The Usefulness of FDG-PET for Monitoring Hyperbaric Oxygen Therapy in Treatment of Bisphosphonate-Related Osteonecrosis of Jaws (BRONJ)

Asaka, Takuya

The Usefulness of FDG-PET for Monitoring Hyperbaric Oxygen Therapy in Treatment of Bisphosphonate-Related Osteonecrosis of Jaws (BRONJ)

Takuya Asaka PhD, Oral Diagnosis and Medicine, Department of Oral Pathobiological Science,, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan

Yoshimasa Kitagawa PhD, Oral Diagnosis and Medicine, Department of Oral Pathobiological Science, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan

Hironobu Hata PhD, Oral Diagnosis and Medicine, Department of Oral Pathobiological Science, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan

Jun Sato PhD, Oral Diagnosis and Medicine, Department of Oral Pathobiological Science, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan

Akira Satoh PhD, Oral Diagnosis and Medicine, Department of Oral Pathobiological Science, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan

Masaaki Miyakoshi PhD, Oral Diagnosis and Medicine, Department of Oral Pathobiological Science, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan

Objectives: Bisphosphonate-related osteonecrosis of jaws (BRONJ) is one of the most complicated inflammatory conditions in oral and maxillofacial region. It is very difficult to correctly evaluate the degree and extent of necrosis and infection. This refractory osteonecrosis often needs extended surgery, leading to impaired quality-of-life. We have performed hyperbaric oxygen therapy (HBO) combined with conservative surgery for advanced cases. The aim of this prospective study was to appraise the value of FDG-PET in the diagnosis and management of this condition.

Methods: Eight patients (Age: 76-90; M/F: 1/7) with BRONJ were enrolled in this study. The treatment protocol includes 20 times of pre-operative HBO, conservative surgery, and then 10 times of post-operative HBO. Each patient underwent FDG-PET and 3-phase bone scintigraphic studies prior to and after the pre-operative HBO. SUVmax was calculated for quantitative analysis of FDG uptake in the lesions. Each image of 3-phase bone scan (perfusion, pool, static) was analyzed using 4 point grading system (G0-G3).

Results: FDG-PET detected the focal area of inflammation in all osteonecrosis cases. SUVmax after HBO (average 3.13±0.96, range 1.79-4.69) was significantly lower (p=0.03) than those of before HBO (average 4.42±1.13, range 2.68-5.64), 4 cases showed remarkably decreased SUVmax. Although the 3 phase static and pool bone images did not change, FDG-PET and perfusion bone image showed remarkable response to HBO for BRONJ (before HBO: 1.75±1.04, after HBO: 0.75±0.71, p=0.03). All 8 cases showed good clinical course avoiding extended surgery.

Conclusions: These preliminary results indicate that FDG-PET is useful for monitoring the effect of HBO for BRONJ. HBO combined with minor conservative surgery may hold a promise for treatment strategy in patients with refractory BRONJ.

References

1) FDG-PET may predict the effectiveness of hyperbaric oxygen therapy in a patient with bisphosphonate-related osteonecrosis of the jaw: report of a case.Fatema CN et.al.Odontology. 2013 Aug 2.[Epub ahead of print]

2) Use of FDG PET to evaluate hyperbaric oxygen therapy for bisphosphonate-related osteonecrosis of the jaw.Yamazaki Y et.al.Clin Nucl Med. 2010 Aug;35(8):590-1