Important radiographic features in the identification of osseous dysplasia–related osteomyelitis

Objectives: The aims of this study were to identify radiographic features that distinguish osseous dysplasia–related osteomyelitis (OD-related OM) from OD without OM and to detect possible causes of OD-related OM. Study Design: Seventeen OD cases with and without OM were examined on planar and volumetric (cone beam computed tomography or multidetector computed tomography) imaging. Cases were divided into 3 groups based on clinical data: symptomatic OM, incidental (asymptomatic) OM, and control (OD without OM). Images were reviewed by 3 precalibrated observers, blinded to clinical information, for OD characteristics (location and extent); radiographic features of OD-related OM; and possible causes. Radiographic features of OD-related OM chosen by at least 2 observers were statistically analyzed within and between groups. Results: Discontinuity of the cortical plates, widening of the radiolucent rim, decreased attenuation of the radiolucent rim, and sequestrum formation were significantly more common in symptomatic and incidental OM groups than in the control group (P ≤.05). Two causes, atrophy of the edentulous ridge and presence of a periapical lesion, were also correlated with OD-related OM (P ≤.05, P ≤.01, respectively). Conclusions: Radiographic features can distinguish OD-related OM from OD. Familiarity with these radiographic features and possible causes may help improve the identification of secondarily infected OD.