What is the role of positron emission tomography in osteonecrosis of the jaws?
OBJECTIVE
Bisphosphonate-related osteonecrosis of the jaw (BP-ONJ) has become an associated side effect of BP therapy and several imaging modalities have been studied to show an ability to detect clinical disease. Because most patients at the authors' university hospital who develop BP-ONJ also undergo concurrent positron emission tomographic (PET) scanning, the authors investigated the utility of PET scans for diagnosis of BP-ONJ.


METHODS
A retrospective chart review was performed of patients whose PET scans were acquired within 1 year of their BP-ONJ diagnosis (1998 through 2006). BP-ONJ was defined as intraoral exposure of the maxilla or mandible in patients on BPs and not given radiation to that area. This was performed at a university hospital with oncologic patients treated with BPs. All PET scans in this study were secondarily reviewed by a single expert reader for internal consistency (T.B.B.). A detailed timeline of the course of BP-ONJ was constructed by the review of medical records for each patient and the relation of each patient's PET scan results to that patient's BP-ONJ disease was evaluated. Data analysis was a descriptive analysis of PET scan findings in this patient population.


RESULTS
Of the 25 patients studied, 5 were excluded for insufficient clinical or radiologic data. Of the 20 remaining patients (16 male, 4 female), 46 PET scans were performed and showed 53 areas of enhancement. Many patients had multiple PET scans performed while experiencing exposed bone, and 5 of these patients had alternating positive and negative scans with exposed bone, resulting in 13 patients with positive enhancement on a scan with exposed bone and 9 patients with no enhancement on a scan with exposed bone. Of the 13 patients with PET enhancement, 4 had signs of clinical infection documented at the time of examination. Sensitivity, specificity, and accuracy of PET scanning for BP-ONJ were 43%, 19%, and 62%, respectively. There were 7 patients with PET scans performed after clinical resolution of their exposed bone and 6 of those had no enhancement.


CONCLUSIONS
The purpose of this study was to report findings on PET scanning for patients with BP-ONJ. Although PET scans are useful in oncology, the present findings do not support their routine use for exclusively diagnosing or following cases of BP-ONJ.
Medical Student, University of Arkansas College of Medicine, Little Rock, AR.
Ryan
R
Belcher
Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR.
Jennings
J
Boyette
Medical Student, University of Arkansas College of Medicine, Little Rock, AR.
Tiffany
T
Pierson
Consultant, Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR.
Eric
E
Siegel
Resident, Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR.
Twyla B
TB
Bartel
Professor, University of Cincinnati Cancer Institute, Cincinnati, OH.
Elias
E
Aniasse
Professor, Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences; University of Arkansas College of Medicine, Little Rock, AR. Electronic address: Bcstackjr@gmail.com.
Brendan
B
Stack
D000328:Adult; D000368:Aged; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000000981:diagnostic imaging*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000706:statistics & numerical data; D012189:Retrospective Studies
D019788:Fluorodeoxyglucose F18