Intraindividual comparison of preoperative ^99mTc-MDP SPECT/CT and intraoperative and histopathological findings in patients with bisphosphonate- or denosumab-related osteonecrosis of the jaw

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• 作者：Alexandre T. Assaf^a ; ^{a.assaf@uke.uni-hamburg.de" class="auth_mail" title="E-mail the corresponding author} ; Tomislav A. Zrnc^b ; Chressen C. Remus^c ; Gerhard Adam^c ; Jozef Zustin^d ; Max Heiland^a ; Reinhard E. Friedrich^a ; Thorsten Derlin^c
• 关键词：Bisphosphonate-related osteonecrosis of the jaw (BRONJ) ; Denosumab-related osteonecrosis of the jaw (DRONJ) ; Scintigraphy ; Bone scan ; SPECT/CT ; Visually Enhanced Lesion Scope (VELscope)
• 刊名：Journal of Cranio-Maxillofacial Surgery
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：43
• 期：8
• 页码：1461-1469
• 全文大小：1617 K

文摘

Bisphosphonate- or denosumab-related osteonecrosis of the jaw (BRONJ/DRONJ) requires reliable preoperative assessment of the extent of disease for surgical planning. The aim of this study was to compare the extent of BRONJ/DRONJ as detected by Tc-99m-methylene diphosphonate (MDP) bone scintigraphy with intraoperative and histopathological findings, and to assess the additional value of hybrid single photon emission computed tomography/computed tomography (SPECT/CT) for evaluation of disease.

Material and methods

Twenty-one patients with BRONJ/DRONJ underwent three-phase bone scintigraphy including SPECT/CT. The diagnostic certainty using conventional SPECT or fused SPECT/CT imaging was compared. Location and extent of disease on scintigraphic imaging and pre- and intra-operative clinical assessment were compared. Intraoperative and histopathological findings served as reference standard.

Results

A total of 29 sites of BRONJ/DRONJ were histopathologically confirmed in 21 patients. Bone scintigraphy demonstrated increased perfusion in 57.1% of patients, increased blood pool in 76.2%, and increased tracer accumulation at the metabolic phase in all patients. The intensity of tracer accumulation at the metabolic phase correlated significantly with clinical stage of disease (r_s = 0.47, p = 0.03). Clinical examination (p < 0.0001), but not SPECT (p = 0.19), underestimated the extent of disease as determined by surgical evaluation. SPECT/CT offered a significantly higher diagnostic certainty (p < 0.0001).

Conclusion

In patients with BRONJ/DRONJ, the true extent of osseous lesions as determined by surgery is significantly underestimated by clinical examination. Tc-99m-MDP bone scintigraphy can reliably predict the extent of disease. Hybrid SPECT/CT may significantly increase the diagnostic certainty of anatomical localization.