Alexandre T. Assaf , Tomislav A. Zrnc , Chressen C. Remus , Gerhard Adam , Jozef Zustin , Max Heiland , Reinhard E. Friedrich , Thorsten Derlin
{"title":"双膦酸盐或denosumumab相关性颌骨骨坏死患者术前99mTc-MDP SPECT/CT与术中及组织病理学结果的个体间比较","authors":"Alexandre T. Assaf , Tomislav A. Zrnc , Chressen C. Remus , Gerhard Adam , Jozef Zustin , Max Heiland , Reinhard E. Friedrich , Thorsten Derlin","doi":"10.1016/j.jcms.2015.06.025","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><p>Bisphosphonate- or denosumab-related osteonecrosis of the jaw<span><span> (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) </span>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.</span></p></div><div><h3>Material and methods</h3><p>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.</p></div><div><h3>Results</h3><p><span>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 (</span><em>r</em><sub><em>s</em></sub> = 0.47, <em>p</em> = 0.03). Clinical examination (<em>p</em> < 0.0001), but not SPECT (<em>p</em> = 0.19), underestimated the extent of disease as determined by surgical evaluation. SPECT/CT offered a significantly higher diagnostic certainty (<em>p <</em> 0.0001).</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":54851,"journal":{"name":"Journal of Cranio-Maxillofacial Surgery","volume":"43 8","pages":"Pages 1461-1469"},"PeriodicalIF":2.1000,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jcms.2015.06.025","citationCount":"25","resultStr":"{\"title\":\"Intraindividual comparison of preoperative 99mTc-MDP SPECT/CT and intraoperative and histopathological findings in patients with bisphosphonate- or denosumab-related osteonecrosis of the jaw\",\"authors\":\"Alexandre T. Assaf , Tomislav A. Zrnc , Chressen C. Remus , Gerhard Adam , Jozef Zustin , Max Heiland , Reinhard E. Friedrich , Thorsten Derlin\",\"doi\":\"10.1016/j.jcms.2015.06.025\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><p>Bisphosphonate- or denosumab-related osteonecrosis of the jaw<span><span> (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) </span>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.</span></p></div><div><h3>Material and methods</h3><p>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.</p></div><div><h3>Results</h3><p><span>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 (</span><em>r</em><sub><em>s</em></sub> = 0.47, <em>p</em> = 0.03). Clinical examination (<em>p</em> < 0.0001), but not SPECT (<em>p</em> = 0.19), underestimated the extent of disease as determined by surgical evaluation. SPECT/CT offered a significantly higher diagnostic certainty (<em>p <</em> 0.0001).</p></div><div><h3>Conclusion</h3><p>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.</p></div>\",\"PeriodicalId\":54851,\"journal\":{\"name\":\"Journal of Cranio-Maxillofacial Surgery\",\"volume\":\"43 8\",\"pages\":\"Pages 1461-1469\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2015-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1016/j.jcms.2015.06.025\",\"citationCount\":\"25\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Cranio-Maxillofacial Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1010518215002024\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"DENTISTRY, ORAL SURGERY & MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Cranio-Maxillofacial Surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1010518215002024","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"DENTISTRY, ORAL SURGERY & MEDICINE","Score":null,"Total":0}
Intraindividual comparison of preoperative 99mTc-MDP SPECT/CT and intraoperative and histopathological findings in patients with bisphosphonate- or denosumab-related osteonecrosis of the jaw
Purpose
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 (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).
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.
期刊介绍：
The Journal of Cranio-Maxillofacial Surgery publishes articles covering all aspects of surgery of the head, face and jaw. Specific topics covered recently have included:
• Distraction osteogenesis
• Synthetic bone substitutes
• Fibroblast growth factors
• Fetal wound healing
• Skull base surgery
• Computer-assisted surgery
• Vascularized bone grafts
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
