FDG-PET/CT Used to Guide Treatment of Osteonecrosis of the Jaw
Calvin Jung DDS, MD, Ray Cheng DDS, David L Hirsch DDS, MD, Kenneth E Fleisher, DDS
Background:
Osteonecrosis of the jaw (ONJ) is defined as the presence of exposed necrotic bone in the oral cavity that persists for 6-8 weeks in a patient with a history of antiresorptive therapy (i.e., bisphosphonate, denosumab) and no prior radiotherapy to the affected site where other diagnoses have been excluded (e.g., dental infection, malignancy). It is estimated that about 30% of ONJ cases present without clinical evidence of bone exposure, and these patients are often under-diagnosed and under-treated. Early diagnosis is challenging because sequestrum formation, fractures and periosteal reaction are all associated with late disease and radiographs may appear normal for lesions <1 cm. Since the presence and extension of ONJ is not always well defined, particularly in the early stages, there is a need for accurate imaging to facilitate diagnosis and treatment. While CT and MR provide better contrast resolution of osseous anatomy, the sensitivity is low for early ONJ. PET/CT is gaining popularity as an adjuvant imaging modality to identify early stage ONJ.
Statement of Problem:
The primary objective of this study is to evaluate the efficacy of FDG PET/CT imaging to determine resections margins for patients with ONJ.
Methods/Data Analysis:
A retrospective chart review was performed for 15 patients diagnosed with ONJ who failed conservative nonsurgical medical therapy and underwent surgical resection based on FDG uptake on PET/CT. The following data was collected for each patient: medical diagnosis that necessitated antiresorptive therapy, age, sex, location of ONJ, type of antiresorptive therapy, and surgical treatment. All patients were followed for a minimum of 6-months.
Results:
We report 87% (13) patients exhibited complete healing. We attributed the delayed healing for the remaining two patients to osteoslcerotic changes associated with the ONJ lesions.
Conclusion:
Our data suggest that FDG-PET/CT imaging is a useful modality for detecting subclinical metabolic changes associated with ONJ lesions. Further investigation is required for long-term outcomes to validate FDG PET/CT in the management of patients with ONJ.
References:
- Van den Wyngaert T, Claeys T, Huizing MT. Initial experience with conservative treatment in cancer patients with osteonecrosis of the jaw (ONJ) and predictors of outcome. Annals of Oncology. Feb 20(2) 331-336, 2009
- Ruggiero S. et al. Practical Guidelines for the Prevention, Diagnosis, and Treatment of Osteonecrosis of the Jaw in Patients with Cancer. JOP 2: 7-14, 2006.