Sestamibi and FDG-PET scans to support diagnosis of jaw osteonecrosis.
Osteonecrosis of the maxillary or mandibular bone is an infrequent but often severe event occurring in patients who undergo prolonged treatment with bisphosphonates. Histology is in some cases mandatory to differentiate it from neoplastic osteolysis, but a biopsy can further contribute to bone damage. Functional imaging obtained by a tracer that shows oncotropic properties, such as Tc99m-sestamibi, in comparison to a non-tumor-specific substance such as FDG-PET, can support the differential diagnosis, thus avoiding invasive procedures. Four patients affected by multiple myeloma and jaw osteonecrosis were prospectively evaluated by sestamibi and FDG-PET scans. Local diagnosis was performed by clinical, radiological and, in some cases, histological evaluations. Each patient was studied by Tc99m-sestamibi, performed by planar anterior and posterior whole-body scans and SPECT of the head and neck, and by PET/CT. Two nuclear medicine physicians, unaware of the final diagnosis, reviewed the images. No sestamibi uptake was evident in the four patients with jaw osteonecrosis, while FDG-PET/CT showed focal uptake in all of them. Our study suggests that the combined use of sestamibi scintigraphy and FDG-PET/CT could support the clinical diagnosis of oral osteonecrosis avoiding the risks of a surgical biopsy. Studies on higher number of patients are necessary to validate these preliminary observations.
Catalano
Lucio
L
Cattedra di Ematologia, Federico II University, via Pansini 5, 80131 Napoli, Italy. lcatalan@unina.it
Del Vecchio
Silvana
S
Petruzziello
Fara
F
Fonti
Rosa
R
Salvatore
Barbara
B
Martorelli
Carmen
C
Califano
Catello
C
Caparrotti
Giuseppe
G
Segreto
Sabrina
S
Pace
Leonardo
L
Rotoli
Bruno
B
D000368:Aged; D004164:Diphosphonates / Q000009:adverse effects; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007571:Jaw Diseases / Q000139:chemically induced / Q000000981:diagnostic imaging*; D009101:Multiple Myeloma / Q000188:drug therapy; D010020:Osteonecrosis / Q000139:chemically induced / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
D004164:Diphosphonates; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D017256:Technetium Tc 99m Sestamibi