title: Three-phase bone scintigraphy for imaging osteoradionecrosis of the jaw.
abstract: This study evaluates the diagnostic utility of 3-phase bone scintigraphy for diagnosing osteoradionecrosis of the jaw (ORNJ).
  
  
  METHODS
  Thirty-two consecutive patients with a history of radiation to the head and neck region (range, 62-70 Gy; mean, 68 Gy; median, 69 Gy) due to squamous cell cancer and suspected ORNJ underwent 3-phase bone scans after injection of 520 to 750 MBq of Tc-MPD. In addition to planar scans, tomographic images (SPECT) were acquired in the second phase and SPECT/CT images during the third phase. Histopathologic findings (n = 18) and clinical follow-up (n = 14) served as reference standard for osteoradionecrosis.
  
  
  RESULTS
  The first, second, and third phases of planar images were rated positive in 18/32 patients (56.3%), 25/32 (78.1%), and 27/32 patients (84.4%), respectively. The late SPECT was positive in all patients (32/32, 100%), respectively. Histopathologic findings available in 18/32 patients (56.3%) confirmed ORNJ in all subjects. Acute inflammation was histologically proven in 18/18 specimens (100%) and additional chronic inflammation in 12/18 (66.7%). In 13/18 (72.2%) specimens, superinfection was evident histopathologically. A photopenic defect with surrounding hypermetabolism, a reported hallmark of ORJN, was found in less than 5%.
  
  
  CONCLUSIONS
  The predominant scintigraphic pattern of osteoradionecrosis includes increased bone mineralization phase in all patients. Central photopenia, reportedly a typical bone scan finding in bisphosphonate-induced osteonecrosis, was not characteristic for ORNJ. A differentiation of acute from chronic inflammatory processes was not possible.
authors.affiliation: From the Departments of *Nuclear Medicine, and †Oral and Maxillofacial Plastic Surgery, University Hospital of Würzburg; ‡Institute of Pathology, University of Würzburg, Würzburg, Germany; and §Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA.
authors.forename: Constantin
authors.initials: C
authors.lastname: Lapa
authors.forename: Christian
authors.initials: C
authors.lastname: Linz
authors.forename: Christina
authors.initials: C
authors.lastname: Bluemel
authors.forename: Anja
authors.initials: A
authors.lastname: Mottok
authors.forename: Urs
authors.initials: U
authors.lastname: Mueller-Richter
authors.forename: Alexander
authors.initials: A
authors.lastname: Kuebler
authors.forename: Peter
authors.initials: P
authors.lastname: Schneider
authors.forename: Johannes
authors.initials: J
authors.lastname: Czernin
authors.forename: Andreas K
authors.initials: AK
authors.lastname: Buck
authors.forename: Ken
authors.initials: K
authors.lastname: Herrmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007568:Jaw / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010025:Osteoradionecrosis / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000473:pathology; D011859:Radiography; D011877:Radionuclide Imaging; D012189:Retrospective Studies