Three-dimensional radiologic-pathologic correlation of medication-related osteonecrosis of the jaw using 3D bone SPECT/CT imaging

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Abstract

Objectives: The aim of this study was to assess a three-dimensional (3D) correlation between preoperative 3D bone single photon emission CT (SPECT)/CT, which allows the visualization of radiotracer uptake on 3D volume-rendered CT images, and histopathological characteristics in the medication-related osteonecrosis of the jaw (MRONJ). Methods: We conducted a full histopathological assessment of the resected jaws in four patients with Stage 2 or 3 MRONJ. The pathologic results were classified as follows: necrosis without any tissue vascularity (N + V-), necrosis with both vascularity and acute inflammatory cell infiltration due to bacterial infection (N + V+I+), necrosis with regenerative vasculature but no inflammatory cell infiltration (N + V+I-), and chronic inflammation without massive necrosis (N-V +I+). These classifications were correlated with imaging results. Results: The N + V- areas visually represented the area of necrotic bone exposed to the oral cavity and were consistent with defect area of radioisotope uptake in SPECT/CT. The N + Vareas were surrounded by the N + V+I + areas where increased radiotracer uptake was clearly seen. Also, abnormal uptake was found in both of the N + V+I- and N-V +I+ areas. The extensive surgical resections from necrotic core to bloody viable margins were performed in all cases, although one had the recurrence of MRONJ at the margin showing abnormal uptake that histologically represented the N + V+I- area. Conclusions: Radiologic-pathologic correlation of MRONJ could be achieved using 3D SPECT/CT. The presence of regenerative vascularity with necrosis or inflammation seemed to determine bone metabolism in MRONJ. The recurrence of MRONJ was observed in one case, and 3D SPECT/CT had preoperatively depicted the recurrence site.

Original languageEnglish
Article number20190208
JournalDentomaxillofacial Radiology
Volume48
Issue number8
DOIs
Publication statusPublished - 2019 Jan 1

Fingerprint

Osteonecrosis
Jaw
Photons
Bone and Bones
Necrosis
Recurrence
Inflammation
Cone-Beam Computed Tomography
Bacterial Infections
Radioisotopes
Mouth

Keywords

  • Infection
  • Medication-related osteonecrosis of the jaw
  • Necrosis
  • Three-dimensional SPECT/CT
  • Vascularity

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Radiology Nuclear Medicine and imaging
  • Dentistry(all)

Cite this

@article{23d0d39c0b62416386ddec41e09cfd30,
title = "Three-dimensional radiologic-pathologic correlation of medication-related osteonecrosis of the jaw using 3D bone SPECT/CT imaging",
abstract = "Objectives: The aim of this study was to assess a three-dimensional (3D) correlation between preoperative 3D bone single photon emission CT (SPECT)/CT, which allows the visualization of radiotracer uptake on 3D volume-rendered CT images, and histopathological characteristics in the medication-related osteonecrosis of the jaw (MRONJ). Methods: We conducted a full histopathological assessment of the resected jaws in four patients with Stage 2 or 3 MRONJ. The pathologic results were classified as follows: necrosis without any tissue vascularity (N + V-), necrosis with both vascularity and acute inflammatory cell infiltration due to bacterial infection (N + V+I+), necrosis with regenerative vasculature but no inflammatory cell infiltration (N + V+I-), and chronic inflammation without massive necrosis (N-V +I+). These classifications were correlated with imaging results. Results: The N + V- areas visually represented the area of necrotic bone exposed to the oral cavity and were consistent with defect area of radioisotope uptake in SPECT/CT. The N + Vareas were surrounded by the N + V+I + areas where increased radiotracer uptake was clearly seen. Also, abnormal uptake was found in both of the N + V+I- and N-V +I+ areas. The extensive surgical resections from necrotic core to bloody viable margins were performed in all cases, although one had the recurrence of MRONJ at the margin showing abnormal uptake that histologically represented the N + V+I- area. Conclusions: Radiologic-pathologic correlation of MRONJ could be achieved using 3D SPECT/CT. The presence of regenerative vascularity with necrosis or inflammation seemed to determine bone metabolism in MRONJ. The recurrence of MRONJ was observed in one case, and 3D SPECT/CT had preoperatively depicted the recurrence site.",
keywords = "Infection, Medication-related osteonecrosis of the jaw, Necrosis, Three-dimensional SPECT/CT, Vascularity",
author = "Hidetaka Miyashita and Kaori Kameyama and Mayu Morita and Taneaki Nakagawa and Tadaki Nakahara",
year = "2019",
month = "1",
day = "1",
doi = "10.1259/dmfr.20190208",
language = "English",
volume = "48",
journal = "Dentomaxillofacial Radiology",
issn = "0250-832X",
publisher = "British Institute of Radiology",
number = "8",

}

TY - JOUR

T1 - Three-dimensional radiologic-pathologic correlation of medication-related osteonecrosis of the jaw using 3D bone SPECT/CT imaging

AU - Miyashita, Hidetaka

AU - Kameyama, Kaori

AU - Morita, Mayu

AU - Nakagawa, Taneaki

AU - Nakahara, Tadaki

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: The aim of this study was to assess a three-dimensional (3D) correlation between preoperative 3D bone single photon emission CT (SPECT)/CT, which allows the visualization of radiotracer uptake on 3D volume-rendered CT images, and histopathological characteristics in the medication-related osteonecrosis of the jaw (MRONJ). Methods: We conducted a full histopathological assessment of the resected jaws in four patients with Stage 2 or 3 MRONJ. The pathologic results were classified as follows: necrosis without any tissue vascularity (N + V-), necrosis with both vascularity and acute inflammatory cell infiltration due to bacterial infection (N + V+I+), necrosis with regenerative vasculature but no inflammatory cell infiltration (N + V+I-), and chronic inflammation without massive necrosis (N-V +I+). These classifications were correlated with imaging results. Results: The N + V- areas visually represented the area of necrotic bone exposed to the oral cavity and were consistent with defect area of radioisotope uptake in SPECT/CT. The N + Vareas were surrounded by the N + V+I + areas where increased radiotracer uptake was clearly seen. Also, abnormal uptake was found in both of the N + V+I- and N-V +I+ areas. The extensive surgical resections from necrotic core to bloody viable margins were performed in all cases, although one had the recurrence of MRONJ at the margin showing abnormal uptake that histologically represented the N + V+I- area. Conclusions: Radiologic-pathologic correlation of MRONJ could be achieved using 3D SPECT/CT. The presence of regenerative vascularity with necrosis or inflammation seemed to determine bone metabolism in MRONJ. The recurrence of MRONJ was observed in one case, and 3D SPECT/CT had preoperatively depicted the recurrence site.

AB - Objectives: The aim of this study was to assess a three-dimensional (3D) correlation between preoperative 3D bone single photon emission CT (SPECT)/CT, which allows the visualization of radiotracer uptake on 3D volume-rendered CT images, and histopathological characteristics in the medication-related osteonecrosis of the jaw (MRONJ). Methods: We conducted a full histopathological assessment of the resected jaws in four patients with Stage 2 or 3 MRONJ. The pathologic results were classified as follows: necrosis without any tissue vascularity (N + V-), necrosis with both vascularity and acute inflammatory cell infiltration due to bacterial infection (N + V+I+), necrosis with regenerative vasculature but no inflammatory cell infiltration (N + V+I-), and chronic inflammation without massive necrosis (N-V +I+). These classifications were correlated with imaging results. Results: The N + V- areas visually represented the area of necrotic bone exposed to the oral cavity and were consistent with defect area of radioisotope uptake in SPECT/CT. The N + Vareas were surrounded by the N + V+I + areas where increased radiotracer uptake was clearly seen. Also, abnormal uptake was found in both of the N + V+I- and N-V +I+ areas. The extensive surgical resections from necrotic core to bloody viable margins were performed in all cases, although one had the recurrence of MRONJ at the margin showing abnormal uptake that histologically represented the N + V+I- area. Conclusions: Radiologic-pathologic correlation of MRONJ could be achieved using 3D SPECT/CT. The presence of regenerative vascularity with necrosis or inflammation seemed to determine bone metabolism in MRONJ. The recurrence of MRONJ was observed in one case, and 3D SPECT/CT had preoperatively depicted the recurrence site.

KW - Infection

KW - Medication-related osteonecrosis of the jaw

KW - Necrosis

KW - Three-dimensional SPECT/CT

KW - Vascularity

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DO - 10.1259/dmfr.20190208

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