title: Intraindividual comparison of preoperative (99m)Tc-MDP SPECT/CT and intraoperative and histopathological findings in patients with bisphosphonate- or denosumab-related osteonecrosis of the jaw.
abstract: OBJECTIVE
  Bisphosphonate- or denosumab-related osteonecrosis of the jaw (BRONJ/DRONJ) requires reliable preoperative assessment of the extent of disease for surgical planning. The aim of this study was to compare the extent of BRONJ/DRONJ as detected by Tc-99m-methylene diphosphonate (MDP) bone scintigraphy with intraoperative and histopathological findings, and to assess the additional value of hybrid single photon emission computed tomography/computed tomography (SPECT/CT) for evaluation of disease.
  
  
  METHODS
  Twenty-one patients with BRONJ/DRONJ underwent three-phase bone scintigraphy including SPECT/CT. The diagnostic certainty using conventional SPECT or fused SPECT/CT imaging was compared. Location and extent of disease on scintigraphic imaging and pre- and intra-operative clinical assessment were compared. Intraoperative and histopathological findings served as reference standard.
  
  
  RESULTS
  A total of 29 sites of BRONJ/DRONJ were histopathologically confirmed in 21 patients. Bone scintigraphy demonstrated increased perfusion in 57.1% of patients, increased blood pool in 76.2%, and increased tracer accumulation at the metabolic phase in all patients. The intensity of tracer accumulation at the metabolic phase correlated significantly with clinical stage of disease (rs = 0.47, p = 0.03). Clinical examination (p < 0.0001), but not SPECT (p = 0.19), underestimated the extent of disease as determined by surgical evaluation. SPECT/CT offered a significantly higher diagnostic certainty (p < 0.0001).
  
  
  CONCLUSIONS
  In patients with BRONJ/DRONJ, the true extent of osseous lesions as determined by surgery is significantly underestimated by clinical examination. Tc-99m-MDP bone scintigraphy can reliably predict the extent of disease. Hybrid SPECT/CT may significantly increase the diagnostic certainty of anatomical localization.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg Eppendorf, University of Hamburg, Martinistr. 52, 20246 Hamburg, Germany. Electronic address: a.assaf@uke.uni-hamburg.de.
authors.forename: Alexandre T
authors.initials: AT
authors.lastname: Assaf
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Basel, University of Basel, Spitalstr. 21, Basel, Switzerland.
authors.forename: Tomislav A
authors.initials: TA
authors.lastname: Zrnc
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg Eppendorf, University of Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Chressen C
authors.initials: CC
authors.lastname: Remus
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg Eppendorf, University of Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Adam
authors.affiliation: Gerhard-Domagk-Institute of Pathology, University Hospital Münster, University of Münster, 48149 Münster, Germany.
authors.forename: Jozef
authors.initials: J
authors.lastname: Zustin
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg Eppendorf, University of Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Max
authors.initials: M
authors.lastname: Heiland
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg Eppendorf, University of Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Reinhard E
authors.initials: RE
authors.lastname: Friedrich
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg Eppendorf, University of Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Derlin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D050071:Bone Density Conservation Agents / Q000009:adverse effects; D000069448:Denosumab / Q000009:adverse effects; D005260:Female; D005453:Fluorescence; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008336:Mandibular Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008439:Maxillary Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D055420:Perfusion Imaging / Q000379:methods; D010781:Photography / Q000379:methods; D011300:Preoperative Care; D019275:Radiopharmaceuticals; D000072098:Single Photon Emission Computed Tomography Computed Tomography / Q000379:methods*; D013669:Technetium Tc 99m Medronate; D051598:Whole Body Imaging / Q000379:methods
chemical_list: D050071:Bone Density Conservation Agents; D019275:Radiopharmaceuticals; D000069448:Denosumab; D013669:Technetium Tc 99m Medronate
keywords: Bisphosphonate-related osteonecrosis of the jaw (BRONJ); Bone scan; Denosumab-related osteonecrosis of the jaw (DRONJ); SPECT/CT; Scintigraphy; Visually Enhanced Lesion Scope (VELscope)