Pilot study of a novel resection extent determination method using bone single-photon emission CT-standardized uptake value in medication-related osteonecrosis of the jaw.

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.