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Letter to the editor regarding “Imaging modalities for drug-related osteonecrosis of the jaw (3), Positron emission tomography imaging for the diagnosis of medication-related osteonecrosis of the jaw”

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JapaneseDentalScienceReview56(2020)84

ContentslistsavailableatScienceDirect

Japanese

Dental

Science

Review

jo u r n al h om ep ag e :w w w . e l s e v i e r . c o m / l o c a t e / j d s r

Lettertotheeditorregarding“Imaging

modalitiesfordrug-relatedosteonecrosisofthe

jaw(3),Positronemissiontomographyimaging

forthediagnosisofmedication-related

osteonecrosisofthejaw”

Keywords:

Jawsosteonecrosis

PetCT

Surgery

We haveread withgreat interest thearticle titled“Imaging modalitiesfordrug-relatedosteonecrosisofthejaw(3),Positron emission tomography imaging for thediagnosisof medication-relatedosteonecrosisofthejaw“byKitagawaetal.andpublished onNovember2019onJapaneseDentalScienceReview[1].

TheauthorsdescribetheirexperienceontheuseofFDGPET and3-phasebonescintigraphyinthediagnosisandmanagement ofMedicationRelatedOsteonecrosisofJaws(MRONJ),namelyin monitoringtheeffectofhyperbaricoxygentherapy.Theauthors confirmthevalidityofnuclearmedicineimaginginthe manage-mentofjawosteonecrosis,evenifitsuseseemstobestilllimited. WethinkthatPETimagingcanbeusefultoaccuratelydetect bonemarginsofresectioninthesurgeryofMRONJ.

Insuchcases,establishingthecorrectsizeoflesionismandatory becauseofthehighriskofrecurrenceincaseofunderestimation oftheextensionoftheosteonecrotic-osteomyeliticbonefragment toberesected.BeingMRONJa“metabolic”disease,theuseof con-ventionalimaging(OPT scanorConeBeamCT)alonecouldnot besufficient toassess therealextensionofthelesions.Nuclear medicineimagingisabletoidentifymetabolicalterationsthatare not“visible”usingCTalone,thusavoidingunderestimationofthe realextensionofimpairedbone.Metabolicevaluationofjawsusing boneseekingradiopharmaceuticalscanrevealincreased osteoblas-ticactivityin areasof regenerative vascularityorinflammation whereasmetabolicimagingusing18F-fluorodeoxyglucose(FDG) allowstoidentifyareasofenhancedglucidicmetabolismrelated toregenerativeorinfectiveprocesses.Itmayhavegreatimpact ondiagnosisandmanagementofMRONJ[1–3].Althoughnuclear medicineimagingischaracterizedbylowerspatialresolutionthan CT,theevidenceofnormalosteoblasticactivityornormalglucidic metabolismcanexcludeosseousalterationsreferabletoMRONJ allowingsurgeonstobetterplanthesegmentalsurgery.Inour opin-ion,theroleof18F-FDGPET/CTshouldbelargelyinvestigatedinthis fieldbecauseoftheoreticallowerradiationdoseandhigher

resolu-tionthanbonescintigraphy.Hence,weagreewiththeimportance ofassessingsuchlesionswiththeaidofnuclearmedicine imag-ingwhichcanevenprovidefurthertridimensionaldetailstobetter assesstheextensionofthespecimenandplanthecorrect surgi-calresectionon“metabolicallyhealthybonemargins”.Suchtools couldintegrateandimprovealsosurgicalplanningfocusedonthe guidedornavigatedsurgicalprocedures.

Authorcontributionstatement

Dr.EnricoNastroSiniscalchi:writingandreviewing. Prof.FabioMinutoli:writingandreviewing. Prof.SergioBaldari:reviewing.

Prof.F.S.DePonte:reviewing.

Theauthors declarethere are noconflictof interest and no foundsforthiscontribution.

References

[1]KitagawaY,OhgaN,AsakaT,etal.Imagingmodalitiesfordrug-related osteonecrosisofthejaw(3),Positronemissiontomographyimagingforthe diagnosisofmedication-relatedosteonecrosisofthejaw.JpnDentSciRev 2019;55(Nov):65–70.

[2]WatanabeS,NakajimaK,KinuyaS.Symposium:imagingmodalitiesfor drug-relatedosteonecrosisofthejaw(5),utilityofbonescintigraphyand 18F-FDGPET/CTinearlydetectionandriskassessmentofmedication-related osteonecrosisofthejaw(secondarypublication).JpnDentSciRev

2019;55(Nov(1)):76–9.

[3]FleisherKE,PhamS,RaadRA,FriedmanKP,GhesaniM,ChanKC,etal.Does fluorodeoxyglucosepositronemissiontomographywithcomputed tomographyfacilitatetreatmentofmedication-relatedosteonecrosisofthe jaw?JOralMaxillofacSurg2016;74(May(5)):945–58.

E.NastroSiniscalchi∗ F.Minutoli S.Baldari F.S.DePonte DepartmentofBiomedicalandDentalSciencesand MorphofunctionalImaging,Universityof Messina-Italy,ViaConsolareValeria,1,98125, Messina,Italy

∗Correspondingauthor.

E-mailaddress:enastrosiniscalchi@unime.it (E.NastroSiniscalchi) 7January2020

https://doi.org/10.1016/j.jdsr.2020.02.002

1882-7616/©2020TheAuthors.PublishedbyElsevierLtdonbehalfofTheJapaneseAssociationforDentalScience.ThisisanopenaccessarticleundertheCCBY-NC-ND

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