Nuclear Medicine and Molecular Imaging

, Volume 46, Issue 3, pp 162–168 | Cite as

Implications of Three-Phase Bone Scintigraphy for the Diagnosis of Bisphosphonate-Related Osteonecrosis of the Jaw

  • Chae Moon Hong
  • Byeong-Cheol Ahn
  • So-Young Choi
  • Do-Hoon Kim
  • Sang-Woo Lee
  • Tae-Geon Kwon
  • Jaetae Lee
Original Article
First Online:
Received:
Revised:
Accepted:

Abstract

Purpose

Bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ) is a well-known serious complication of BP treatment. This study was undertaken to evaluate the diagnostic usefulness of three-phase bone scintigraphy in patients with BRONJ.

Methods

Forty-one patients (48 lesions) with clinically proven BRONJ (2 males, 39 females, age 74.3 ± 6.7 years) underwent Tc-99 m HDP bone scintigraphy. Visual interpretation and semiquantitative analysis of uptakes using lesion-to-contralateral uptake ratios during the blood pool phase (BUR) and during the osseous phase (OUR) were performed, and relations were sought between these and various clinical parameters.

Results

Three-phase bone scintigraphy showed increased perfusion and blood pooling in 21 (63.6 %) and 27 (81.8 %) of 33 lesions, respectively. The osseous phase was positive for 45 (93.8 %) of the 48 lesions. Of the four inflammatory clinical parameters of BRONJ [pus discharge, pain, swelling, and erythrocyte sedimentation rate (ESR)], patients with three or more parameters had more positive findings in vascular and blood pool phase images (p = 0.033, p = 0.027). By semiquantitative analysis, patients with a positive ESR had statistically higher BUR and OUR (both p < 0.001). Higher stage BRONJ lesions had higher OUR than lower stage lesions (p = 0.003). In addition, bone scintigraphy revealed three clinically covert BRONJ lesions without bone exposure, and four patients were up-staged based on bone scintigraphy.

Conclusions

Bone scintigraphy provides a relatively sensitive means of detecting BRONJ, so it was helpful for accurate BRONJ staging. Furthermore, increased uptakes in vascular and blood pool phases of three-phase bone scintigraphy were related to the inflammatory activity of BRONJ.

Keywords

Three-phase bone scintigraphy Bisphosphonate Osteonecrosis Jaws 
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Notes

Acknowledgments

This research was financially supported by the Ministry of Knowledge Economy (MKE), Korea Institute for Advancement of Technology (KIAT) and Daegyeong Leading Industry Office through the Leading Industry Development for Economic Region, a grant from the Nuclear Research & Development Program of the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science & Technology (MEST), and the Brain Korea 21 Project in 2012.

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Copyright information

© Korean Society of Nuclear Medicine 2012

Authors and Affiliations

  • Chae Moon Hong
    • 1
  • Byeong-Cheol Ahn
    • 1
  • So-Young Choi
    • 2
  • Do-Hoon Kim
    • 1
  • Sang-Woo Lee
    • 1
  • Tae-Geon Kwon
    • 2
  • Jaetae Lee
    • 1
  1. 1.Department of Nuclear Medicine, School of Medicine and HospitalKyungpook National UniversityDaeguSouth Korea
  2. 2.Department of Oral & Maxillofacial Surgery, School of DentistryKyungpook National UniversityDaeguSouth Korea

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