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CT Scans of Maxillofacial Osteonecrosis/NICO
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Thin-sliced (1.5 mm.) scan of the maxilla with most of anterior showing ghost marrow scattered with cavitations of various sizes.  A large cavitation just the left of midline is surrounded by ghost marrow (hazy, slight radiopacity).

CT Scans for Osteonecrosis and NICO -- A Review

Routine Computer Assisted Tomography (CT, CAT) scans are very helpful in detecting necrotic marrow and bone in the rounded ends of long bones, but they have not proven to be effective in detecting alterations in the marrow spaces of the facial bones.  On the other hand, the new generation of spiral CT scans can provide very thin-sliced views, as thin as 1.0-1.5 mm., and such views are often able to detect not just destroyed marrow of the facial bones but marrow which has undergone ischemic damage but is still viable. Both horizontal and vertical views should be carefully examined for areas of complete blackness (empty area of cavitation) or hazy, diffuse grayness (ghost marrow).  Occasional lesions will show small focal spots of whiteness (radiopacity) when fragments of viable bone remain surrounded by death tissues or when chronic ischemic conditions slowly produce excess bone formation (condensing osteitis, bone scar).

Examples of CT Scans of Maxillofacial Osteonecrosis

Figure 1: Vertical CT slice shows large bilobed cavitation immediately behind and between the roots of the maxillary right incisors (left white arrows).  Additional lesion is more posteriorly located on the hard palate (right white arrow); the floor of the sinus is perforated (small black arrows). Figure 2: Parographic CT view shows multiple areas of marrow destruction, especially between the left maxillary incisors.  All teeth are viable, hence, the periapical radiolucencies are not related to dental infections. Figure 3: Thin-sliced CT view of maxilla with 2 cm. area of ghost marrow behind the left incisors, wrapping round the incisive canal. Figure 4: Vertical slice of the right maxilalry bicuspid region shows an irregular hollow marrow space along the facial aspect of the root and extending superiorly to the floor of the maxillary sinus.  This was not visible using routine periapical radiographs.

Other Types of Imaging Tests in Maxillofacial Osteonecrosis

Note: MRI and additional CT scans are not yet placed on this website.