The role of magnetic resonance imaging and scintigraphy in the diagnosis of pathologic changes of the mandible after radiation therapy.
A prospective study of 85 patients with oral cancer, treated with high-dose radiation therapy, was performed to assess the value of magnetic resonance imaging (MRI) and scintigraphy for diagnosis of pathologic changes in the mandible. During postradiotherapeutic monitoring, radiation osteomyelitis occurred in 12 cases, tumor recurrences infiltrating the mandible in five cases, and progressive periodontal disease in nine cases. MRI permitted early diagnosis of radiation osteomyelitis in 11 out of 12 cases; only two cases were false positive. In scintigraphy with 99mTc-HDP, all alterations of the mandible, such as osteoradionecrosis, tumor infiltration, and periodontitis, showed a high uptake, resulting in a sensitivity of up to 100%, but a low specificity of 57%. Scintigraphy permitted assessment of the extension and location of the lesions. Both methods were superior to conventional radiography and clinical examination and should be integrated into a comprehensive follow-up program after radiation therapy.
Bachmann
G
G
Department of Radiology, Justus-Liebig-University of Giessen, Germany.
Rössler
R
R
Klett
R
R
Rau
W S
WS
Bauer
R
R
D000328:Adult; D000368:Aged; D005189:False Positive Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008334:Mandible / Q000000981:diagnostic imaging / Q000473:pathology / Q000528:radiation effects*; D008336:Mandibular Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D008339:Mandibular Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000532:radiotherapy*; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D010019:Osteomyelitis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology; D010025:Osteoradionecrosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology; D010518:Periodontitis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology; D011446:Prospective Studies; D011832:Radiation Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D011834:Radiation Monitoring; D019275:Radiopharmaceuticals; D011878:Radiotherapy / Q000009:adverse effects; D011879:Radiotherapy Dosage; D012680:Sensitivity and Specificity; D013669:Technetium Tc 99m Medronate / Q000031:analogs & derivatives; D015899:Tomography, Emission-Computed, Single-Photon
D019275:Radiopharmaceuticals; C024226:technetium Tc 99m hydroxymethylene diphosphonate; D013669:Technetium Tc 99m Medronate