Bone Scintigraphy and Positron Emission Tomography in the Early Diagnosis of MRONJ

Overview

Journal Open Med (Wars)

Specialty General Medicine

Date 2025 Feb 24

PMID 39989613

Authors

Daniele Pergolini

Mohamed Mohsen

Gianluca Tenore

Gaspare Palaia

Lorenzo Magnifico

Alessandro Del Vecchio

Umberto Romeo

Affiliations

Soon will be listed here.

Abstract

Objectives: The aim of this study is to evaluate the bone scintigraphy (BS) and positron emission tomography (PET) in the early diagnosis of medication-related osteonecrosis of the jaws (MRONJ) and their possible use in the identification of patients at risk for MRONJ.

Material And Methods: Thirty-one patients treated with ONJ-related drugs and who had undergone BS or PET for the evaluation of bone lesions were included in the study. The jaws of each patient were divided into four areas. For each area, the presence of pathological tracer uptake was evaluated and related to the eventual MRONJ development. Sensitivity, specificity, and predictive values of both techniques were determined. The latency from the finding of pathological tracer uptake in BS or PET to the clinical diagnosis of MRONJ and the odds ratio were also calculated.

Results: Sensitivity and specificity of BS for MRONJ prediction were, respectively, 83.3 and 87.5%. Positive and negative predictive values were, respectively, 73.2 and 92.8%. The odds ratio was 35. Sensitivity of PET was 33.3%, specificity was 94.9%, and positive and negative predictive values were 70.0 and 80.0%, respectively. The odds ratio was 9.333. All values were statistically significant.

Conclusions: BS and PET may be accurate techniques for an early prediction of MRONJ.

References

Belcher R, Boyette J, Pierson T, Siegel E, Bartel T, Aniasse E . What is the role of positron emission tomography in osteonecrosis of the jaws?. J Oral Maxillofac Surg. 2013; 72(2):306-10. DOI: 10.1016/j.joms.2013.07.038. View

Watanabe S, Nakajima K, Kinuya S . Symposium: Imaging modalities for drug-related osteonecrosis of the jaw (5), utility of bone scintigraphy and F-FDG PET/CT in early detection and risk assessment of medication-related osteonecrosis of the jaw (secondary publication). Jpn Dent Sci Rev. 2019; 55(1):76-79. PMC: 6431786. DOI: 10.1016/j.jdsr.2018.12.002. View

Krasnow A, Hellman R, Timins M, Collier B, Anderson T, Isitman A . Diagnostic bone scanning in oncology. Semin Nucl Med. 1997; 27(2):107-41. DOI: 10.1016/s0001-2998(97)80043-8. View

Lesclous P, Abi Najm S, Carrel J, Baroukh B, Lombardi T, Willi J . Bisphosphonate-associated osteonecrosis of the jaw: a key role of inflammation?. Bone. 2009; 45(5):843-52. DOI: 10.1016/j.bone.2009.07.011. View

Di Fede O, Panzarella V, Mauceri R, Fusco V, Bedogni A, Lo Muzio L . The Dental Management of Patients at Risk of Medication-Related Osteonecrosis of the Jaw: New Paradigm of Primary Prevention. Biomed Res Int. 2018; 2018:2684924. PMC: 6164200. DOI: 10.1155/2018/2684924. View

Bedogni A, Mauceri R, Fusco V, Bertoldo F, Bettini G, Di Fede O . Italian position paper (SIPMO-SICMF) on medication-related osteonecrosis of the jaw (MRONJ). Oral Dis. 2024; 30(6):3679-3709. DOI: 10.1111/odi.14887. View

Chiandussi S, Biasotto M, Dore F, Cavalli F, Cova M, Di Lenarda R . Clinical and diagnostic imaging of bisphosphonate-associated osteonecrosis of the jaws. Dentomaxillofac Radiol. 2006; 35(4):236-43. DOI: 10.1259/dmfr/27458726. View

Catalano L, Del Vecchio S, Petruzziello F, Fonti R, Salvatore B, Martorelli C . Sestamibi and FDG-PET scans to support diagnosis of jaw osteonecrosis. Ann Hematol. 2007; 86(6):415-23. DOI: 10.1007/s00277-007-0263-0. View

Drake M, Clarke B, Khosla S . Bisphosphonates: mechanism of action and role in clinical practice. Mayo Clin Proc. 2008; 83(9):1032-45. PMC: 2667901. DOI: 10.4065/83.9.1032. View

10.

Fleisher K, Raad R, Rakheja R, Gupta V, Chan K, Friedman K . Fluorodeoxyglucose positron emission tomography with computed tomography detects greater metabolic changes that are not represented by plain radiography for patients with osteonecrosis of the jaw. J Oral Maxillofac Surg. 2014; 72(10):1957-65. DOI: 10.1016/j.joms.2014.04.017. View

11.

Wilde F, Steinhoff K, Frerich B, Schulz T, Winter K, Hemprich A . Positron-emission tomography imaging in the diagnosis of bisphosphonate-related osteonecrosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 107(3):412-9. DOI: 10.1016/j.tripleo.2008.09.019. View

12.

Kitagawa Y, Ohga N, Asaka T, Sato J, Hata H, Helman J . Imaging modalities for drug-related osteonecrosis of the jaw (3), Positron emission tomography imaging for the diagnosis of medication-related osteonecrosis of the jaw. Jpn Dent Sci Rev. 2019; 55(1):65-70. PMC: 6430078. DOI: 10.1016/j.jdsr.2018.12.001. View

13.

Stopeck A, Lipton A, Body J, Steger G, Tonkin K, De Boer R . Denosumab compared with zoledronic acid for the treatment of bone metastases in patients with advanced breast cancer: a randomized, double-blind study. J Clin Oncol. 2010; 28(35):5132-9. DOI: 10.1200/JCO.2010.29.7101. View

14.

Raje N, Woo S, Hande K, Yap J, Richardson P, Vallet S . Clinical, radiographic, and biochemical characterization of multiple myeloma patients with osteonecrosis of the jaw. Clin Cancer Res. 2008; 14(8):2387-95. DOI: 10.1158/1078-0432.CCR-07-1430. View

15.

Boffano P, Agnone A, Neirotti F, Bonfiglio R, Brucoli M, Ruslin M . Epidemiology, etiopathogenesis, and management of MRONJ: A European multicenter study. J Stomatol Oral Maxillofac Surg. 2024; 125(5S1):101931. DOI: 10.1016/j.jormas.2024.101931. View

16.

Khan A, Morrison A, Hanley D, Felsenberg D, McCauley L, ORyan F . Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res. 2014; 30(1):3-23. DOI: 10.1002/jbmr.2405. View

17.

Tsuchimochi M, Kurabayashi T . Symposium: Imaging modalities for drug-related osteonecrosis of the jaw (1), role of imaging in drug-related osteonecrosis of the jaw: An up-to-date review (secondary publication). Jpn Dent Sci Rev. 2019; 55(1):1-4. PMC: 6348294. DOI: 10.1016/j.jdsr.2018.11.004. View

18.

Campisi G, Mauceri R, Bertoldo F, Bettini G, Biasotto M, Colella G . Medication-Related Osteonecrosis of Jaws (MRONJ) Prevention and Diagnosis: Italian Consensus Update 2020. Int J Environ Res Public Health. 2020; 17(16). PMC: 7460511. DOI: 10.3390/ijerph17165998. View

19.

Hong C, Ahn B, Choi S, Kim D, Lee S, Kwon T . Implications of three-phase bone scintigraphy for the diagnosis of bisphosphonate-related osteonecrosis of the jaw. Nucl Med Mol Imaging. 2014; 46(3):162-8. PMC: 4043030. DOI: 10.1007/s13139-012-0144-x. View

20.

ORyan F, Khoury S, Liao W, Han M, Hui R, Baer D . Intravenous bisphosphonate-related osteonecrosis of the jaw: bone scintigraphy as an early indicator. J Oral Maxillofac Surg. 2009; 67(7):1363-72. DOI: 10.1016/j.joms.2009.03.005. View