İlaç ilişkili veya radyasyon sonrası mandibula osteonekrozu BT bulguları

Özet

İlaç ilişkili çene osteonekrozu ve osteoradyonekroz, mandibular kemiğin nekrozu ve ikincil inflamasyonuyla karışık litik-sklerotik BT değişiklikleri oluşturabilir. Kontrastsız BT serisi kortikal düzensizliği, sekestrüasyonu, periost reaksiyonunu ve patolojik kırıkları saptar; kontrastlı fazda eşlik eden yumuşak doku ödemi veya enfektif değişimleri gösterebilir, ancak tek başına hastalığın etiyolojisini kesin olarak ayırt edemez. BT bulgularının kemik metastazı veya akut osteomiyelit ile karıştırılması ayırıcı tanıyı zorlaştırabilir.

Faz ve pencere

Kemik algoritması tanısal: Kontrastsız ince kesit kemik serisinde mandibulada osteoliz-osteoskleroz birlikteliği, kortikal düzensizlik veya perforasyon, sekestr ayrışması ve periost reaksiyonu aranırken kemik detayının değerlendirilmesinde kontrasttan bağımsız kemik algoritması kullanılır.
Kontrastlı yumuşak doku: Yumuşak doku ödemi, mukozal kalınlaşma veya fistül oluşumu lezyonun uzantılarını gösterir; ancak BT veya KBKT gibi üç boyutlu görüntüleme yöntemleri hastalığı kemik metastazından veya diğer patolojilerden tek başına kesin olarak ayırt edemez.

Önerilen pencereler: Kemik (G 1800 / M 400), Yumuşak doku (G 400 / M 40).

BT bulguları

Alveoler kemikten başlayarak mandibulada lokalize, genişlemiş veya ileri evre osteolitik ve osteosklerotik odaklar görülebilir.
Düzensiz kortikal erozyon, bukkal korteks perforasyonu veya mandibular konturda kesinti.
Canlı kemik içinde ya da çevresinde sekestr ve kemik içinde kemik görünümü.
Solid veya tabakalı periostal yeni kemik reaksiyonu.
Mandibular kanalın belirginleşmesi, kanala komşu osteoskleroz veya osteoliz ve sekestrasyon görülebilir.
İleri evre lezyonlarda patolojik kırık, konnektif doku şişmesi ve fistül oluşumu izlenebilir.
Lezyonun diş çekim alanı veya ışınlanmış mandibular segmentle anatomik örtüşmesi.

Normalde

Mandibular kanalın belirginleşmesi MRONJ'de görülebilen bir bulgudur. Lezyonu karşı mandibula ve komşu sağlıklı kemikle karşılaştırarak sklerotik-litik dağılımı, mandibular kanalın seçilebilirliğini ve periost reaksiyonunu değerlendirin; etiyolojinin belirlenmesi için görüntüleme bulgularını hastanın tıbbi öyküsüyle birlikte yorumlayın.

Normal BT ile kıyasla

Aynı bölgenin, kaynak veri setinde patoloji içermediği belirtilen bir BT incelemesini kesit kesit kaydırın; organ sınırlarını açarak anatomiyi hasta görüntüsüyle karşılaştırın. Küçük rastlantısal bulgular tümüyle dışlanmamıştır.

Kaynak: TotalSegmentator v2.01 veri seti (Wasserthal ve ark., Radiology: Artificial Intelligence 2023), CC BY 4.0, vaka s0849; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Bakteriyel osteomiyelit: periapikal enfeksiyon kökenli olup sekestrasyon ve kortikal yıkım gösterebilir; BT bulguları MRONJ ile büyük ölçüde örtüşebilir.
Kemik metastazı: mandibulada osteolitik veya osteosklerotik yıkım yaratarak MRONJ ile benzer radyografik özellikler gösterebilir; bu nedenle ayırıcı tanıda dikkate alınmalıdır.
Primer çene tümörü: ekspansil veya infiltratif kemik yıkımı ve kitle bileşeni görülebilir; biyolojik davranış ve görüntüleme örtüşebilir.
Kronik diffüz sklerozan osteomiyelit, mandibulada proliferatif endosteal reaksiyonla seyreden non-süpüratif inflamatuvar bir kemik hastalığıdır.

Tuzaklar

İlaç ilişkili osteonekrozun görüntüleme açısından patognomonik bir bulgusu yoktur; BT saptamaları ilaç kullanım öyküsü, radyasyon alanı ve klinik kriterlerin yerine geçmez.
Fistül, gaz veya yumuşak doku inflamasyonu MRONJ'nin kendisine ait olabilir veya sekonder enfeksiyonu işaret edebilir; bu bulguların tek başına etiyolojik ayrım yapmaya yetmediği unutulmalıdır.
Diş restorasyonlarına bağlı metal artefaktları görüntü kalitesini bozabilir ve anatomik detayların değerlendirmesini zorlaştırabilir; bu durum ayırıcı tanıda dikkate alınmalıdır.

Kendini dene

Antirezorptif ilaç öyküsü bulunan kişide mandibulada yaygın skleroz, lizis, kortikal düzensizlik ve sekestr var. Görüntü tek başına hangi sonucu kesinleştiremez?
Cevabı göster
İlaç ilişkili etiyoloji. BT kemik hasarını ve yayılımını gösterir; bu patern osteomiyelit veya osteoradyonekrozla örtüşebilir. İlaç ilişkili tanı görüntüye özgü bir işaretle doğrulanmaz.
Mandibular osteonekroz olasılığında sekestr ve kortikal perforasyonu en doğrudan hangi seri ortaya koyar?
Cevabı göster
Kontrastsız kemik algoritması. Sekestr ve kortikal kontur yüksek çözünürlüklü kemik rekonstrüksiyonunda değerlendirilir. Yumuşak doku ve anjiyo fazları kemik kenarlarını bu amaçla en iyi gösteren seri değildir.

İlgili konular

Kaynaklar

Bu sayfadaki 33 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 15 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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