Decisive diagnosis of infected mandibular osteoradionecrosis with a Tc-99m-labelled anti-granulocyte Fab'-fragment.
The accepted golden standard for detection of inflammatory bone disease is conventional three-phase bone scanning. Hyperperfusion, a high blood-pool activity and elevated bone metabolism are typical signs for an acute osteomyelitis. However, in case of subacute, chronic inflammation, neither elevated blood flow nor high blood-pool activity may be seen. This may cause difficulties in differentiating such cases from neoplastic or postoperative changes. This case report verifies the possible advantage of immunoscintigraphy with Tc-99m-labelled anti-granulocyte Fab'-fragments (LeukoScan) in a patient with infected mandibular osteoradionecrosis, who had equivocal clinical symptoms and questionable radiographic results. LeukoScan is shown to be more sensitive in case of subacute bone inflammation compared with three-phase bone scanning. However, acquisition of delayed images after 24 hours including SPECT is inevitable in case of negative scans during the first hours of investigation.
Kampen
W U
WU
Clinic of Nuclear Medicine, Christian-Albrechts-University Kiel, Germany. ukampen@nuc-med.uni-kiel.de
Brenner
W
W
Terheyden
H
H
Bohuslavizki
K H
KH
Henze
E
E
D000368:Aged; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy; D003937:Diagnosis, Differential; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008336:Mandibular Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D010025:Osteoradionecrosis / Q000000981:diagnostic imaging* / Q000601:surgery; D011859:Radiography; D019275:Radiopharmaceuticals; D011878:Radiotherapy / Q000009:adverse effects; D015899:Tomography, Emission-Computed, Single-Photon
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D019275:Radiopharmaceuticals; C101172:Sulesomab