MRI-detected intraosseous bone marrow edema recedes after effective therapy of periodontitis

OBJECTIVES

T2 STIR MRI sequences can detect preclinical changes associated with periodontal inflammation, i.e. intraosseous edema in the tooth-supporting bone. In this study, we assessed whether MRI can be used for monitoring periodontal disease.

MATERIAL AND METHODS

In a prospective cohort study, we examined 35 patients with periodontitis between 10/2018 and 04/2019 by using 3D isotropic T2-weighted short tau inversion recovery (STIR) and Fast Field Echo T1-weighted Black bone sequences. All patients received standardized clinical exams before and three months after non-surgical periodontal therapy. Bone marrow edema extent was quantified in the STIR sequence at 922 sites before and after treatment. Results were compared with standard clinical findings. Non-parametric statistical analysis was performed.

RESULTS

Non-surgical periodontal treatment caused significant improvement in mean probing depth (p < 0.001) and frequency of bleeding on probing (p < 0.001). The mean depth of osseous edema per site was reduced from a median [IQR] of 2 [1, 3] mm at baseline to 1 [0, 3] mm, (p < 0.001). Periodontal treatment reduced the frequency of sites with edema from 35 to 24% (p < 0.01).

CONCLUSION

The decrease of periodontal bone marrow edema, as observed with T2 STIR MR imaging, is indicative of successful periodontal healing.

CLINICAL RELEVANCE STATEMENT

T2 STIR hyperintense bone marrow edema in the periodontal bone decreases after treatment and can therefore be used to evaluate treatment success. Furthermore, MRI reveals new options to depict hidden aspects of periodontitis.

KEY POINTS

• T2 STIR hyperintense periodontal intraosseous edema was prospectively investigated in 35 patients with periodontitis before and after treatment and compared to clinical outcomes. • The frequency of affected sites was reduced from 35 to 24% (p < 0.001), and mean edema depth was reduced from a median [IQR] of 2 [1, 3] mm at baseline to 1 [0, 3] mm 3 months after treatment. (p < 0.001). • T2 STIR sequences can be used to monitor the posttreatment course of periodontitis.

Magnetic resonance imaging as a diagnostic tool for periodontal disease: A prospective study with correlation to standard clinical findings-Is there added value?

AIM

To evaluate the correlation between standard clinical findings, radiographic (OPT) and magnetic resonance imaging (MRI) as well as to assess whether MRI is capable of providing additional information related to the severity and extent of periodontal disease.

METHODS

42 patients with generalized periodontitis received pre-interventional MRI scans. These were compared to MR images of a periodontal healthy control group (n = 34). The extent of the osseous oedema, detected by MRI, was set in correlation with clinical periodontitis-associated findings.

RESULTS

A highly significant correlation between bone oedema and clinical testings such as probing depth (p < 0.0001) and bleeding on probing (p < 0.0001) was revealed. The oedema exceeded the extent of demineralized bone. Patients with a positive BOP test showed a 2.51-fold increase in risk of already having a bone oedema around the respective tooth even if probing depth was ≤3 mm (logistic binary regression analysis, OR 2.51; 95% CI: 1.54-4.11; p < 0.0001).

CONCLUSION

MRI findings correlated with standard clinical findings, and MRI was able to depict intraosseous changes before any osseous defect had occurred.

MRI of the inferior alveolar nerve and lingual nerve-anatomical variation and morphometric benchmark values of nerve diameters in healthy subjects

OBJECTIVE

Since MRI using dedicated imaging sequences has recently shown promising results in direct visualization of the inferior alveolar nerve (IAN) and the lingual nerve (LN) with high spatial resolution, the aim of this study was to generate suitable standard specifications to reliably depict the IAN and LN in MRI and to delineate the anatomy and its variants of these nerves in healthy subjects.

METHODS

Thirty healthy volunteers were examined on a 3-T scanner (Elition, Philips Healthcare, Best, the Netherlands). The sequence protocol consisted of 3D STIR, 3D DESS, and 3D T1 FFE "black bone" sequences.

RESULTS

The study reconfirmed a good feasibility of direct visualization of proximal and peripheral portions of the IAN and of the proximal course of the LN. The STIR sequence showed the highest apparent signal to noise ratio (aSNR) and best apparent nerve-muscle contrast to noise ratio (aNMCNR) for IAN and for the LN. The applied MRI sequences allowed to differentiate the tissue composition of the neurovascular bundle inside the mandibular canal.

CONCLUSION

Dedicated MRI sequence protocols proved effectively to detect the IAN and LN and their course in healthy volunteers. The tissue composition of the mandibular neurovascular bundle was conclusively distinguishable as was the varying topography inside multiple bony channels.

CLINICAL RELEVANCE

The presented data on the precise and valid visualization of the IAN and LN have clinical implications in respect to local anesthesia prior to dental treatments in the mandible but also regarding surgical procedures and implant insertion in the molar region.

Reproducibility of volumetric measurements on maxillary sinuses

Although computer assisted volumetric quantification of human maxillary sinuses is commonly used to measure volumetric changes during life, reliability data for this procedure are lacking. The objective of this retrospective study is to test a semi-automatic virtual volumetric analysis technique on 36 CT scans of human maxillary sinuses. Three examiners with different clinical experience performed all measurements in three replicates. As principle of proof, the technique was examined on 12 phantoms with known volumes. The validation of the method revealed that the mean relative error was 0.364%. For the retrospective volumetric measurements from maxillary sinuses the intra- and inter-examiner agreement was quantified using appropriate intraclass correlation coefficients (ICC 1,k and ICC 2,k) and the Bland-Altman analysis. ICC values ranging from 0.997 to 0.999 indicate almost perfect agreement for intra- and inter-examiner data. The Bland-Altman analysis demonstrated good intra- as well as inter-examiner agreement for the two proficient examiners and a lack of agreement for the untrained examiner. It can be concluded that this measurement procedure using CT scans could be strongly recommended for clinical application to determine the volume of human maxillary sinuses reliably.

Matrix-assisted autologous chondrocyte implantation into a 14cm(2) cartilage defect, caused by steroid-induced osteonecrosis

Modern chemotherapy protocols have improved the prognosis for acute lymphoblastic leukaemia (ALL), one of the most common paediatric malignancies, but their high-dose corticosteroids lead to osteonecrosis in up to 9% of ALL patients. A 13.5-year-old female patient developed massive osteonecrosis of the right knee after successful ALL treatment. She presented at the age of 17.5 years as a candidate for knee arthroplasty after conservative treatment had failed. Magnetic Resonance Imaging (MRI) revealed severe osteonecrosis, with the cartilage layer of the medial femoral condyle completely detached from the bone. We preferred to attempt a two-step biological reconstruction in this young patient, with arthroscopy of the right knee joint and removal of the dissected cartilage layer of the medial condyle. Matrix-assisted autologous chondrocyte implantation (MACI) was performed with harvested chondrocytes after imaging had indicated vital bone remodelling. Rehabilitation was according to MACI guidelines and after 5.5 years, the patient shows continuous clinical improvement and is satisfied with the result. The Lysholm score improved from 45 to 99 and Tegner's activity score from 1 to 4. MRI follow-up showed a solid cartilage layer covering the medial condyle as a result of bone and chondral regeneration. Even if this approach had failed, bone remodelling would have still provided better conditions for knee arthroplasty.

Late onset Charcot–Marie–Tooth 2 syndrome caused by two novel mutations in the MPZ gene

MPZ gene mutations cause demyelinating and axonal Charcot–Marie–Tooth (CMT) disease. Two novel MPZ mutations are reported in very late onset and progressive CMT syndrome. The N60H caused axonal CMT in a large family, whereas the I62M occurred in a single patient presenting with a primary axonal neuropathy. Previously, chronic polyradiculoneuritis was assumed in two patients. Molecular genetic testing and particularly screening for MPZ mutations in late onset neuropathies are important to differentiate acquired and inherited neuropathies.