Analysis of bone single-photon emission CT/CT and diffusion-weighted MR imaging in medication-related osteonecrosis of the jaw: focusing on the correlation between standardized uptake values and apparent diffusion coefficient values.

Am J Nucl Med Mol Imaging 2024;14(4):230-238 www.ajnmmi.us /ISSN:2160-8407/ajnmmi0156847 Original Article Analysis of bone single-photon emission CT/CT and diffusion-weighted MR imaging in medication-related osteonecrosis of the jaw: focusing on the correlation between standardized uptake values and apparent diffusion coefficient values Yasuhito Tezuka1, Ichiro Ogura1,2 Quantitative Diagnostic Imaging, Field of Oral and Maxillofacial Imaging and Histopathological Diagnostics, Course of Applied Science, The Nippon Dental University Graduate School of Life Dentistry at Niigata, Niigata, Japan; 2Department of Oral and Maxillofacial Radiology, The Nippon Dental University School of Life Dentistry at Niigata, Niigata, Japan 1 Received March 27, 2024; Accepted August 8, 2024; Epub August 25, 2024; Published August 30, 2024 Abstract: The purpose of this study is to investigate bone SPECT/CT and diffusion-weighted MR imaging (DWI) in medication-related osteonecrosis of the jaw (MRONJ), focusing on the correlation between standardized uptake values (SUVs) and apparent diffusion coefficient (ADC) values. Twenty-nine patients with MRONJ who underwent SPECT/CT and DWI were included in this study. SUVs (maximum and mean) with SPECT/CT, and ADC values (maximum, mean and minimum) with DWI were analyzed on characteristics in MRONJ, such as stage, location, medication and underlying disease, by Mann-Whitney U test. Furthermore, the correlation between SUVs and ADC values for characteristics in MRONJ were assessed by Spearman’s rank correlation test for nonparametric data. A p-value lower than 0.05 was considered as statistically significant. SUVs and ADC values have no significant differences for all characteristics in MRONJ. Negative correlations were found in all cases and in stage 2 cases, and no correlations were found in stage 3 cases. In addition, negative correlations were found in maxillary cases, mandibular cases, non-bisphosphonate cases, osteoporosis cases, and malignant tumor cases. In conclusion, this study found multiple correlations between SUVs and ADC values in MRONJ, especially in stage 2. Suggesting that ADC values and SUVs may change with disease progression and the possibility of predicting MRONJ progression by SUVs and ADC values. Keywords: Radionuclide imaging, single-photon emission-computed tomography, apparent diffusion coefficient, medication-related osteonecrosis of the jaw Introduction Antiresorptive agents, including bisphosphonates and denosumab, are commonly used for osteoporosis and tumors with bone metastases [1]. Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse effect reported in patients treated with antiresorptive agents and angiogenesis inhibitors [2]. Symptoms of MRONJ have been reported to include pain, swelling, bone exposure, fistulae, erythematous, ulcerated soft tissue or pathologic fractures [3]. These symptoms can significantly impair the health and quality of life of MRONJ patients [4]. However, MRONJ stage evaluation is done by clinical symptoms, and the relationship with the stage of quantitative evaluation by imaging has not been well reported. Diffusion-weighted MR imaging (DWI) with apparent diffusion coefficient (ADC) maps is a useful tool in MR images that can provide a quantitative measure of the diffusivity of water in each voxel of biological tissue [5]. In the head and neck region, ADC has been shown to be useful in pre- dicting and diagnosing lesions [6]. ADC in the bone marrow of MRONJ has also been reported and its usefulness has been investigated [7]. Bone single-photon emission CT/CT (SPECT/CT) is diagnostic imaging modality that can show physiological changes in bone, and standardized uptake values (SUVs) obtained from bone SPECT/CT enable quantitative evaluation of lesions [8, 9]. Currently, there are several reports on the use of bone SPECT/CT SUV for the evaluation of MRONJ [10-12]. However, SPECT/CT has several drawbacks such as taking a long time, exposing the patient to radiation, and being invasive, because radioisotopes are administered intravenously and their accumulation is visualized. MRONJ shows more severe clinical manifestations as the stage advances, but the details of its progression are not clear. Although there are reports of SUV and ADC values at each stage of MRONJ, however, to our knowledge, no correlation between SUV and ADC values has been reported in the literature. The purpose of this study is to https://doi.org/10.62347/FFPG9819 Analysis of bone SPECT/CT and DWI in MRONJ rectal cancer and 1 multiple myeloma). All patients with MRONJ were diagnosed and treated for osteoporosis or malignant tumor at other hospital. Imaging acquisition SPECT/CT scans were obtained by a SPECT/CT scanner (Optima NM/CT 640, GE Healthcare, Tokyo, Japan), equipped with 4-slices CT scanner for attenuation correction, following our institution’s protocol [8-12]. Patients were administered an intravenous injection of 740 MBq of 99m Tc-hydroxymethylene diphosphonate (99mTc-HMDP, Clear Bone Injectable, Nihon Medi-Physics, Tokyo, Japan) 4 hours before SPECT acquisition. Figure 1. Flowchart of MRONJ imaging examinations at our hospital. Patients with suspected MRONJ will first undergo panoramic radiographs and CT. Next, an MRI is performed to confirm the status of the bone marrow. Subsequently, SPECT/CT is performed when considering surgical treatment. examine the differences between stage 2, stage 3 and other characteristics and stage progression in MRONJ, focusing on the correlation between SUV and ADC. Material and methods Patients This study was approved by the ethics committee of our university (ECNG-R-318). After providing written informed consent, 29 patients (10 men and 19 women; mean age 74.7 years [range, 48-91 years]) with clinically considered MRONJ who underwent SPECT/CT and MRI at our university hospital from March 2022 to December 2023 were included. Figure 1 shows the process of imaging examination in MRONJ at our hospital. Diagnosis and staging of MRONJ were based on clinical symptoms in accordance with the 2022 American Association of Oral and Maxillofacial Surgeons (AAOMS) position paper [13]. Patients’ medications were classified into 2 groups: bisphosphonate (BP) cases (5 minodronate, 3 alendronate, 3 ibandronate, 2 zoledronate and 1 risedronate) and non-bisphosphonate (non-BP) cases (14 denosumab and 1 bevacizumab). Patients’ underlying diseases were classified into 2 groups: osteoporosis cases (15 cases) and malignant tumor cases (5 prostate cancer, 3 breast cancer, 2 lung cancer, 1 kidney cancer, 1 thyroid cancer, 1 231 The SPECT scan was acquired using lowenergy high-resolution collimator, the 140 keV photoenergy peak for 99mTc, a 128 × 128 matrix of 4.2 mm pixel size, and a total of 60 projections (30 steps) over 360° with a dwell time of 10 s/step. Subsequent to the SPECT acquisition, a low-dose CT transmission scan was performed with 120 kV and 20 mA using a 512 × 5 (...truncated)