Utility of 18F-FDG PET/CT in risk assessment of Medication-related osteonecrosis of jaw.

Objective: The clinical utility of quantitative fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for classification of medication-related osteonecrosis of the jaw (MRONJ) was determined.

Methods: Seventy-one lesions in 59 patients clinically diagnosed as MRONJ, based on American Association of Oral and Maxillofacial Surgeons (AAOMS) diagnostic criteria by Japanese Society of Oral Surgery specialists and who received 18F-FDG PET/CT examinations, were enrolled. For analysis, standard uptake values (SUV), including maximum (SUVmax), peak (SUVpeak), and mean (SUVmean) were evaluated, and also metabolic lesion volume (MLV) for total volume above the threshold, and total lesion glycolysis (TLG), calculated as MLVxSUVmean. To compare quantitative values between clinical stages, one-way repeated measures analysis of variance and subsequent post-hoc analysis were used.

Results: The mean SUVmax values for AAOMS stage 1 (n=13), 2 (n=43), and 3 (n=15) patients were 3.68±0.83, 6.15±1.32, and 9.92±1.63, respectively, while MLV values were 6.51±5.53, 8.76±9.74, and 13.92±13.89, respectively, and TLG values were 16.84±17.23, 31.36±35.25, and 66.27±58.51, respectively. Maximum SUV and TLG showed significant differences between clinical stages (P<0.0001 and P=0.0029, respectively). With stage increase, MLV showed a mild increasing tendency, though the difference between stages was not significant (P=0.13), while SUVmax value differences between individual stages were significant in subsequent post-hoc analysis (P<0.0001). Furthermore, post-hoc analysis indicated that the stage 3 TLG value was significantly greater than that of stage 1 and 2 (P<0.01 and P<0.05, respectively).

Conclusions: For MRONJ patients, SUVmax and TLG derived from quantitative 18F-FDG PET/CT results are reliable objective indicators useful for disease activity evaluation and staging.