technetium-tc-99m-medronate and Jaw-Diseases

Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is a well-described clinical condition with consistent radiographic findings. The purpose of this report was to review these findings in an attempt to offer important diagnostic, prognostic, and therapeutic information associated with BRONJ.. The findings of studies assessing the radiographic landmarks on plain films, intraoral films, orthopantograph, computed tomography, magnetic resonance imaging, and nuclear bone scans in patients with BRONJ were analyzed.. The radiographic findings in patients with BRONJ include osteosclerosis, osteolysis, dense woven bone, a thickened lamina dura, subperiosteal bone deposition, and failure of postsurgical remodeling.. Consistent imaging findings are noted in the BRONJ patient. Imaging is an essential part of the clinical assessment of the BRONJ patient and might be an additional tool for tracking the progression of the disease.

Topics: Bone Density Conservation Agents; Diphosphonates; Fluorodeoxyglucose F18; Humans; Jaw Diseases; Magnetic Resonance Imaging; Osteonecrosis; Positron-Emission Tomography; Radiography, Panoramic; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Tomography, X-Ray Computed

Nuclear medicine studies often play a significant role in the diagnosis and treatment of oral and maxillofacial diseases. While not commonly used in everyday dental practice, the dental provider should have a conversational knowledge of these imaging modalities and understand the indications and limitations of these studies. The purpose of this review is to discuss the nuclear medicine studies that have applications in the head and neck region as well as their indications, limitations, and diagnostic conclusions that can be drawn from these studies.

Topics: Citrates; Gallium; Head and Neck Neoplasms; Humans; Jaw Diseases; Radionuclide Imaging; Radiopharmaceuticals; Salivary Gland Diseases; Sentinel Lymph Node Biopsy; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon

Theoretically, the bisphosphonates used to treat metastatic bone disease could influence the results of nuclear bone scans which use the structurally similar technetium 99m methylene diphosphonate (99mTc MDP). A prospective clinical study was designed to explore this hypothesis.. Patients with metastatic breast cancer receiving intravenous bisphosphonate (IVBP) therapy who had > or =3 osseous lesions on nuclear bone scan were eligible. A baseline bone scan (number 1) was performed as clinically indicated and IVBP with zoledronic acid was administered within 72 hours. A second bone scan (number 2) was performed within 72 hours of zoledronic acid dosing. Both bone scans were reviewed in a blinded fashion and assessed for changes in the number and intensity of osseous lesions. Ten patients were planned to yield at least 30 lesions.. Ten patients were enrolled. One patient withdrew consent and 1 was excluded due to protocol deviation. Among the 8 patients were 163 assessable osseous lesions. The median time from bone scan number 1 to IVBP was 1 day (range, 1-2 days). The median time from IVBP to bone scan number 2 was 2 days (range, 1-3 days). The paired imaging showed no changes in the total number of bone metastases. One hundred sixty-one lesions were identical in both scans; in 1 patient there were 2 lesions that were discordant, one more intense, the other less intense.. These data do not support the hypothesis that IVBP therapy interferes with bone scan results.

Topics: Adult; Aged; Bone Density Conservation Agents; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Humans; Imidazoles; Infusions, Intravenous; Jaw Diseases; Middle Aged; Osteonecrosis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Zoledronic Acid

The aim of this study was to compare the results of radionuclide bone scans of the jaws with data obtained at the nuclear medicine department from a brief and feasible dental history, taking special account of cases with a positive scan and no recent dental events. Ninety-eight patients undergoing radionuclide bone scan as part of their diagnosis in non-dental, oncological and non-oncological diseases were imaged with 99mTc-labelled oxidronate. Superior and inferior halves of the mandible and maxilla (392 quadrants) were regarded as normal or having an abnormally high uptake. A recent (1 year) dental history was also obtained through a brief questionnaire and data were referred to each quadrant of the jaws. The association between the bone scan and dental disease was assessed by means of the chi-squared test. The overall results of scintigraphy and history coincided in 66 patients (46 with abnormal and 20 with normal findings; P = 0.002). Twenty-five patients had a positive scintigram without any known dental disorder. Results of scintigraphy and history coincided in 254 quadrants (78 with abnormal and 176 with normal findings; P < 0.001). Eighty-three quadrants had hot spots in the scintigram without any known dental lesion. It can be concluded that abnormal jaw scintigrams are frequent in patients without known dental disease, and this may indicate silent osteoblastic activity. These observations should be reported to the dentist for several reasons. First, they may reveal asymptomatic dental lesions. Second, the use of oral prostheses and implants is increasing and they require the support of healthy alveolar bone.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Jaw; Jaw Diseases; Male; Medical History Taking; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tooth Diseases

It is important to recognize osteonecrosis of the jaws in patients treated with bisphosphonates because an early diagnosis can make a significant difference to the outcome of the disease. The aim of this study is to describe the radiological features of bisphosphonate osteonecrosis (BON) in order to aid its prompt recognition.. A conventional radiograph, a computed tomograph (CT), a magnetic resonance image (MRI) and a 99Tc(m)-MDP 3-phase bone scan were carried out for 11 patients with BON. The main imaging findings of osteonecrosis are described.. Conventional radiography and CT displayed osteolytic lesions with the involvement of cortical bone. MRI demonstrated the characteristic features of osteonecrosis and the oedema of soft tissues. Both CT and MRI were very useful in defining the extent of the lesions. 99Tc(m)-MDP three-phase bone scan was the most sensitive tool to detect the osteonecrosis at an early stage.. 99Tc(m)-MDP three-phase bone scans who could be used as a screening test to detect subclinical osteonecrosis in patients who have received bisphosphonates. CT scans and MRI are useful in defining the features and extent of osteolytic lesions.

Topics: Aged; Aged, 80 and over; Bone Density Conservation Agents; Bone Neoplasms; Diphosphonates; Female; Humans; Imidazoles; Jaw Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Multiple Myeloma; Osteonecrosis; Radiography, Panoramic; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Zoledronic Acid

The purpose of this study was to investigate the potential usefulness of single photon emission computed tomography (SPECT) bone scanning with technetium-99m methylene diphosphonate (Tc-99m MDP) in the diagnosis of idiopathic jaw pain. Unlike planar bone scanning, SPECT uses tomographic technology to provide 3-dimensional images, which are more useful in localizing small lesions.. Twenty patients, each with a diagnosis of chronic idiopathic jaw pain, were compared after SPECT bone scanning with 20 age-matched and gender-matched normal controls. Uptake was identified and compared in sites with previously detected jaw pathoses and jaw pain.. Nineteen of 20 patients with jaw pain evaluated with SPECT had positive scans, in contrast with 12 of 20 control subjects (P <.04). Positive scans were correlated with painful sites in 15 of 20 patients, with the remaining 5 patients demonstrating no uptake in painful locations. Patients with jaw pain demonstrated 37 of 80 mouth quadrants with positive scans, in contrast with 21 of 80 mouth quadrants in the controls (P <.01). Nineteen of 24 painful mouth quadrants had uptake in the pain group. Of the 21 quadrants positive in the controls, 17 were correlated with previously detected jaw pathoses. The sensitivity and specificity for detecting painful sites were 0.79 and 0.68, respectively. The sensitivity and specificity for detecting previously identified pathoses in the jaws of normal controls were 0. 80 and 0.93, respectively.. Patients with idiopathic jaw pain had a significantly greater frequency of positive SPECT bone scans when compared with normal controls. However, the sensitivity and specificity of SPECT bone scans in detecting painful sites were low. These findings suggest that SPECT bone scanning with Tc-99m MDP is not indicated as a routine imaging procedure for the detection of jaw pathoses, but may be considered as a potential research tool in the future study of chronic idiopathic jaw pain.

Topics: Adult; Case-Control Studies; Chi-Square Distribution; Facial Pain; Female; Humans; Jaw Diseases; Male; Middle Aged; Osteomyelitis; Periapical Diseases; Periodontal Diseases; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

A 38-year-old woman sought treatment with cranio-facial dysplasia involving the cranium, maxilla and the mandible. Her chief complaint was a mandibular swelling, which had appeared about 2 years previously, had gradually enlarged, and was associated with spontaneous pain. X-ray film examination revealed a ground-glass opacity with blurred demarcation and a 99 Tc medronate bone scan disclosed an increase in tracer uptake in the cranium, maxilla and mandible. The rest of the skeleton was not affected. Histological examination of the lesions revealed solid proliferation of spindle-shaped cells associated with islands of osteid and bone trabecullae with Chinese letter pattern and numerous multinucleated giant cells consistent with fibrous dysplasia. The continued osteoblastic activity of involved bones, coupled with the medical condition of the patient, restricted the management of the patient to largely supportive and palliative care.

Topics: Adult; Diagnosis, Differential; Facial Bones; Female; Fibrous Dysplasia, Polyostotic; Humans; Jaw Diseases; Skull; Technetium Tc 99m Medronate

A case of chronic recurrent multifocal osteomyelitis in a 14-year-old girl is presented. The disease had an initial aggressive osteolytic appearance involving both the maxilla and the mandible. Conservative treatment with minimal surgical intervention has been successful in this case during a 2-year follow-up period. The value of magnetic resonance imaging and bone scintigraphy in this case and the cause of chronic recurrent multifocal osteomyelitis is discussed.

Topics: Adolescent; Bone Regeneration; Chronic Disease; Female; Humans; Jaw Diseases; Magnetic Resonance Imaging; Osteomyelitis; Radionuclide Imaging; Recurrence; Technetium Tc 99m Medronate

To assess the usefulness of indium-111 white blood cell and technetium-99m methylene diphosphonate bone single photon emission computed tomography (SPECT), computed tomography (CT), and magnetic resonance (MR) imaging in cranial osteomyelitis.. Twenty-six cases (25 patients: 13 male, 12 female; mean age, 55 years) of suspected osteomyelitis were evaluated. Sixteen were postoperative. Final diagnosis was established by means of bone culture in 18 cases and clinical follow-up in eight.. Of 35 CT scans, 10 were true-positive (TP); three false-negative (FN); 13, true-negative (TN); one, false-positive (FP); and eight, equivocal. Of 36 SPECT scans, 19 were TP; 13, TN; one, FP; one, FN; and two, equivocal. Of 11 MR images four were TP; five, TN; and two, FN.. CT is best for differentiation between soft-tissue and bone infection. MR imaging is best for assessment of the calvaria and skull base. SPECT is best for assessment of altered bone and may be the best technique for follow-up.

Topics: Adolescent; Adult; Aged; Biopsy; Cells, Cultured; Female; Follow-Up Studies; Humans; Indium Radioisotopes; Jaw Diseases; Leukocytes; Magnetic Resonance Imaging; Male; Middle Aged; Osteomyelitis; Retrospective Studies; Sensitivity and Specificity; Skull; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Bone scans are frequently used to detect osteoblastic areas in bone, including bony metastases in patients with existing tumors. Various dental conditions have been found to cause areas in the jaws to have increased uptake of radiopharmaceuticals. We studied 30 patients with an existing cancer or previous history of cancer with the use of total body bone scans, panoramic radiographs, and dental examinations, and we found no correlation between the intensity of radionuclide uptake in the jaws on the bone scans and the number of teeth in each jaw, the age of the patient, the degree of periodontal disease, or the number of dental pathoses per jaw. The frequency and intensity of positive scan results were related to the presence or absence of intrabony lesions in the jaws. Dental disease therefore does not appear to mask metastatic disease in the jaws; however, when metastasis is suspected, a dental examination with radiographs is recommended.

Topics: Adult; Aged; Diagnosis, Differential; Female; Humans; Jaw Diseases; Jaw Neoplasms; Male; Middle Aged; Mouth Diseases; Periodontal Diseases; Radiation Dosage; Radiography, Panoramic; Radionuclide Imaging; Reproducibility of Results; Technetium Tc 99m Medronate; Tooth Diseases

Topics: Animals; Dogs; Jaw; Jaw Diseases; Radiation Injuries, Experimental; Radionuclide Imaging; Technetium Tc 99m Medronate; Time Factors

Topics: Animals; Disease Models, Animal; Dogs; Jaw; Jaw Diseases; Lasers; Osteoradionecrosis; Radiation Injuries; Radiation Injuries, Experimental; Radionuclide Imaging; Technetium Tc 99m Medronate; Time Factors; Ultrasonography

Topics: Diphosphonates; Humans; Jaw Diseases; Jaw Fractures; Jaw Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Temporomandibular Joint Dysfunction Syndrome