Black bone MRI morphometry for mandibular cortical bone measurement in head and neck cancer patients: prospective method comparison with CT

Lisanne V van Dijk; Juan Ventura; Kareem A Wahid; Lin L Zhu; Brigid A McDonald; Sara Ahmed; Keith L Sanders; Sonja M Stieb; Lance McCoy; Christina S Sharafi; Kathryn E Preston; Natalie A West; Sarah Mirbahaeddin; Dina M El-Habashy; Travis Salzillo; Samuel Mulder; Joly Fahim; Aubryane DeArmas; Mona Arbab; Yao Ding; Jihong Wang; Bastien Rigaud; Anando Sen; Mark Chambers; Katherine A Hutcheson; Kristy K Brock; Abdallah S R Mohamed; Stephen Y Lai; Clifton D Fuller; MRI-Radiotherapy Development Cooperative

doi:10.1016/j.oooo.2025.12.013

Black bone MRI morphometry for mandibular cortical bone measurement in head and neck cancer patients: prospective method comparison with CT

Oral Surg Oral Med Oral Pathol Oral Radiol. 2026 May;141(5):690-700. doi: 10.1016/j.oooo.2025.12.013. Epub 2025 Dec 29.

Authors

Lisanne V van Dijk¹, Juan Ventura², Kareem A Wahid³, Lin L Zhu⁴, Brigid A McDonald³, Sara Ahmed⁵, Keith L Sanders⁶, Sonja M Stieb⁷, Lance McCoy⁸, Christina S Sharafi⁹, Kathryn E Preston¹⁰, Natalie A West¹¹, Sarah Mirbahaeddin³, Dina M El-Habashy¹², Travis Salzillo³, Samuel Mulder¹¹, Joly Fahim³, Aubryane DeArmas³, Mona Arbab¹³, Yao Ding¹⁴, Jihong Wang¹⁴, Bastien Rigaud¹⁴, Anando Sen¹⁵, Mark Chambers¹⁶, Katherine A Hutcheson¹⁷, Kristy K Brock¹⁸, Abdallah S R Mohamed¹⁹, Stephen Y Lai²⁰, Clifton D Fuller²¹; MRI-Radiotherapy Development Cooperative

Affiliations

¹ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; University Medical Center Groningen, University of Groningen, Groningen, NL, USA.
² Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; John Sealy School of Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX, USA.
³ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁴ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Harvard Radiation Oncology Program, Boston, MA, USA.
⁵ Department of Radiation Oncology, Baylor College of Medicine, Houston, TX, USA.
⁶ Department of Bioinformatics and Systems Medicine, McWilliams School of Biomedical Informatics, Houston, TX, USA.
⁷ Department of Radio-Oncology, KSA Cantonal Hospital Aarau, Aarau, Switzerland.
⁸ Department of Medicine, Morehouse School of Medicine, Atlanta, GA, USA.
⁹ College of Osteopathic Medicine, NOVA Southeastern University, Fort Lauderdale, FL, USA.
¹⁰ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; College of Pharmacy, University of Houston, Houston, TX, USA.
¹¹ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX, USA.
¹² Transitional Year Program, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA.
¹³ Department of Radiation Oncology, UT Southwestern, Dallas, TX USA.
¹⁴ Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
¹⁵ School of Healthcare and Nursing Sciences, Northumbria University, Newcastle upon Tyne, England.
¹⁶ Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
¹⁷ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
¹⁸ The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX, USA; Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Program for Image-Guided Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
¹⁹ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Radiation Oncology, Baylor College of Medicine, Houston, TX, USA; Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
²⁰ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX, USA; Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Program for Image-Guided Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
²¹ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX, USA; Program for Image-Guided Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: cdfuller@mdanderson.org.

Abstract

Objectives: Determine the utility of low-flip angle "black bone" magnetic resonance imaging (MRI) for cortical mandibular bone assessment compared to computed tomography (CT).

Methods: Quantification of cortical mandibular bone width was performed per Hamada et al. at 15 cross-sectional interdentium locations on pretreatment black bone MRI and CT for 15 oropharyngeal cancer patients, with interobserver analyses on a subset of three patients by 11 observers. CT and MRI measurements were compared using Bland-Altman analysis, Lin's concordance, and Deming regression; interobserver variability was assessed with absolute variance and intraclass correlation coefficient (ICC).

Results: Bland Altman and Deming regression analyses showed CT and black bone MRI measurements were comparable within ±0.85mm limits of agreement, and systematically smaller for MRI. ICC (0.60[0.52;0.67]) showed moderate equivalence between modalities. The average absolute variance between the observers was similar on CT (1.13±0.06mm) and MRI (1.15±0.06mm). ICC analysis showed that measurement consistency was significantly higher (p<0.001) for black bone MRI (0.43[0.32;0.56]) than CT (0.22[0.13;0.35]); nonetheless, ICC was poor for both modalities.

Conclusion: Black bone MRI is a viable alternative to CT for assessing mandibular cortical bone and early detection of anatomical changes like osteoradionecrosis. Both modalities showed similar interobserver variability, which may be reduced through (semi)automated measurement.

Publication types

Comparative Study

MeSH terms

Aged
Cortical Bone* / diagnostic imaging
Cortical Bone* / pathology
Female
Head and Neck Neoplasms* / diagnostic imaging
Humans
Magnetic Resonance Imaging* / methods
Male
Mandible* / diagnostic imaging
Mandible* / pathology
Middle Aged
Observer Variation
Oropharyngeal Neoplasms* / diagnostic imaging
Oropharyngeal Neoplasms* / pathology
Prospective Studies
Tomography, X-Ray Computed* / methods

Abstract

Publication types

MeSH terms

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