Preoperative Assessment of Medication-Related Osteonecrosis of the Jaw Using [18F]fluoride Positron Emission Tomography (PET)/CT and [18F]fluorodeoxyglucose PET/MRI in Correlation with Histomorphometry and Micro-CT—A Prospective Comparative Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patient Cohort
2.2. Study Protocol
2.3. [18F]FDG PET/MRI
2.4. [18F]fluoride PET/CT
2.5. Image Analysis
2.6. Bone Specimens
2.7. Surgical Technique
2.8. Micro-CT and Histomorphometric Analysis
2.9. Statistics
3. Results
3.1. Patient Characteristics
3.2. Qualitative Imaging
3.3. Quantitative Imaging
3.4. Microarchitecture
3.5. Histomorphometry
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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(a) | |||||||||
Patient | Sex; Age | Primary Diagnosis | Antiresorptive Drug; Application | Duration of Treatment # | Antibiotics | Duration of Antibiotic Treatment § | Clinical Outcome after Surgery | Follow Up | Clinical Outcome at Endpoint of Follow Up |
1 | male; 67 yr. | Prostate cancer | Zoledronate; iv | 79 months | Clindamycin; Moxifloxacin | 32 (25o; 7iv) | cured | 30 months | cured |
2 | female; 76 yr. | Breast cancer | Zoledronate; iv | 22 months | Cefuroxime; Moxifloxacin | 32 (25o; 7iv) | cured | 29 months | cured at origin; new necrosis at the upper jaw |
3 | female; 68 yr. | Breast cancer | Denosumab; sc | 48 months | Sultamicillin; Ampicillin/Sulbactam; Metronidazole; Cefuroxime | 29 (22o; 7iv) | cured | 40 months | cured |
4 | male; 65 yr. | Kidney cancer | Denosumab; sc | 6 months | Sultamicillin; Ampicillin/Sulbactam; Clindamycin | 32 (25o; 7iv) | cured | 18 months | cured |
5 | male; 65 yr. | Multiple myeloma | Zoledronate; iv | 13 months | Sultamicillin; Metronidazole | 40 (33o; 7iv) | cured | 10 months | cured |
6 | male; 79 yr. | Multiple myeloma | Zoledronate; iv Denosumab; sc | 24 months | Sultamicillin; Ampicillin/Sulbactam | 22 (15o; 7iv) | cured | 6 months | cured |
7 | male; 77 yr. | Multiple myeloma | Zoledronate; iv | 7 months | Sultamicillin; Ampicillin/Sulbactam; Metronidazole | 21 (14o; 7iv) | cured | 5 months | cured |
(b) | |||||||||
Patient | Sex; Age | Primary Diagnosis | Location of Necrosis | Antiresorptive Drug; Application | Duration of Treatment # | Antibiotics | Duration of Antibiotic Treatment * | Follow Up | Clinical Outcome at Endpoint of Follow Up |
8 | female; 53 yr. | Breast cancer | Lower jaw both sides | Denosumab (biannual) | 18 months | none | 60 months | spontaneous sequestrum; cured | |
9 | female; 76 yr. | Breast cancer | Lower jaw both sides | Ibandronate Denosumab | 138 months | Sultamicillin; Moxifloxacin | 87 (80o; 7iv) | 63 months | sequestrum; not cured |
10 | male; 68 yr. | Lung cancer | Lower jaw both sides | Denosumab | 29 months | Metronidazole (local application) | each visit | 7 months | sequestrum; not cured |
11 | male; 76 yr. | Prostate cancer | Lower jaw left | Zoledronate | 18 months | Sultamicillin | 280 (o) | 12 months | died; not cured |
12 | female; 78 yr. | Breast cancer | Lower jaw both sides | Zoledronate Denosumab | 58 months | Sultamicillin Sulfamethoxazole/Trimetoprima | 263 (o) | 40 months | not cured |
Imaging Markers | Affected Bone | Healthy Bone | SQI | p Value |
---|---|---|---|---|
T2w | 28 ± 19 | 40 ± 26 | 0.9 ± 0.4 | >0.05 |
T1w | 140 ± 58 | 303 ± 124 | 0.5 ± 0.3 | 0.0005 |
T1w post-contrast (bone) | 304 ± 143 | 281 ± 151 | 1.4 ± 0.7 | >0.05 |
[18F]FDG PET SUVmean (bone) | 1.1 ± 0.4 | 0.6 ± 0.2 | 2.0 ± 1.1 | 0.003 |
[18F]FDG PET SUVmean (soft tissue) | 4.1 ± 1.4 | 1.9 ± 0.3 | 2.2 ± 0.9 | 0.0004 |
[18F]fluoride PET SUVmean (bone) | 21 ± 12 | 2.4 ± 0.8 | 8.9 ± 3.3 | 0.00001 |
Hounsfield Units | 1085 ± 218 | 271 ± 136 | 6.5 ± 7.4 | 0.00001 |
Micro-CT | Necrotic Bone | Medium [18F]fluoride Uptake | High [18F]fluoride Uptake | p Value |
---|---|---|---|---|
BV/TV | 0.24 ± 0.09 | 0.27 ± 0.14 | 0.33 ± 0.15 | >0.05 |
(0.12–0.49) | (0.14–0.52) | (0.14–0.6) | ||
BS/BV | 4.41 ± 2.97 | 5.34 ± 2.05 | 5.42 ± 1.88 | >0.05 |
(2.3–10.48) | (2.78–8.61) | (2.78–8.61) | ||
Tr.Th. (mm) | 0.48 ± 0.25 | 0.43 ± 0.17 | 0.41 ± 0.15 | >0.05 |
(0.19–0.87) | (0.25–0.71) | (0.23–0.72) | ||
Tr.N. (mm−1) | 0.59 ± 0.10 | 0.63 ± 0.12 | 0.86 ± 0.10 | >0.05 |
(0.28–1.21) | (0.35–0.96) | (0.24–1.51) | ||
Tr.Sp. (mm) | 1.62 ± 0.26 | 1.31 ± 0.31 | 1.14 ± 0.26 | >0.05 |
(0.54–2.75) | (0.65–3.64) | (0.65–2.26) | ||
Euler Index | 1.36 ± 1.86 | 1.28 ± 0.87 | 2.13 ± 2.35 | >0.05 |
(0.19–5.69) | (0.31–2.97) | (0.13–8.10) | ||
BMD (g·cm−3) | 656.0 ± 38.6 | 580.1 ± 46.1 | 750.0 ± 38.6 | >0.05 |
(567.2–764.5) | (555.5–997.2) | (519.5–937.9) |
Histological Samples | Necrotic Bone | Medium [18F]fluoride Uptake | High [18F]fluoride Uptake | p Value |
---|---|---|---|---|
Osteocytes/mm2 | 10.2 ± 48.2 | 164.4 ± 53.6 | 335.5 ± 48.2 | 0.0005 |
Lacunae/mm2 | 347.5 ± 37.9 | 305.1 ± 42.3 | 444.3 ± 37.9 | 0.01 |
Osteoblasts/mm | 24.5 ± 14.5 | 37.9 ± 8.9 | 42.9 ± 8.4 | >0.05 |
Osteoclasts/mm | 1.5 ± 0.5 | 1.6 ± 0.3 | 1.6 ± 0.3 | >0.05 |
Resorption lacunae, mean length (mm) | 0.033 ± 0.004 | 0.033 ± 0.004 | 0.025 ± 0.004 | >0.05 |
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Reinert, C.P.; Pfannenberg, C.; Gückel, B.; Dittmann, H.; la Fougère, C.; Nikolaou, K.; Reinert, S.; Schönhof, R.; Hoefert, S. Preoperative Assessment of Medication-Related Osteonecrosis of the Jaw Using [18F]fluoride Positron Emission Tomography (PET)/CT and [18F]fluorodeoxyglucose PET/MRI in Correlation with Histomorphometry and Micro-CT—A Prospective Comparative Study. Diagnostics 2024, 14, 428. https://doi.org/10.3390/diagnostics14040428
Reinert CP, Pfannenberg C, Gückel B, Dittmann H, la Fougère C, Nikolaou K, Reinert S, Schönhof R, Hoefert S. Preoperative Assessment of Medication-Related Osteonecrosis of the Jaw Using [18F]fluoride Positron Emission Tomography (PET)/CT and [18F]fluorodeoxyglucose PET/MRI in Correlation with Histomorphometry and Micro-CT—A Prospective Comparative Study. Diagnostics. 2024; 14(4):428. https://doi.org/10.3390/diagnostics14040428
Chicago/Turabian StyleReinert, Christian Philipp, Christina Pfannenberg, Brigitte Gückel, Helmut Dittmann, Christian la Fougère, Konstantin Nikolaou, Siegmar Reinert, Rouven Schönhof, and Sebastian Hoefert. 2024. "Preoperative Assessment of Medication-Related Osteonecrosis of the Jaw Using [18F]fluoride Positron Emission Tomography (PET)/CT and [18F]fluorodeoxyglucose PET/MRI in Correlation with Histomorphometry and Micro-CT—A Prospective Comparative Study" Diagnostics 14, no. 4: 428. https://doi.org/10.3390/diagnostics14040428