Buyukdereli Gulgun, Guney Isa Burak, Ozerdem Gokhan, Kesiktas Erol
Department of Nuclear Medicine, Cukurova University Faculty of Medicine, Adana, Turkey.
Ann Nucl Med. 2006 Feb;20(2):89-93. doi: 10.1007/BF02985619.
The aim of this study was to evaluate the value of bone scintigraphy for the assessment of graft viability following vascularized bone grafts in patients with mandibular reconstruction.
We investigated 16 patients with vascularized grafts from the fibula (13 patients) and iliac crest (3 patients) in the last 8 years. For the follow up of all these patients, Tc-99m MDP bone scintigraphy was performed between 2-10 days postoperatively. SPECT study was included in 5 patients. For the evaluation of the grafts, a six-grade scoring system was used. The grading system was based on a comparison of tracer uptake between graft and the cranium. The uptake was defined as increasing from grade 6 to grade 1.
Thirteen of the 16 grafts had an uncomplicated clinical course. Complications in the graft occurred in three patients. In the analysis of planar scintigrams, patients with uncomplicated healing showed increased uptake in 12 of the 13 grafts (grade 1-3) and 1 showed the same level tracer uptake compared to cranium (grade 4). In the failed 3 grafts, decreased uptake was observed (grade 5 and 6). In 5 patients, SPECT was performed in addition to planar imaging. In these patients, 4 of the 5 grafts had an uncomplicated clinical course and 1 had a complicated one. In the analysis of SPECT images, while all the grafts with an uncomplicated clinical course exhibited increased uptake (grade 1-3), the failed graft showed decreased uptake (grade 6).
Three-phase bone scintigraphy performed within 10 days after the mandibular reconstruction is a useful tool to monitor the viability and early complications of vascularized mandibular bone grafts. SPECT is also recommended. It may contribute to interpretation of the bone scans and to precise assessment of graft viability.
本研究旨在评估骨闪烁显像在评估下颌骨重建患者血管化骨移植后移植物存活情况中的价值。
我们调查了过去8年中16例接受腓骨（13例）和髂嵴（3例）血管化移植的患者。对所有这些患者进行随访，术后2 - 10天进行锝-99m亚甲基二膦酸盐（Tc-99m MDP）骨闪烁显像。5例患者进行了单光子发射计算机断层扫描（SPECT）研究。为评估移植物，采用六级评分系统。该评分系统基于比较移植物与颅骨之间的示踪剂摄取情况。摄取情况从6级到1级定义为逐渐增加。
16例移植物中有13例临床过程顺利。3例患者的移植物出现并发症。在平面闪烁显像分析中，愈合顺利的患者中，13例移植物中有12例摄取增加（1 - 3级），1例与颅骨相比示踪剂摄取水平相同（4级）。在3例失败的移植物中，观察到摄取减少（5级和6级）。5例患者除平面显像外还进行了SPECT检查。在这些患者中，5例移植物中有4例临床过程顺利，1例有并发症。在SPECT图像分析中，所有临床过程顺利的移植物均显示摄取增加（1 - 3级），而失败的移植物显示摄取减少（6级）。
下颌骨重建术后10天内进行的三相骨闪烁显像，是监测血管化下颌骨移植存活情况及早期并发症的有用工具。也推荐使用SPECT。它可能有助于骨扫描的解读以及对移植物存活情况的精确评估。
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