Abstract
Objective
Three-phase bone scintigraphy has been used for the diagnosis of osteomyelitis in some regions of the body. However, its utility in patients with chronic osteomyelitis of the mandible (COM) has been reported only occasionally and the significance has not been fully examined. The aim of this study was to investigate what can be identified from each phase of the three-phase bone scintigraphy in patients with COM.
Methods
Three-phase bone scintigraphy using 99mTc-labeled phosphonates was performed [96 s (phase 1), 5 min (phase 2) and 3 h (phase 3)] in 15 patients with COM. An increase in accumulation was regarded as a positive result in visual analysis. We investigated the positive ratio of each phase, including in the classification of the disease type, serum white blood cell count, C-reactive protein value and morbidity period. We also calculated the uptake ratio relative to the contralateral side using mean and maximum counts of the region of interest in semiquantitative analysis and investigated the correlation between the uptake ratios of each phase.
Results
The positive ratio of phases 2 and 3 was 100% and higher than that of phase 1 (33.3%, p = 0.0001). Almost all patients with a positive result in phase 1 had the osteolytic type (5/6). The extent of increased uptake on phase 3 images was similar to that of phase 2 images. The uptake ratio of phase 2 correlated with that of phase 3 (mean: r = 0.88, p < 0.0001, max: r = 0.78, p = 0.0006), but was not as high as that of phase 3.
Conclusions
The phase 1 results reflect hyperemia and have a strong potential to diagnose the disease type. Phase 3 alone is sufficient to diagnose the disease and the extent of lesion in patients with highly suspected COM.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Guhlmann A, Brecht-Krauss D, Suger G, Glatting G, Kotzerke J, Kinzl L, et al. Chronic osteomyelitis: detection with FDG PET and correlation with histopathologic findings. Radiology. 1998;206:749–54.
Schuknecht B, Valavanis A. Osteomyelitis of the mandible. Neuroimaging Clin N Am. 2003;13:605–18.
Schauwecker DS. The role of nuclear medicine in osteomyelitis. In: Collier Jr BD, Fogelman I, Rosenthall R, editors. Skeletal nuclear medicine. St. Louis: Mosby; 1996. p. 183–202.
Davenport MS, Brown RK, Frey KA. Utility of delayed whole-body bone scintigraphy after directed three-phase scintigraphy. AJR. 2009;193:338–42.
Yang DC, Ratani RS, Mittal PK, Chua RS, Pate SM. Radionuclide three-phase whole-body bone imaging. Clin Nucl Med. 2002;27:419–26.
El-Maghraby TA, Moustafa HM, Pauwels EK. Nuclear medicine methods for evaluation of skeletal infection among other diagnostic modalities. Q J Nucl Med Mol Imaging. 2006;50:167–92.
Maurer AH, Chen DC, Camargo EE, Wong DF, Wagner HN Jr, Alderson PO. Utility of three-phase skeletal scintigraphy in suspected osteomyelitis: concise communication. J Nucl Med. 1981;22:941–9.
Buyukdereli G, Guney IB, Ozerdem G, Kesiktas E. Evaluation of vascularized graft reconstruction of the mandible with Tc-99m MDP bone scintigraphy. Ann Nucl Med. 2006;20:89–93.
Dore F, Filippi L, Biasotto M, Chiandussi S, Cavalli F, Di Lenarda R. Bone scintigraphy and SPECT/CT of bisphosphonate-induced osteonecrosis of the jaw. J Nucl Med. 2009;50:30–5.
Hakim SG, Bruecker CW, HCh Jacobsen, Hermes D, Lauer I, Eckerle S, et al. The value of FDG-PET and bone scintigraphy with SPECT in the primary diagnosis and follow-up of patients with chronic osteomyelitis of the mandible. Int J Oral Maxillofac Surg. 2006;35:809–16.
Rohlin M. Diagnostic value of bone scintigraphy in osteomyelitis of the mandible. Oral Surg Oral Med Oral Pathol. 1993;75:650–7.
Tsuchimochi M, Higashino N, Okano A, Kato J. Study of combined technetium 99m methylene diphosphonate and gallium 67 citrate scintigraphy in diffuse sclerosing osteomyelitis of the mandible: case reports. J Oral Maxillofac Surg. 1991;49:887–97.
Jacobsson S, Hollender L, Lindberg S, Larsson A. Chronic sclerosing osteomyelitis of the mandible. Scintigraphic and radiographic findings. Oral Surg Oral Med Oral Pathol. 1978;45:167–74.
Gilday DL, Paul DJ, Paterson J. Diagnosis of osteomyelitis in children by combined blood pool and bone imaging. Radiology. 1975;117:331–5.
Yoshii T, Nishimura H, Yoshikawa T, Furudoi S, Yoshioka A, Takenono I, et al. Therapeutic possibilities of long-term roxithromycin treatment for chronic diffuse sclerosing osteomyelitis of the mandible. J Antimicrob Chemother. 2001;47:631–7.
Kumta SM, Huang L, Cheng YY, Chow LT, Lee KM, Zheng MH. Expression of VEGF and MMP-9 in giant cell tumor of bone and other osteolytic lesions. Life Sci. 2003;73:1427–36.
Niida S, Kaku M, Amano H, Yoshida H, Kataoka H, Nishikawa S, et al. Vascular endothelial growth factor can substitute for macrophage colony-stimulating factor in the support of osteoclastic bone resorption. J Exp Med. 1999;190:293–8.
Lee K, Kaneda T, Mori S, Minami M, Motohashi J, Yamashiro M. Magnetic resonance imaging of normal and osteomyelitis in the mandible: assessment of short inversion time inversion recovery sequence. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96:499–507.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fukumitsu, N., Ujigawa, K., Mori, Y. et al. What can be identified by three-phase bone scintigraphy in patients with chronic osteomyelitis of the mandible?. Ann Nucl Med 24, 287–293 (2010). https://doi.org/10.1007/s12149-010-0362-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12149-010-0362-1