Blood-pool SPECT in addition to bone SPECT in the viability assessment in mandibular reconstruction

Area of Science:

• Maxillofacial Surgery
• Nuclear Medicine
• Radiology

Background:

• Assessing the viability of vascularized and non-vascularized grafts in mandibular reconstruction is a significant challenge in maxillofacial surgery.
• Trauma and surgical interventions often necessitate complex mandibular reconstructions.

Purpose of the Study:

• To evaluate the feasibility and image quality of blood-pool SPECT for assessing mandibular reconstruction viability.
• To compare blood-pool SPECT with non-invasive bone scintigraphy and bone SPECT.
• To determine the clinical predictive value of these imaging techniques.

Main Methods:

• The study included 12 male patients with maxillofacial trauma undergoing mandibular reconstruction with micro-vascularized or non-vascularized bone grafts.
• Three-phase bone scintigraphy, blood-pool SPECT, and delayed bone SPECT scans were performed between postoperative days 5-7.
• Control CT scans were conducted at 6 months post-surgery.

Main Results:

• One non-vascularized graft was identified as non-viable at week one, with resorption noted on CT at 6 months.
• Delayed bone SPECT and blood-pool SPECT indicated viability for remaining non-vascularized and all micro-vascularized grafts.
• Blood-pool SPECT provided clear assessment of the entire graft, whereas delayed SPECT only clearly visualized anterior and posterior graft ends.

Conclusions:

• Combined use of blood-pool and delayed SPECT scans enhances early assessment of graft viability in mandibular reconstruction.
• This combined imaging approach offers detailed prognostic information for clinicians during patient follow-up.