Interesting Image

Magnetic Resonance Imaging Signal Changes Mimicking Bone Metastasis in Patients Receiving Bisphosphonate Therapy


  • İpek Tamsel
  • Mehmet Argın
  • Ayşegül Akgün

Received Date: 15.03.2020 Accepted Date: 31.05.2020 Mol Imaging Radionucl Ther 2021;30(2):122-125 PMID: 34082517

Bisphosphonates are inorganic pyrophosphate agents that reduce bone turnover. These agents reduce bone pain and delay skeletal complications, such as fractures in patients with metastatic lytic lesions, malignant-related hypercalcemia, multiple myeloma, Paget’s disease of bone, and osteoporosis. Osteonecrosis, developing in the jaw bones specifically, has been described as a complication associated with the use of bisphosphonates. In this report, we presented osteonecrosis-like magnetic resonance imaging findings that can be confused with bone metastasis in two patients who underwent long-term bisphosphonate treatment and the value of bone scan and 18flor-fluorodeoxyglucose positron emission tomography/computerized tomography in the differential diagnosis.

Keywords: Bisphosphonate, osteonecrosis, long bone, magnetic resonance imaging, bone scan, 18F-flourodeoxyglucose positron emission tomography/computerized tomography


Informed Consent: Consent was obtained from the two cases in the study.

Peer-review: Externally peer-reviewed.

Authorship Contributions

Surgical and Medical Practices: İ.T., M.A., A.A., Concept: İ.T., M.A., A.A., Design: İ.T., M.A., A.A., Data Collection or Processing: İ.T., M.A., A.A., Analysis or Interpretation: İ.T., M.A., A.A., Literature Search: İ.T., M.A., A.A., Writing: İ.T., M.A., A.A.

Conflict of Interest: No conflict of interest was declared by the authors.

Financial Disclosure: The authors declared that this study received no financial support.


  1. Obinata K, Shirai S, Ito H, Nakamura M, Carrozzo M, Macleod I, Carr A, Yamazaki Y, Tei K. Image findings of bisphosphonate related osteonecrosis of jaws comparing with osteoradionecrosis. Dentomaxillofac Radiol 2017;46:20160281.
  2. Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL. Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg 2004;62:527-534.
  3. Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 2003;61:1115-1117.
  4. Saito A, Nakamura Y, Tanaka R, Inoue S, Okiyama N, Ishitsuka Y, Maruyama H, Watanabe R, Yoshida K, Ishiko A, Fujimoto M, Shinkuma S, Fujisawa Y. Unusual Bone Lesions with Osteonecrosis Mimicking Bone Metastasis of Squamous Cell Carcinoma in Recessive Dystrophic Epidermolysis Bullosa. Acta Derm Venereol 2019;99:1166-1169.
  5. Agrawal K, Tripathy SK, Sen RK, Santhosh S, Bhattacharya A. Nuclear medicine imaging in osteonecrosis of hip: Old and current concepts. World J Orthop 2017;8:747-753.
  6. Talamo G, Angtuaco E, Walker RC, Dong L, Miceli MH, Zangari M, Tricot G, Barlogie B, Anaissie E. Avascular necrosis of femoral and/or humeral heads in multiple myeloma: results of a prospective study of patients treated with dexamethasone-based regimens and high-dose chemotherapy. J Clin Oncol 2005;23:5217-5223.
  7. Choi KH, Oh JK, Kim SH, Yoo ID, Choi EK, Han EJ. Osteonecrosis Mimicking Bone Metastasis in Femoral Head on (18)F-FDG PET/CT: A Case Report. Nucl Med Mol Imaging 2011;45:68-71.