Quantitative evaluation of anti-resorptive agent-related osteonecrosis of the jaw using bone single photon emission computed tomography in clinical settings: relationship between clinical stage and imaging

Objective: This study aimed to use quantitative values, calculated from bone single photon emission computed tomography (SPECT) imaging, to estimate the reliability of progression evaluation for anti-resorptive agent-related osteonecrosis of the jaw (ARONJ). Methods: The study population consisted of 21 patients (23 lesions), clinically diagnosed with mandibular ARONJ, who underwent SPECT/CT scanning. Diagnosis and staging of ARONJ were performed according to the American Association of Oral and Maxillofacial Surgeons (AAOMS) definition and the recommendations of the International Task Force on ONJ. Hybrid SPECT/CT imaging quantitative analyses were performed on a workstation. Each volume of interest (VOI) was semi-automatically placed over a lesion with areas of high tracer accumulation, using the GI-BONE^® software default threshold method settings. Additionally, control VOI was manually set over an unaffected area. Measured parameters included standardized uptake values (SUV)—maximum (SUV_max) and mean (SUV_mean), metabolic bone volume (MBV)—the total volume above the threshold, and total bone uptake (TBU) as calculated by MBV × SUV_mean. We also calculated the SUV ratio (rSUV) between the lesion and control area, factoring for differences in individual bone metabolism; the ratios were termed rSUV_max and rSUV_mean, accordingly. The product of multiplying the rSUV_mean by MBV of a lesion was defined as the ratio of TBU (rTBU). Quantitative values were compared between clinical stages by the Kruskal–Wallis test and subsequent post hoc analysis. Results: MBVs (cm³) were: median, [IQR] Stage 1, 8.28 [5.62–9.49]; Stage 2, 15.28 [10.64–24.78]; and Stage 3, 34.61 [29.50–40.78]. MBV tended to increase with stage increase. Furthermore, only MBV showed a significant difference between clinical stages (p < 0.01). Subsequent post hoc analysis showed no significant difference between stages 1 and 2 (p = 0.12) but a significant difference between stages 2 and 3 (p = 0.048). rSUVmax and rTBU tended to increase with stage increase, but the differences between the stages were not significant (p = 0.10 and p = 0.055, respectively). Conclusion: MBV, which includes the concept of volume, showed significant differences between clinical stages and tended to increase with the stage increase. As an objective and reliable indicator, MBV might be an adjunct diagnostic method for staging ARONJ.