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Pilot study of a novel resection extent determination method using bone single-photon emission CT-standardized uptake
Naoya Hayashi1,2, Norikazu Matsutomo2, Ryotaro Tokorodani1
1Division of Radiology, Department of Medical Technology, Kochi Medical School Hospital, Kochi 783-8505, Japan.
Objective:
Surgery is the standard treatment for medication-related osteonecrosis of the jaw (MRONJ). However, there are few reports on the appropriate extent of the bone resection. This pilot study explores the feasibility of a new method for estimating the extent of resection using bone single-photon emission CT (SPECT)-standardized uptake value (SUV).
Methods:
We retrospectively analysed 8 MRONJ patients who underwent curettage (n = 2), curettage with removal of the separated sequestrum (n = 2), or marginal resection (n = 4) as part of extensive surgery. The resected regions were compared with the regions estimated using SPECT-SUV. The agreement between the SPECT cold region and the resected region was evaluated using the Dice coefficient (defined as the ratio of 2× overlap volume to resected volume plus SPECT cold region volume), overlap ratio, and volume ratio. The inclusion of CT findings (osteolytic, gap- and irregular-type periosteal reactions, and mixed-type osteosclerosis) in the estimated region was also evaluated. Additionally, histopathological findings from 3 marginal resection cases were used to validate the estimated region.
Results:
In all cases, the resected region included the cold regions observed on bone SPECT, with radiotracer accumulation confirmed around the resected region. CT-osteolytic regions were included within the estimated region. The Dice coefficient was 0.53 ± 0.10, the overlap ratio was 86.7 ± 7.2%, and the volume ratio was 235.0 ± 74.7%. Histopathological analysis revealed significant osteocyte necrosis in cold regions, whereas areas with an SUV of 9 displayed normal osteocytes, newly formed bone, and mild inflammatory cell infiltration.
Conclusion:
This study suggests that the setting of the SPECT cold region using bone SPECT-SUV may allow for the estimation of the extent of resection in early-to-intermediate-stage MRONJ.
Insights
This study suggests bone single-photon emission computed tomography (SPECT)-standardized uptake value (SUV) can estimate the extent of bone resection needed for medication-related osteonecrosis of the jaw (MRONJ). This method aids in surgical planning for MRONJ patients.
Area of Science:
- Oncology
- Oral and Maxillofacial Surgery
- Nuclear Medicine
Background:
- Surgery is the primary treatment for medication-related osteonecrosis of the jaw (MRONJ).
- Determining the appropriate extent of bone resection for MRONJ remains challenging.
- Accurate assessment of affected bone is crucial for effective surgical intervention.
Purpose of the Study:
- To explore the feasibility of using bone single-photon emission computed tomography (SPECT) standardized uptake value (SUV) to estimate the extent of bone resection in MRONJ.
- To evaluate the correlation between SPECT-defined cold regions and surgically resected areas.
- To assess the utility of SPECT-SUV in guiding surgical margins for MRONJ.
Main Methods:
- Retrospective analysis of 8 MRONJ patients undergoing various surgical procedures (curettage, sequestrectomy, marginal resection).
- Comparison of resected bone regions with SPECT-SUV estimated cold regions.
- Evaluation of agreement using Dice coefficient, overlap ratio, and volume ratio; CT and histopathology were used for validation.
Main Results:
- All resected regions encompassed SPECT-defined cold areas, with tracer accumulation noted around the margins.
- CT-osteolytic regions were consistently included within the SPECT-estimated resection area.
- Histopathology confirmed osteocyte necrosis in SPECT cold regions and viable bone in areas with SUV of 9.
Conclusions:
- Bone SPECT-SUV shows promise for estimating the required extent of resection in early-to-intermediate stage MRONJ.
- This imaging-based method can potentially optimize surgical planning and improve outcomes for MRONJ patients.
- Further studies are warranted to validate SPECT-SUV as a standard tool for MRONJ surgical guidance.
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