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Objectives <p>Diffuse sclerosing osteomyelitis (DSO) is a diagnosis of exclusion with incompletely understood mechanisms underlying acute pain episodes. This study aimed to characterize Magnetic Resonance Imaging (MRI) features of DSO to investigate imaging findings associated with acute pain during disease relapse.</p> Materials and methods <p>This single-center, retrospective observational study included 14 patients diagnosed with DSO. All subjects underwent MRI using a 3T Siemens MAGNETOM Vida scanner equipped with a 15-channel mandibular coil. MRI datasets were evaluated for cortical bone alterations, lymph node enlargement, contrast enhancement patterns, and soft-tissue or perineural edema.</p> Results <p>MRI demonstrated thickened cortical bone (85.7%, 95% CI 57.2–97.8), cortical destruction (35.7%, 95% CI 12.8–64.9%), pathologically enlarged lymph nodes (64.3%, 95% CI 35.1–87.2) and contrast enhancement within the mandibular bone (78.6%, 95% CI 49.2–95.3) and masticatory muscles 42.9%, (95% CI 17.7–71.1) as characteristic features of DSO. Perineural edema was present in 57.1% (95% CI: 28.9–82.3) of all patients and in 100% of patients with active pain relapse.</p> Conclusion <p>In DSO patients, mandibular-coil MRI can reveal perineural inflammation, particularly perineural edema, which appears to be associated with pain symptoms and may serve as a diagnostic aid in the often-challenging identification of DSO. These observations are based on the present data and do not establish a causal relationship between perineural edema and pain.</p> Clinical relevance <p>MRI may enhance diagnostic accuracy in DSO, help identify relapse-associated inflammatory changes, and improve understanding of pain mechanisms, thereby supporting more tailored therapeutic strategies.</p>

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MRI characteristics of diffuse sclerosing osteomyelitis of the mandible and the association of perineural edema with pain relapse: a retrospective cohort study

  • 期刊论文

  • 发表日期：

    2026年3月10日

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  • Ina Dewenter,
  • Sophia Stoecklein,
  • Eric Hesse,
  • Riham Fliefel,
  • Ralf Schmidmaier,
  • Sven Otto,
  • Katharina Theresa Obermeier

摘要

Objectives

Diffuse sclerosing osteomyelitis (DSO) is a diagnosis of exclusion with incompletely understood mechanisms underlying acute pain episodes. This study aimed to characterize Magnetic Resonance Imaging (MRI) features of DSO to investigate imaging findings associated with acute pain during disease relapse.

Materials and methods

This single-center, retrospective observational study included 14 patients diagnosed with DSO. All subjects underwent MRI using a 3T Siemens MAGNETOM Vida scanner equipped with a 15-channel mandibular coil. MRI datasets were evaluated for cortical bone alterations, lymph node enlargement, contrast enhancement patterns, and soft-tissue or perineural edema.

Results

MRI demonstrated thickened cortical bone (85.7%, 95% CI 57.2–97.8), cortical destruction (35.7%, 95% CI 12.8–64.9%), pathologically enlarged lymph nodes (64.3%, 95% CI 35.1–87.2) and contrast enhancement within the mandibular bone (78.6%, 95% CI 49.2–95.3) and masticatory muscles 42.9%, (95% CI 17.7–71.1) as characteristic features of DSO. Perineural edema was present in 57.1% (95% CI: 28.9–82.3) of all patients and in 100% of patients with active pain relapse.

Conclusion

In DSO patients, mandibular-coil MRI can reveal perineural inflammation, particularly perineural edema, which appears to be associated with pain symptoms and may serve as a diagnostic aid in the often-challenging identification of DSO. These observations are based on the present data and do not establish a causal relationship between perineural edema and pain.

Clinical relevance

MRI may enhance diagnostic accuracy in DSO, help identify relapse-associated inflammatory changes, and improve understanding of pain mechanisms, thereby supporting more tailored therapeutic strategies.