Skip Navigation LinksHome > January 2014 - Volume 39 - Issue 1 > Three-Phase Bone Scintigraphy for Imaging Osteoradionecrosis...
Clinical Nuclear Medicine:
doi: 10.1097/RLU.0000000000000296
Original Articles

Three-Phase Bone Scintigraphy for Imaging Osteoradionecrosis of the Jaw

Lapa, Constantin MD*; Linz, Christian MD; Bluemel, Christina MD*; Mottok, Anja MD; Mueller-Richter, Urs MD; Kuebler, Alexander MD; Schneider, Peter MD*; Czernin, Johannes MD§; Buck, Andreas K. MD*; Herrmann, Ken MD

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Abstract

Abstract

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 99mTc-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.

Copyright © 2013 by Lippincott Williams & Wilkins

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