Copper accumulation in the sequestrum of medication-related osteonecrosis of the jaw

Development of Cu application using dual-energy computed tomography for detecting medication-related osteonecrosis of the jaw

INTRODUCTION

The present study developed an application using dual-energy computed tomography (DECT) focused on Cu for detecting medication-related osteonecrosis of the jaw (MRONJ).

MATERIALS AND METHODS

First, we performed two types of phantom studies using a Cu wire syringe and pig mandible with Cu wire to detect Cu on DECT. Second, DECT examinations of 44 patients with MRONJ were performed to compare lesion and normal bone sites using single-energy CT, DECT-virtual non-calcium (VNCa), and DECT-Cu applications. Quantitative analyses of VNCa CT and CT values were performed, and a cut-off value was calculated using receiver operating characteristic analysis. Third, we compared the Cu content in the MRONJ and normal bone groups using inductively coupled plasma atomic emission spectroscopy (ICP-AES).

RESULTS

The material-specific differences in attenuation between the two different energies enabled the accurate separation of Cu from Ca in phantom studies. The sensitivity and specificity for single-energy CT, DECT-VNCa, and DECT-Cu applications were 97.7% and 2.3%, 86.4% and 81.8%, and 88.6% and 97.7%, respectively. Thus, VNCa CT values obtained on DECT-Cu application images showed the highest area under the curve value and maximal diagnostic efficacy in differentiating lesion sites from normal bone sites. On ICP-AES analyses, the Cu content was significantly higher in the MRONJ group than in the normal bone group.

CONCLUSION

DECT-Cu application demonstrated better diagnostic performance in detecting MRONJ compared with single-energy CT or DECT-VNCa.

Quantitation and distribution of metallic elements in sequestra of medication-related osteonecrosis of jaw (MRONJ) using inductively coupled plasma atomic emission spectroscopy and synchrotron radiation X-ray fluorescence analysis

Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse effect of antiresorptive agents like bisphosphonates. Abnormal concentrations of various trace metallic elements contained in bone minerals have been associated with MRONJ. In this study, we focused on trace metallic elements contained in the MRONJ sequestrum; their content and distribution were compared to those in osteomyelitis and non-inflammatory bones using inductively coupled plasma atomic emission spectroscopy (ICP-AES) and synchrotron radiation X-ray fluorescence analysis (SR-XRF). On ICP-AES analyses, various trace elements (Co, Cr, Cu, Fe, K, Mg, Ni, Sb, Ti, V, Pb) were significantly more in MRONJ sequestra than non-inflammatory bones. The Cu content was significantly higher in MRONJ sequestra than osteomyelitis and non-inflammatory bones. The Cu content in MRONJ sequestra was high even after decalcification. Additionally, Cu was distributed along the trabecular structures in decalcified MRONJ specimens, as observed using SR-XRF analysis. Therefore, this study was indicative of the characteristic behavior of Cu in MRONJ.

Basics and applications of ELNES calculations

The electron energy loss near edge structures (ELNES) appearing in an electron energy loss spectrum obtained through transmission electron microscopy (TEM) have the potential to unravel atomic and electronic structures with sub-nano meter resolution. For this reason, TEM-ELNES has become one of the most powerful analytical methods in materials research. On the other hand, theoretical calculations are indispensable in interpreting the ELNES spectrum. Here, the basics and applications of one-particle, two-particle and multi-particle ELNES calculations are reviewed. A key point for the ELNES calculation is the proper introduction of the core-hole effect. Some applications of one-particle ELNES calculations to huge systems of more than 1000 atoms, and complex systems, such as liquids, are reported. In the two-particle calculations, the importance of the correct treatment of the excitonic interaction is demonstrated in calculating the low-energy ELNES, for example at the Li-K edge. In addition, an unusually strong excitonic interactions in the O-K edge of perovskite oxides is identified. The multi-particle calculations are necessary to reproduce the multiplet structures appearing at the transition metal L2,3-edges and rare-earth M4,5-edges. Applications to dilute magnetic semiconductors and Li-ion battery materials are presented. Furthermore, beyond the 'conventional' ELNES calculations, theoretical calculations of electron/X-ray magnetic circular dichroism (MCD) and the vibrational information in ELNES, are reported.