Department of Nuclear Medicine and Radiology.
Department of Oral and Maxillofacial Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
Nucl Med Commun. 2021 Jan;42(1):51-57. doi: 10.1097/MNM.0000000000001297.
The aim of the study was to evaluate the value of single-photon emission computed tomography/computed tomography (SPECT/CT) for therapy response assessment of jaw osteomyelitis.
Thirty-four baseline and 74 follow-up SPECT/CT examinations for therapy response assessment were performed in 34 patients with jaw osteomyelitis. SPECT/CT and planar late-phase bone scintigraphy images were assessed at baseline and follow-up, according to the following criteria: tracer uptake grade (0 = no uptake, 1 = low uptake, 2 = moderate uptake and 3 = high uptake); and morphologic signs (osteolysis, sequestration, sclerosis, periosteal reaction and pathologic fracture).
At baseline, SPECT/CT showed marked (grade 2 or 3) uptake in 91% (31/34) of the patients, osteolysis in 85% (29/34), sclerosis in 71% (24/34), periosteal reaction in 44% (15/34) and a sequestrum in 24% (8/34). In 24 patients with clinically complete remission during or after at least 12 months' therapy, bone scintigraphy showed grade 0 or 1 uptake in 100% (24/24) and SPECT/CT in 91% (22/24) of the patients. Sclerosis with the disappearance of osteolysis, sequestration and periosteal reactions was the predominant morphologic finding in complete responders (68%; 16/24). In 10 patients with symptoms of exacerbation of the osteomyelitis, 80% (8/10) showed increasing uptake, 90% (9/10) sclerosis, 80% osteolysis (8/10) and 40% (4/10) osteolysis and periosteal reactions.
SPECT/CT is a valuable tool to accurately assess therapy response, disease exacerbation and complications of jaw osteomyelitis. Low-grade (grade 1) residual tracer uptake is common in patients with clinically complete remission and is suggestive of ongoing bone remodeling and healing.
本研究旨在评估单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）在颌骨骨髓炎治疗反应评估中的价值。
对 34 例颌骨骨髓炎患者的 34 次基线和 74 次随访 SPECT/CT 检查进行了治疗反应评估。根据以下标准评估 SPECT/CT 和平面晚期骨闪烁显像图像：示踪剂摄取分级（0=无摄取，1=低摄取，2=中度摄取，3=高摄取）；和形态学征象（骨质溶解、死骨、硬化、骨膜反应和病理性骨折）。
基线时，SPECT/CT 在 91%（31/34）的患者中显示明显（分级 2 或 3）摄取，85%（29/34）的患者有骨质溶解，71%（24/34）的患者有硬化，44%（15/34）的患者有骨膜反应，24%（8/34）的患者有死骨。在 24 例至少 12 个月治疗期间或之后临床完全缓解的患者中，骨闪烁显像在 100%（24/24）的患者中显示 0 级或 1 级摄取，SPECT/CT 在 91%（24/24）的患者中显示。完全缓解者的主要形态学表现为硬化伴骨质溶解、死骨和骨膜反应消失（68%；16/24）。在 10 例骨髓炎症状加重的患者中，80%（8/10）的患者摄取增加，90%（9/10）的患者硬化，80%（8/10）的患者骨质溶解，40%（4/10）的患者骨质溶解伴骨膜反应。
SPECT/CT 是一种评估颌骨骨髓炎治疗反应、疾病加重和并发症的有价值的工具。在临床完全缓解的患者中，低级别（1 级）残留示踪剂摄取是常见的，提示持续的骨重塑和愈合。
