Intraindividual comparison of preoperative99m Tc-MDP SPECT/CT and intraoperative and histopathological findings in patients with bisphosphonate- or denosumab-related osteonecrosis of the jaw

• Published in: Journal of cranio-maxillo-facial surgery 2015, Vol.43 (8), p.1461-1469
• Main Authors: Assaf, Alexandre T, Zrnc, Tomislav A, Remus, Chressen C, Adam, Gerhard, Zustin, Jozef, Heiland, Max, Friedrich, Reinhard E, Derlin, Thorsten
• Format: Article
• Language: English
• Subjects: Surgery
• ISSN: 1010-5182
• DOI: 10.1016/j.jcms.2015.06.025

Abstract 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 ( r s  = 0.47, p  = 0.03). Clinical examination ( p