Quantitative Analysis of Multimodal Skeletal SPECT/CT Reconstructions in Diagnosing Medication-related Osteonecrosis of the Jaw

Utility of quantitative standardized uptake value from pre-operative bone SPECT/CT for predicting post-surgical MRONJ healing response

BACKGROUND

Medication-related osteonecrosis of the jaw (MRONJ) is a challenging condition often associated with long-term use of anti-resorptive medications. Accurate diagnosis is essential, but predicting the prognosis is particularly difficult due to the high likelihood of recurrence after surgery. This study assesses the utility of quantitative values from bone SPECT/CT as predictors of surgical outcomes in MRONJ patients.

MATERIALS AND METHODS

We analyzed a cohort of 57 MRONJ patients who underwent surgical treatment. Preoperative bone SPECT/CT scans were used to obtain the maximal SUV (SUVmax) of MRONJ lesions and the ratio of the SUVmax to the mean SUV of a reference region (rSUVmax). Logistic regression analysis was performed to evaluate the relationship between preoperative SUVmax and rSUVmax and surgical outcomes, adjusting for confounders such as age, sex, diabetes, type of bone-modifying agent, MRONJ-affected sites, and stage.

RESULTS

Both SUVmax and rSUVmax values increased with the progression from MRONJ stage 1 to stage 3 and were higher in the No Resolution group compared to the Complete Resolution group. Multivariate logistic regression analysis revealed that higher rSUVmax values were significantly associated with poor surgical outcomes (OR, 1.51; 95% CI, 1.07-2.14), whereas SUVmax values were not significantly associated (OR, 1.05; 95% CI, 0.98-1.13). Preoperative MRONJ stages did not significantly predict MRONJ resolution.

CONCLUSION

rSUVmax from bone SPECT/CT may serve as a valuable prognostic tool for assessing MRONJ severity and predicting surgical outcomes. Incorporating rSUVmax measurements into clinical practice could enhance decision-making and improve patient management.

CLINICAL TRIAL REGISTRATION

None.

Detectability of cold tumors by xSPECT bone technology compared with hot tumors: a supine phantom study

Detecting cold as well as hot tumors is vital for interpreting bone tumors on single-photon emission computed tomography (SPECT) images. This study aimed to visually and quantitatively demonstrate the detectability of cold tumors using xSPECT technology compared with that of hot tumors in the phantom study. Five tumors of different sizes and normal bone contained a mixture of 99mTc and K2HPO4 in a spine phantom. We acquired SPECT data using an xSPECT protocol and transverse images were reconstructed using xSPECT Bone (xB) and xSPECT Quant (xQ). Mean standardized uptake values (SUVmean) in volumes of interest (VOI) were calculated. Recovery coefficients (RCs) for each tumor site were calculated with reference to radioactive concentrations. The SUVmeans of the whole vertebral body for hot tumor bone image in cortical bone phantom reconstructed by with xB and xQ were 5.77 and 4.86 respectively. The SUVmean of xB was similar to the true value. The SUVmeans for xB and xQ reconstructed images of cold tumors were both approximately 0.16. The RC of the cold tumor on xQ images increased as the tumor diameter decreased, whereas that of xB remained almost constant regardless of the tumor diameter. In conclusion, the quantitative accuracy of detecting hot and cold tumors was higher in the xB image than in the xQ image. Moreover, the visual detectability of cold tumors was also excellent in xB images.