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Assaf, AT; Zrnc, TA; Remus, CC; Adam, G; Zustin, J; Heiland, M; Friedrich, RE; Derlin, T.
Intraindividual comparison of preoperative (99m)Tc-MDP SPECT/CT and intraoperative and histopathological findings in patients with bisphosphonate- or denosumab-related osteonecrosis of the jaw.
J Craniomaxillofac Surg. 2015; 43(8):1461-1469 Doi: 10.1016/j.jcms.2015.06.025
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Co-authors Med Uni Graz: Zrnc Tomislav
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Abstract:: 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. 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. 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 (rs = 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). 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. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
Find related publications in this database (using NLM MeSH Indexing): Adult -; Aged -; Aged, 80 and over -; Bisphosphonate-Associated Osteonecrosis of the Jaw - diagnostic imaging; Bisphosphonate-Associated Osteonecrosis of the Jaw - pathology; Bisphosphonate-Associated Osteonecrosis of the Jaw - surgery; Bone Density Conservation Agents - adverse effects; Denosumab - adverse effects; Female -; Fluorescence -; Humans -; Intraoperative Care -; Male -; Mandibular Diseases - diagnostic imaging; Mandibular Diseases - pathology; Mandibular Diseases - surgery; Maxillary Diseases - diagnostic imaging; Maxillary Diseases - pathology; Maxillary Diseases - surgery; Middle Aged -; Perfusion Imaging - methods; Photography - methods; Preoperative Care -; Radiopharmaceuticals -; Single Photon Emission Computed Tomography Computed Tomography - methods; Technetium Tc 99m Medronate -; Whole Body Imaging - methods
Find related publications in this database (Keywords): Bisphosphonate-related osteonecrosis of the jaw (BRONJ); Denosumab-related osteonecrosis of the jaw (DRONJ); Scintigraphy; Bone scan; SPECT/CT; Visually Enhanced Lesion Scope (VELscope)