Three-phase bone scintigraphy for imaging osteoradionecrosis of the jaw.

Abstract:

UNLABELLED:This study evaluates the diagnostic utility of 3-phase bone scintigraphy for diagnosing osteoradionecrosis of the jaw (ORNJ). METHODS:Thirty-two consecutive patients with a history of radiation to the head and neck region (range, 62-70 Gy; mean, 68 Gy; median, 69 Gy) due to squamous cell cancer and suspected ORNJ underwent 3-phase bone scans after injection of 520 to 750 MBq of Tc-MPD. In addition to planar scans, tomographic images (SPECT) were acquired in the second phase and SPECT/CT images during the third phase. Histopathologic findings (n = 18) and clinical follow-up (n = 14) served as reference standard for osteoradionecrosis. RESULTS:The first, second, and third phases of planar images were rated positive in 18/32 patients (56.3%), 25/32 (78.1%), and 27/32 patients (84.4%), respectively. The late SPECT was positive in all patients (32/32, 100%), respectively. Histopathologic findings available in 18/32 patients (56.3%) confirmed ORNJ in all subjects. Acute inflammation was histologically proven in 18/18 specimens (100%) and additional chronic inflammation in 12/18 (66.7%). In 13/18 (72.2%) specimens, superinfection was evident histopathologically. A photopenic defect with surrounding hypermetabolism, a reported hallmark of ORJN, was found in less than 5%. CONCLUSIONS:The predominant scintigraphic pattern of osteoradionecrosis includes increased bone mineralization phase in all patients. Central photopenia, reportedly a typical bone scan finding in bisphosphonate-induced osteonecrosis, was not characteristic for ORNJ. A differentiation of acute from chronic inflammatory processes was not possible.

journal_name

Clin Nucl Med

authors

Lapa C,Linz C,Bluemel C,Mottok A,Mueller-Richter U,Kuebler A,Schneider P,Czernin J,Buck AK,Herrmann K

doi

10.1097/RLU.0000000000000296

subject

Has Abstract

pub_date

2014-01-01 00:00:00

pages

21-5

issue

1

eissn

0363-9762

issn

1536-0229

journal_volume

39

pub_type

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