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J Nucl Med. 2008; 49 (Supplement 1):9P
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General Clinical Specialties: Musculoskeletal

Musculoskeletal

FDG-PET to evaluate osteomyelitis of the mandible: Correlation with CT, MR, bone scan, and pathology

Yoshimasa Kitagawa1, Yutaka Yamazaki1, Hata Hironobu1, Shuichi Takinami2, Kakuko Kanegae3 and Nagara Tamaki3

1 Oral Diagnosis and Medicine; 2 Dental Radiology; 3 Nuclear Medicine, Hokkaido University, Sapporo, Japan

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Objectives: Chronic osteomyelitis of the mandible (COM) still represents the most complicated inflammatory condition in oral and maxillofacial region. Aim of this prospective study was to appraise the value of FDG-PET in the diagnosis of COM, with correlation of conventional imaging modalities and pathology.

Methods: Seven patients (Age: 42-69; M/F: 5/2) with COM (odontogenic infection 3, osteoradionecrosis 2, and diffuse sclerosing osteomyelitis 2) were enrolled in the study. Each patient underwent FDG-PET, Ga and 3-phase bone scintigraphy with SPECT as well as MR and CT, before surgical intervention during the same period. Radiographic characteristics were compared with histology.

Results: In odontogenic osteomyelitis, hot spot areas of bone scan were much larger than those of PET, which demonstrated slightly increased accumulation of FDG in 2 cases, thus PET results precisely reflected histological findings. Osteoradionecrosis showed severe diffuse bone destruction involving cortical bone by CT, altered marrow signal intensity by MR, and increased uptake by bone scan. These abnormal findings with larger extent were beyond pathological areas. However, FDG-PET precisely showed only focal areas corresponding to the pathology. Based on PET evaluation, one patient successfully underwent a reduced form of surgery. As for diffuse sclerosing osteomyelitis, CT showed characteristic findings of periosteal reaction scattered with osteolysis. PET revealed distinctive accumulation .

Conclusions: FDG-PET has a clinical impact for the diagnosis and management of patients with COM, because FDG-PET metabolic imaging facilitates differentiation of inflammation and infection from bone remodelling.





This Article
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Right arrow Articles by Kitagawa, Y.
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Right arrow Articles by Kitagawa, Y.
Right arrow Articles by Tamaki, N.