technetium-tc-99m-medronate and Mandibular-Neoplasms

We report a case of MFH of the mandible in a 16-year-old girl. The mandible is a rare location of MFH of bone, with only 21 cases described in the literature. Clinical, pathologic, and radiologic features are discussed, with special emphasis on the unusual pathologic and radiographic features.

Topics: Adolescent; Biopsy; Chronic Disease; Diagnosis, Differential; Female; Histiocytoma, Benign Fibrous; Humans; Mandible; Mandibular Neoplasms; Radiography, Panoramic; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Dentists need to be aware of the relationship between malignancies and paresthesia or complete loss of sensation in a jaw segment. In particular, dentists should be aware of numb chin syndrome (NCS) and its clinical manifestations, as well as the limitations of using panoramic radiographs to detect the causative malignancy.. The authors report two cases of paresthesia in the mental region. No lesions were readily apparent on the patients' panoramic radiographs. To exclude the presence of disease in the mandible that could have been responsible for the NCS, the authors obtained computed tomographic (CT) images. They identified metastases to the mandible from primary malignant tumors elsewhere in the body.. To prevent misdiagnosis of NCS, dentists need to be aware of the clinical manifestations of NCS, the need for CT imaging, the shortcomings of panoramic radiographs and the value of obtaining detailed and accurate medical and dental histories from patients.

Topics: Aged; Chin; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Hypesthesia; Male; Mandibular Neoplasms; Multiple Myeloma; Paresthesia; Prostatic Neoplasms; Radiography, Panoramic; Radiopharmaceuticals; Syndrome; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

A 25-year-old woman presented with a disturbance in the opening of her mouth 5 months before admission. On admission, painful swelling of the right preauricular region was revealed. Computed tomography (CT) demonstrated a soft tissue density mass around the right condylar process of the mandible. Tc-99m hydroxymethylene diphosphonate (HMDP) bone scintigraphy and Ga-67 citrate scintigraphy showed avid uptake in the mass. The tumor was histologically identified as an osteoblastic osteosarcoma of the right mandible. There are few reports of Ga-67 citrate scintigraphy findings of osteoblastic osteosarcoma of the mandible. The accumulation patterns on Tc-99m HMDP bone scintigraphy and Ga-67 citrate scintigraphy are possibly characteristic of osteoblastic osteosarcoma of the mandible.

Topics: Adult; Arthralgia; Citrates; Female; Gallium; Humans; Mandibular Neoplasms; Osteoblastoma; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Temporomandibular Joint

Whether a patient with head and neck cancer has mandibular invasion or not is important in determining the method of resection surgery. But, no modality is adequately reliable when used alone in the evaluation of mandibular invasion. Therefore, to more accurately diagnose mandibular invasion in head and neck cancer, we used a new modality, namely, 99mTc methylene diphosphonate (MDP) or 99mTc hydroxymethylene diphosphonate (HMDP) and 201Tl chloride dual isotope single photon emission computed tomography (Tc/Tl SPECT). The aim of this study is to disclose the usefulness of Tc/Tl SPECT in the assessment of mandibular invasion by head and neck cancers. 99mTc-MDP or -HMDP SPECT (Tc SPECT)s and 201Tl chloride SPECT (Tl SPECT)s were performed in 34 patients with suspected mandibular involvement of head and neck cancer. Thirty of 34 cases underwent both TcMTl SPECT and CT examination. Tc/Tl SPECT fusion images were obtained using the Automatic Registration Tool (ART, TOSHIBA, Japan) system. In the diagnosis of mandibular invasion on Tc/Tl SPECT fusion images, a problem was that the range of Tc and Tl uptake was changed by the condition of display used in the reconstruction and expression of the images. Then, prior to clinical evaluation, to reveal the most appropriate upper window level for display, a phantom study was performed. In a clinical study, the upper window level was set at 40 or 50%, which were verified to be the proper values in the preliminary study. The diagnostic accuracy obtained using Tc SPECT, TcMTl SPECT and CT was compared with the histopathological findings. Tc/Tl SPECT at 40 and 50% upper window level had higher specificity, accuracy, and positive predictive value (73.3%, 85.3%, 81.8%) than Tc SPECT alone (21.4%, 67.6%, 64.5%) and higher sensitivity and negative predictive value (94.7%, 91.7%) than CT (70.6%, 72.2%) for detecting mandibular invasion. Tc/Tl SPECT was a useful diagnostic procedure for the assessment of mandibular invasion by head and neck cancers.

Topics: Head and Neck Neoplasms; Humans; Mandibular Neoplasms; Neoplasm Invasiveness; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Technetium Tc 99m Medronate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

Investigating the scintigraphic images of jaws may have a diagnostic value of bone alterations of dental origin. Anterior view of whole body bone scintigraphy revealed hot spot on jaws of 61% (279) of patients. Twenty-six patients (mean age 58.3 year) from all of those who had increased tracer uptake (ITU) in the maxillo-mandibular region were called back for dental examination. 279 out of 459 (61%) patients had ITU in the maxillo-mandibular region. Dental examination revealed the dental origin of ITU in all cases. In case of periapical pathosis tracer uptake showed 28.79% increase compared to the contralateral side. In marginal periodontitis 23.82% ITU was found. In case of loading due to prosthesis 13.06% ITU was observed. The mean DMF-T value was 26.36 +/- 4.52 (D = 4.12, M = 20.8, F = 1.44). The prosthetic index was 0.42 on the mandible. The above mentioned data mean very low oral health conditions of the patients included in this examination. The results show that bone scintigraphy is a valuable procedure in detecting tooth related jaw lesions. Bone scintigraphy provides very useful data on oral health of these patients. Enrolling of these patients into regular dental care is inevitable.

Topics: Bone Remodeling; DMF Index; Humans; Mandibular Diseases; Mandibular Neoplasms; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tooth Diseases

A case of osteoid osteoma (OO) in the mandible of 26-year-old female is presented. Her main complaint was intermittent pain during a 3 year period. The panoramic radiograph of the mandible showed diffuse sclerosis including an ill-defined circular radiopacity in the molar region. Computed tomography (CT) revealed an osseous lesion of 10 mm diameter that was located in the cortical bone of the mandible. Bone scintigraphy showed a localized region of high uptake of 99mTc HMDP. The lesion was diagnosed as an OO by histopathological examination of the surgical specimen and CT findings. Since radiological appearance has very significant meaning in the differentiation of an OO from other bone forming tumors, CT is the method of choice when the main symptom is pain and the conventional radiography was not informative.

Topics: Adult; Biopsy; Female; Follow-Up Studies; Humans; Mandibular Neoplasms; Osteoma, Osteoid; Osteosclerosis; Radiography, Panoramic; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Skeletal scintigraphy, a sensitive diagnostic tool used to detect changes in bone, is helpful for evaluating bone invasion by oral cancer. However, the exact sites of accumulation of 99mTc-phosphate compounds in the mandible have not yet been fully elucidated. The aim of this study was to determine the localization of 99mTc-methylene diphosphonate (MDP) in the areas of mandible that have been invaded by cancer.. Seven patients with oral cancer (lower gingiva, 4; tongue, 2; floor of the mouth, 1) who underwent surgical treatment with mandibular bone resection were included in the study. Autoradiography and contact macroradiography were used for evaluation of 99mTc-MDP accumulation.. Radioactivity reflecting accumulation of 99mTc-MDP was documented encircling the portion of the mandible with cancerous invasion, suggesting that 99mTc-MDP accumulated in immature bone. High uptake also was found in the periosteal reactive bone around the cortical bone.. The amount of increased 99mTc-MDP circumscribing carcinoma invasion varies among cases. Additionally, uptake may not correspond directly with the amount of the carcinoma invasion; that seen in periosteal bone could be attributed mistakenly to bone invasion in planar scintigraphy.

Topics: Aged; Alveolar Process; Autoradiography; Carcinoma, Adenoid Cystic; Carcinoma, Squamous Cell; Female; Gingival Neoplasms; Humans; Male; Mandibular Neoplasms; Middle Aged; Mouth Floor; Neoplasm Invasiveness; Radionuclide Imaging; Technetium Tc 99m Medronate; Tongue Neoplasms

It is important for head and neck surgeons planning their operative approach to assess tumor infiltration to the mandible by intraoral squamous-cell carcinomas. Two- to 3-hr planar bone scintigraphy is sensitive but not specific in detecting mandibular invasion by tumor. We evaluated 3-hr SPECT bone scintigraphy, which provides better anatomical detail, to determine if it more accurately assesses tumor invasion.. Thirty consecutive patients with proven intraoral squamous-cell carcinomas were studied. Semiquantitative assessment of the mandible was performed with a three-level graded scoring system, based on comparisons of tracer uptake in the mandible to that in the upper cervical vertebrae and in an unaffected part of mandible. Lesion-to-cervical spine (L/S) count ratios and lesion-to-nonlesion (L/N) count ratios in the mandible on the 3-hr SPECT images were calculated.. All patients with proven tumor invasion showed higher tracer uptake than those with normal mandible or other dental diseases. The L/S and L/N count ratios on the SPECT images were significantly higher in patients with tumor invasion than in those without (L/S, p < 0.001; L/N, p < 0.01). L/S ratios provided better differentiation than L/N ratios.. Bone SPECT provides a reliable means of assessing tumor invasion to the mandible by intraoral squamous-cell carcinomas.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Cervical Vertebrae; Female; Humans; Male; Mandible; Mandibular Neoplasms; Middle Aged; Mouth Floor; Mouth Neoplasms; Neoplasm Invasiveness; Technetium Tc 99m Medronate; Time Factors; Tomography, Emission-Computed, Single-Photon

Detecting osseous involvement is clinically important in the management of oral carcinoma. Thirty-one patients with osseous involvement due to oral carcinoma who underwent panoramic radiography and bone scintigraphy were evaluated retrospectively. Bone scintigraphy confirmed osseous involvement in all 31 (100%) of these patients. In 27 (87%) of 31 patients with osseous involvement, both the panoramic radiogram and bone scintigram were positive. In the remaining four patients (13%), bone scintigram was positive for mandibular or maxillary invasion, while panoramic radiogram was negative. There were no instances of an abnormal radiogram with a normal bone scintigram. These findings strongly suggest that bone scintigraphy is more sensitive than panoramic radiography in detecting osseous involvement of the mandible and maxilla due to oral carcinoma. Furthermore, bone scintigraphy was a critical pre-surgical in determining the extent of the osseous involvement.

Topics: Carcinoma, Squamous Cell; Cheek; Diagnostic Errors; Evaluation Studies as Topic; Gingival Neoplasms; Humans; Mandibular Neoplasms; Maxillary Neoplasms; Melanoma; Mouth Neoplasms; Neoplasm Invasiveness; Radiography, Panoramic; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate

A prospective study of 85 patients with oral cancer, treated with high-dose radiation therapy, was performed to assess the value of magnetic resonance imaging (MRI) and scintigraphy for diagnosis of pathologic changes in the mandible. During postradiotherapeutic monitoring, radiation osteomyelitis occurred in 12 cases, tumor recurrences infiltrating the mandible in five cases, and progressive periodontal disease in nine cases. MRI permitted early diagnosis of radiation osteomyelitis in 11 out of 12 cases; only two cases were false positive. In scintigraphy with 99mTc-HDP, all alterations of the mandible, such as osteoradionecrosis, tumor infiltration, and periodontitis, showed a high uptake, resulting in a sensitivity of up to 100%, but a low specificity of 57%. Scintigraphy permitted assessment of the extension and location of the lesions. Both methods were superior to conventional radiography and clinical examination and should be integrated into a comprehensive follow-up program after radiation therapy.

Topics: Adult; Aged; False Positive Reactions; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Mandible; Mandibular Diseases; Mandibular Neoplasms; Middle Aged; Mouth Neoplasms; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Osteomyelitis; Osteoradionecrosis; Periodontitis; Prospective Studies; Radiation Injuries; Radiation Monitoring; Radiopharmaceuticals; Radiotherapy; Radiotherapy Dosage; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

To date no investigation has proven accurate and reliable for assessing mandibular invasion by carcinoma prior to surgery. This prospective study compared a new imaging modality, single photon emission computed tomography (SPECT), with clinical examination and high resolution CT scanning to evaluate the sensitivity and specificity of each method in detecting mandibular invasion by squamous cell carcinoma. Twenty-nine patients (21 men, 8 women) with an oral cavity/oropharyngeal carcinoma were studied. All underwent primary surgery and/or radiotherapy where indicated. Resected mandibles were decalcified and examined for tumour infiltration. Imaging studies were read independently by two experienced observers. Clinical examination predicted bone invasion with a sensitivity of 90% and a specificity of only 25%. CT had a sensitivity of 89% and a specificity of 57% while SPECT imaging had a sensitivity of 100% and a specificity of 29%. Using Fisher's exact test and the Kappa statistic for pairwise comparisons between each method, SPECT imaging was complementary to CT in the pre-operative assessment of mandibular invasion.

Topics: Aged; Carcinoma, Squamous Cell; Female; Humans; Male; Mandible; Mandibular Neoplasms; Mouth Neoplasms; Neoplasm Invasiveness; Oropharyngeal Neoplasms; Prospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

A case of hepatocellular carcinoma metastatic to the mandible is described. The patient reported swelling, pain, and trismus after a pathologic fracture. After a systematic examination with the use of 99mTc-methylene diphosphonate, 67Ga-citrate, and 99mTc-pyridoxyl-5-methyl triptophan scintigraphy the primary focus was discovered in the right lobe of the liver. The focus was confirmed by computed tomography and magnetic resonance imaging. The histopathologic diagnosis of hepatocellular carcinoma was made from a biopsy specimen of the mandibular lesion.

Topics: Carcinoma, Hepatocellular; Fatal Outcome; Gallium Radioisotopes; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Mandibular Neoplasms; Middle Aged; Organotechnetium Compounds; Pyridoxal; Radiography, Panoramic; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Tryptophan

Extracolonic manifestations of Gardner's syndrome are common and may precede the detection of colonic polyps. Tc-MDP bone scintigraphy performed on a patient with Gardner's syndrome demonstrated intense uptake of radiotracer within the maxilla and mandible as a result of the dental anomalies associated with this disorder. Nuclear scintigraphy has a role in the imaging of these patients for skeletal anomalies, the detection of thyroid carcinoma, and for skeletal metastases when colon carcinoma is detected.

Topics: Adult; Fibromatosis, Aggressive; Gardner Syndrome; Humans; Male; Mandibular Neoplasms; Maxillary Neoplasms; Osteoma; Radionuclide Imaging; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

A primary Ewing's tumor in the mandible is reported, and the diagnostic imaging features of this lesion are discussed. Modalities used included panoramic and plain films, computed tomography, and 99mTc-MDP scintigraphy.

Topics: Adolescent; Diagnosis, Differential; Humans; Male; Mandibular Neoplasms; Radiography, Panoramic; Radionuclide Imaging; Sarcoma, Ewing; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Ultrasonography

Topics: Ameloblastoma; Child; Diagnostic Imaging; Humans; Male; Mandibular Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Several imaging techniques, such as conventional radiography, sonography, computed tomography, isotope scanning and magnetic resonance tomography are used for evaluation of malignant tumors in the region of the floor of the mouth and the tongue. At present, conventional radiography, as well as computed tomography and isotope scanning are the techniques preferred for examination of the mandible. In this study, the results of conventional radiographic examination, computed tomography, ultrasound and Tc scanning in detecting tumor invasion of the mandibular bone, are documented and correlated to surgical and histological findings. The results suggest that ultrasound--our primary diagnostic imaging technique for evaluation of tumors of the floor of the mouth and the tongue--not only provides excellent imaging of tumor extension in soft tissue but also allows accurate diagnosis of osteodestructions of the mandible. In most regions ultrasound had the same accuracy in detecting tumor invasion of the mandible. In the alveolar process, however, sonography was superior to other imaging techniques. The lingual surface of the mandibular ramus can not be screened by the extraoral sonography.

Topics: Carcinoma, Squamous Cell; Diagnostic Imaging; Female; Humans; Male; Mandibular Diseases; Mandibular Neoplasms; Middle Aged; Mouth Neoplasms; Neoplasm Invasiveness; Osteolysis; Radiography, Panoramic; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Ultrasonography

There is given a report about first clinical experiences in the partial cryodevitalization of the mandible. 3 tumor-bearing patients were treated. The resection of the mandible was not necessary. The process of revitalisation was observed by bone scanning.

Topics: Bone Regeneration; Carcinoma, Squamous Cell; Cryosurgery; Follow-Up Studies; Humans; Mandible; Mandibular Neoplasms; Osteosarcoma; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Aged; Ameloblastoma; Female; Humans; Image Processing, Computer-Assisted; Mandibular Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Topics: Adenocarcinoma; Bone and Bones; Gallium Radioisotopes; Humans; Male; Mandibular Neoplasms; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Carcinoma, Squamous Cell; Humans; Male; Mandibular Neoplasms; Mastoiditis; Methods; Middle Aged; Radionuclide Imaging; Skull; Technetium Tc 99m Medronate; Tomography, X-Ray Computed