Quantitative assessment of the cervical lymph nodes affected by medication-related osteonecrosis of the jaw using diffusion-weighted imaging

Purpose: This study aimed to quantitively assess the apparent diffusion coefficient (ADC) values of cervical lymph nodes that were affected by medication-related osteonecrosis of the jaw (MRONJ). Method: This retrospective study analyzed the ADC map of 70 patients with or without MRONJ (Stage 0 to 3) between April 2019 and March 2022. The mean ADC values of the submandibular (level ⅠB) and superior internal jugular (level IIA) nodes in normal participants and patients with MRONJ were calculated, and differences were analyzed using the Mann–Whitney test. Moreover, receiver operating characteristic (ROC) curve analysis was performed to evaluate the ability of ADC values to predict lymph nodes (LNs) that were affected by MRONJ. P < 0.05 was considered statistically significant. Results: The mean ADCs (×10 -3 mm 2 /s) of level IB in the normal and MRONJ groups were 0.75 ± 0.08 and 0.94 ± 0.15, respectively. The mean ADCs of level IIA in the normal and MRONJ groups were 0.8 ± 0.07 and 0.99 ± 0.16, respectively. ROC analysis revealed cutoff ADC values of 0.83 (level IB) and 0.93 (level IIA) for distinguishing between the normal and MRONJ groups. The sensitivity, specificity, accuracy, and area under the ROC curve values were 0.66–0.82, 0.86–0.97, 0.81–0.84, and 0.86–0.88, respectively. Conclusion: This study revealed that the ADC value of cervical LNs that were affected by MRONJ was significantly different from those of the normal group. Thus, it may be a characteristic finding of MRONJ.