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Prognostic Value of Bone Scintigraphy in Cancer Patients With Osteonecrosis of the Jaw

Van den Wyngaert, Tim MD*†; Huizing, Manon T. MD, PhD*; Fossion, Eric MD, DDS; Vermorken, Jan B. MD, PhD*

doi: 10.1097/RLU.0b013e3181feeb72
Original Article

Purpose of the Report: Identifying imaging predictors of healing of osteonecrosis of the jaw (ONJ) in cancer patients may assist in better stratification of treatment strategies.

Materials and Methods: Patients with ONJ were followed prospectively and underwent bone scintigraphy, both planar and single-photon emission computed tomography (SPECT) imaging. End points were time to healing and the number of recurrences. Studied parameters included lesion visibility, pattern of uptake, and quantification of uptake relative to the unaffected side.

Results: A total of 22 patients were recruited (3 men; 19 women) with a stage 1 ONJ lesion in 8, stage 2 in 9, and stage 3 ONJ in 5 patients. Median duration of follow-up was 12 months (range, 6–37). SPECT acquisitions proved superior over planar images in detecting ONJ lesions (P = 0.03). Quantification of tracer uptake in the ONJ lesion relative to the unaffected side showed increasing uptake with higher stages of ONJ: mean, 1.67 (95% confidence interval [CI], 1.17–2.18) in stage 1, 2.72 (95% CI, 2.24–3.20) in stage 2, and 4.62 (95% CI, 3.98–5.26) in stage 3. In addition, this relative ratio of uptake was found to be an independent predictor of ONJ healing (hazard ratio, 0.24; 95% CI, 0.07–0.82; P = 0.02). Neither ONJ stage nor relative ratio of uptake were predictors of the occurrence of ONJ relapses.

Conclusions: Bone scintigraphy in patients with ONJ is feasible and SPECT acquisitions are preferred over planar images. Relative quantification of tracer uptake provides prognostic information independent of clinical stage that may assist in identifying patients with a poor prognosis.

From the Departments of *Medical Oncology and †Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium; and ‡Department of Oral and Maxillo-Facial Surgery, ZNA Middelheim, Wilrijk, Belgium.

Received for publication March 28, 2010; revision accepted June 26, 2010.

Dr. Van den Wyngaert has received lecture fees from Novartis Pharmaceuticals Corporation. Dr. Van den Wyngaert and Prof. Fossion have participated in scientific advisory boards for Novartis Pharmaceuticals Corporation. All other authors have no conflicts of interest.

This work is entirely original and has not been presented before.

Reprints: Tim Van den Wyngaert, MD, Department of Medical Oncology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium. E-mail:

Copyright © 2011 Wolters Kluwer Health, Inc. All rights reserved.