Department of Oral and Maxillofacial Surgery, Hyogo Medical University, 1-1 Mukogawa-Cho, Nishinomiya, Hyogo, 663-8501, Japan.
Department of Radiology, School of Medicine, Hyogo Medical University, Nishinomiya, Japan.
Jpn J Radiol. 2023 Jul;41(7):760-767. doi: 10.1007/s11604-023-01389-z. Epub 2023 Jan 19.
For assessment of therapeutic response in medication-related osteonecrosis of the jaw (MRONJ) cases, the clinical usefulness of quantitative bone single-photon computed tomography-computed tomography (SPECT/CT) results was investigated.
Sixteen patients (18 lesions) with a clinical diagnosis of MRONJ underwent bone SPECT/CT scanning before and during/after anti-inflammatory therapy given for 3 or more months. The GI-BONE software package was used to determine standard uptake values (SUVs), including maximum (SUVmax), peak (SUVpeak), and mean (SUVmean), and metabolic bone volume (MBV) and also total bone uptake (TBU). In both responders (downstage) and non-responders (upstage or no change), differences in quantitative values between the first and second SPECT/CT examinations were analyzed using a Wilcoxon test.
Following therapy, significant reductions in SUVmax, SUVpeak, SUVmean, MBV and TBU values for 11 lesions were noted in the responders after therapy (p = 0.003, p = 0.006, p = 0.004, p = 0.003, and p = 0.002, respectively). On the other hand, those for the seven lesions in the non-responder group were not significantly different (p = 0.17, p = 0.16, p = 0.26, p = 0.96, and p = 0.12, respectively). Results for SUVmax change showed sensitivity and specificity values of 45.5% and 85.7%, respectively, for differentiating responders from non-responders, with - 37.3% the optimal cutoff value. Those for MBV change were 72.7 and 85.7%, respectively, with - 29.4% the optimal cutoff value. Those for TBU change were 81.8% and 85.7%, respectively, with - 36.3% the optimal cutoff value.
The present findings showed that therapeutic response in MRONJ cases could be determined by use of quantitative SUV, MBV, and TBU values based on bone SPECT/CT findings.
为了评估药物相关性下颌骨坏死（MRONJ）病例的治疗反应，研究了定量骨单光子发射计算机断层扫描-计算机断层扫描（SPECT/CT）结果的临床应用价值。
16 名（18 个病灶）临床诊断为 MRONJ 的患者在接受抗炎治疗 3 个月以上后进行了骨 SPECT/CT 扫描。使用 GI-BONE 软件包确定标准摄取值（SUV），包括最大（SUVmax）、峰值（SUVpeak）和平均（SUVmean），以及代谢骨体积（MBV）和总骨摄取（TBU）。在应答者（降级）和非应答者（升级或无变化）中，使用 Wilcoxon 检验分析首次和第二次 SPECT/CT 检查之间定量值的差异。
治疗后，11 个病灶的 SUVmax、SUVpeak、SUVmean、MBV 和 TBU 值在应答者中显著降低（p = 0.003，p = 0.006，p = 0.004，p = 0.003，p = 0.002）。另一方面，7 个非应答者病灶的这些值没有显著差异（p = 0.17，p = 0.16，p = 0.26，p = 0.96，p = 0.12）。SUVmax 变化的结果显示，区分应答者和非应答者的敏感性和特异性分别为 45.5%和 85.7%，最佳截断值为-37.3%。MBV 变化的敏感性和特异性分别为 72.7%和 85.7%，最佳截断值为-29.4%。TBU 变化的敏感性和特异性分别为 81.8%和 85.7%，最佳截断值为-36.3%。
本研究结果表明，可根据 SPECT/CT 骨发现，使用定量 SUV、MBV 和 TBU 值来确定 MRONJ 病例的治疗反应。
