly necrotic bone. In contrast, surgical resection is extensive, including a substantial portion of surrounding bone. The concept that the MRONJ lesion is a composite of affected but viable ("compromised") and necrotic bone is supported by histopathological data. Hence, removing only the necrotic bone during lesion debridement could inadvertently leave behind residual compromised bone in the lesion, subsequently contributing to persistence or reestablishment of the lesion. Using 2 case reports, this manuscript illustrates a novel assessment of the MRONJ lesion to enable demarcation of both the compromised and necrotic portions of the lesion. This assessment uses tumor-surveillance functional bone imaging data that may already be available for cancer patients with MRONJ and fuses these data digitally with computed tomography/cone-beam computed tomography imaging of the jaw obtained during MRONJ assessment. If validated, preoperative functional imaging-based assessment of the MRONJ lesion could enable surgeons to eliminate both the compromised and nonviable portions of the lesion precisely with conservative debridement, matching surgical resection in outcome.
Insights
This study introduces a new imaging technique to better identify all affected bone in medication-related osteonecrosis of the jaw (MRONJ) lesions. Precise debridement using this method may improve treatment outcomes for MRONJ patients.
Area of Science:
- Oral and Maxillofacial Surgery
- Oncology
- Radiology
Background:
- Medication-related osteonecrosis of the jaw (MRONJ) poses treatment challenges, with surgical debridement often being less predictable than resection.
- Current debridement relies on visual cues of bone viability, potentially leaving compromised bone behind.
- MRONJ lesions comprise both necrotic and affected-but-viable (
Observation:
- Histopathological data suggest MRONJ lesions contain both necrotic and compromised bone.
- Conventional debridement may not remove all affected bone, risking lesion persistence.
- This manuscript presents a novel assessment method using functional bone imaging fused with CT/CBCT.
Findings:
- The novel assessment aims to demarcate both compromised and necrotic portions of MRONJ lesions.
- This technique utilizes existing tumor-surveillance functional bone imaging data.
- Digital fusion of functional imaging with CT/CBCT aids in precise lesion demarcation.
Implications:
- Preoperative functional imaging could enable precise, conservative debridement of MRONJ.
- This approach may allow for the removal of both compromised and necrotic bone, improving outcomes.
- Validated functional imaging-based assessment could refine surgical strategies for MRONJ, potentially matching resection efficacy with less invasive debridement.
