Quantitative assessment of mandibular bone marrow using computed tomography texture analysis for detect stage 0 medication-related osteonecrosis of the jaw

Purpose: Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication of treatment with bisphosphonates or antiangiogenic inhibitors. MRONJ has four stages (0–3); however, stage 0 MRONJ is difficult to detect using computed tomography (CT). This study aimed to quantitatively assess the mandibular bone marrow using texture analysis to detect stage 0 MRONJ from CT images. Methods: This retrospective study included 25 patients with stage 0 MRONJ who had a history of treatment with bisphosphonates and underwent CT and magnetic resonance imaging (MRI). The mandibular bone marrow with abnormal signals (T1-weighted imaging: low, T2-weighted imaging: low or high, short-tau inversion recovery: high) on MRI, and no qualitative characteristic CT and oral findings indicative of osteonecrosis (exposed bone, sequestrum, periosteal reaction, and osteolysis) was identified as 0 MRONJ. Texture features of the bone marrow of the mandible with MRONJ and the contralateral, normal mandibular bone marrow were extracted using an open-access software, namely, LIFEx. The volumes of interest (VOIs) were manually placed on CT images by tracing the bilateral mandibular bone marrow regions, excluding the teeth, mandibular canal, and cortical bone. Thirty-seven texture features were extracted from each VOI. Results: Six gray-level run length matrix features and four gray-level zone length matrix features exhibited significant differences between mandibular bone marrow with and without MRONJ. Conclusions: CT was able to quantitatively assess texture features of normal mandibular bone marrow and that with MRONJ. Texture analysis may be useful as a new method for detecting stage 0 MRONJ using CT.