Utility of Emission Tomography in Evaluation of Mandibular Bone Grafts

Abstract

Bone scanning, performed within 1 week postoperatively, is valuable in predicting the survival of revascularized composite flap grafts. Conventional planar scintigraphy is limited by a two-dimensional representation of three-dimensional structures. Single photon emission computed tomography (SPECT) is a technique in which a gamma camera rotates around the patient, acquires multiple projections, and with the aid of a computer, reconstructs three-dimensional representations. We wished to evaluate the potential advantages of SPECT in the assessment of mandibular graft viability and to compare it with planar scanning. These noninvasive methods of assessing the vascular supply are critical to patient management in the early postoperative period because the presence of or inability to exclude vascular compromise commands surgical exploration of the anastomosis for graft salvage. Fifteen patients who underwent mandibular reconstruction with revascularized free grafts were studied by both planar and SPECT scintigraphy. Long-term follow-up data were correlated with the outcome predicted by the scanning.

Bone scintigraphy in the evaluation of bone grafts used for mandibular reconstruction

“…It is especially important in "buried flaps" which are transferred without overlying skin that would allow clinical assessment of the graft viability [1][2][3]. The application of SPET has been recommended for bone scintigraphy in the evaluation of mandibular bone grafts [6,7,27,28]. It has been emphasized that in comparison to planar imaging, SPET permits more accurate assessment of the uptake in the graft (because superimposition is avoided) and has a higher sensitivity in the detection of graft viability.…”

“…In contrast, bone scintigraphy has proved to be of value especially for the evaluation of grafts to the mandible [5]. Single-photon emission tomography (SPET) has been proposed to be superior to planar imaging [6,7]. Most investigations of scintigraphic results in the evaluation of mandibular bone grafts consider either revascularized [1-3, 8, 9] or non-revascularized [10][11][12] grafts.…”

Incorporation of allograft for acetabular reconstruction: Single photon emission CT in 21 hip arthroplasties followed for 2.5-5 years

“…Scintimetry with 99mTc-labeled diphosphonates is an accepted method for the assessment of bone graft viability (Kelly et al 1975, Berggren et al 1982, Dzeblo et al 1982, Collier et al 1987, Fig et al 1990, Lukash et al 1990, Ramsay et al 1991. However, in the hip it is unreliable because a thin layer of living bone overlying dead bone can lead to misinterpretations; the precise location of the increased activity is difficult to determine because of the 2-dimensional visualization.…”

Stellenwert der SPECT/CT zur Abklärung von Kiefererkrankungen

“…der Fragestellung Transplantatvitalität und beschrieben eine bessere Sensitivität der SPECTUntersuchung. Andere Autoren bestätig-ten die gute Eignung der SPECT für diese Fragestellung [27,28]. Bisher liegen nur Studien zum Einsatz der SPECT vor.…”