Hayashi Naoya, Matsutomo Norikazu, Tokorodani Ryotaro, Fukami Mitsuha, Nishimori Miki, Nakatani Kie, Yoshioka Yukio, Hayashi Yoshihiro, Murakami Ichiro, Yamagami Takuji, Yamamoto Tetsuya, Yamamoto Tomoaki
Division of Radiology, Department of Medical Technology, Kochi Medical School Hospital, Kochi 783-8505, Japan.
Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, Tokyo 181-8612, Japan.
Dentomaxillofac Radiol. 2025 Sep 1;54(6):495-501. doi: 10.1093/dmfr/twaf032.
Surgery is the standard treatment for medication-related osteonecrosis of the jaw (MRONJ). However, there are few reports on the appropriate extent of the bone resection. This pilot study explores the feasibility of a new method for estimating the extent of resection using bone single-photon emission CT (SPECT)-standardized uptake value (SUV).
We retrospectively analysed 8 MRONJ patients who underwent curettage (n = 2), curettage with removal of the separated sequestrum (n = 2), or marginal resection (n = 4) as part of extensive surgery. The resected regions were compared with the regions estimated using SPECT-SUV. The agreement between the SPECT cold region and the resected region was evaluated using the Dice coefficient (defined as the ratio of 2× overlap volume to resected volume plus SPECT cold region volume), overlap ratio, and volume ratio. The inclusion of CT findings (osteolytic, gap- and irregular-type periosteal reactions, and mixed-type osteosclerosis) in the estimated region was also evaluated. Additionally, histopathological findings from 3 marginal resection cases were used to validate the estimated region.
In all cases, the resected region included the cold regions observed on bone SPECT, with radiotracer accumulation confirmed around the resected region. CT-osteolytic regions were included within the estimated region. The Dice coefficient was 0.53 ± 0.10, the overlap ratio was 86.7 ± 7.2%, and the volume ratio was 235.0 ± 74.7%. Histopathological analysis revealed significant osteocyte necrosis in cold regions, whereas areas with an SUV of 9 displayed normal osteocytes, newly formed bone, and mild inflammatory cell infiltration.
This study suggests that the setting of the SPECT cold region using bone SPECT-SUV may allow for the estimation of the extent of resection in early-to-intermediate-stage MRONJ.
手术是药物相关性颌骨坏死（MRONJ）的标准治疗方法。然而，关于骨切除的合适范围的报道较少。这项初步研究探讨了一种使用骨单光子发射计算机断层扫描（SPECT）标准化摄取值（SUV）估计切除范围的新方法的可行性。
我们回顾性分析了8例接受刮除术（n = 2）、刮除术联合去除分离的死骨（n = 2）或边缘切除术（n = 4）作为广泛手术一部分的MRONJ患者。将切除区域与使用SPECT-SUV估计的区域进行比较。使用Dice系数（定义为2倍重叠体积与切除体积加SPECT冷区体积之比）、重叠率和体积比评估SPECT冷区与切除区域之间的一致性。还评估了估计区域中是否包含CT表现（溶骨性、间隙性和不规则性骨膜反应以及混合型骨硬化）。此外，使用3例边缘切除术病例的组织病理学结果来验证估计区域。
在所有病例中，切除区域包括骨SPECT上观察到的冷区，切除区域周围证实有放射性示踪剂积聚。CT溶骨区域包含在估计区域内。Dice系数为0.53±0.10，重叠率为86.7±7.2%，体积比为235.0±74.7%。组织病理学分析显示冷区有明显的骨细胞坏死，而SUV为9的区域显示正常骨细胞、新形成的骨和轻度炎症细胞浸润。
本研究表明，使用骨SPECT-SUV设置SPECT冷区可能有助于估计早期至中期MRONJ的切除范围。
