18Fフッ化物陽電子放射断層撮影（PET）および18FDG PETによる顎骨骨髄炎の評価-コンピュータ断層撮影（CT）および磁気共鳴画像法（MRI）との比較：前向きPET/CTおよびPET/MRIパイロットスタディ

[18F]Fluoride Positron-Emission Tomography (PET) and [18F]FDG PET for Assessment of Osteomyelitis of the Jaw in Comparison to Computed Tomography (CT) and Magnetic Resonance Imaging (MRI): A Prospective PET/CT and PET/MRI Pilot Study.

抄録

顎骨骨髄炎（OMJ）の範囲と疾患活動性を評価するために、コンピュータ断層撮影（CT）および磁気共鳴画像（MRI）と比較して、[18F]フッ化物陽電子放射断層撮影（PET）および[18F]フルオロデオキシグルコース（FDG）-PETによる画像特性を検討すること。6名の女性患者（55.3±10.0歳）が、症候性OMJの評価のために登録された。4/6人の患者が[18F]FDG-PET/MRIと[18F]フッ化物PET/CTを、1人がMRIと[18F]フッ化物PET/CT、1人が[18F]FDG-PET/MRIのみとした。画像解析は、放射線科医2名、口腔顎顔面外科医1名、核医学専門医1名が担当した。罹患した顎骨の範囲は，罹患した顎骨と健常な顎骨のPETトレーサー取り込み，CT-Hounsfield-Units（HU），MRIパラメータなど定性的および定量的に分析した．全例で健常顎骨と比較して海綿体硬化を認め（560±328HU vs 282±211HU，＞0.05），3/6例で皮質侵食が認められた．骨髄の浮腫とガドリニウムの増強は5/6人に認められた．罹患顎骨では、健常顎骨と比較して、すべての患者で[18F]フッ化物取り込みが増加し（SUVmean 15.4 ± 4.2 vs. 2.1 ± 0.6; < 0.05）、[18F]FDG 取り込みが中等度に増加した（SUVmean 1.9 ± 0.7 vs. 0.7 ± 0.2; > 0.05）。代謝活性の上昇した領域の範囲は、すべての患者において形態的変化の範囲よりも小さかった。顎骨の代謝と炎症に関する情報は、形態学的変化とは異なるため、OMJの範囲と活動性をより正確かつ客観的に評価できる可能性を持っている。

To investigate imaging features of osteomyelitis of the jaw (OMJ) using [18F]fluoride positron emission tomography (PET) and [18F]fluorodeoxyglucose (FDG)-PET compared with computed tomography (CT) and magnetic resonance imaging (MRI) to assess extent and disease activity. Six female patients (55.3 ± 10.0 years) were enrolled for assessment of symptomatic OMJ. 4/6 patients underwent [18F]FDG-PET/MRI and [18F]fluoride-PET/CT, one patient MRI and [18F]fluoride-PET/CT and another patient only [18F]FDG-PET/MRI. Image analysis was performed by two radiologists, an oral and maxillofacial surgeon, and a nuclear medicine specialist. The extent of affected jawbone was analyzed both qualitatively and quantitatively, including the PET tracer uptake, CT-Hounsfield-Units (HU) and MRI parameters in affected and healthy jawbone. All patients had trabecular sclerosis in the affected jawbone compared to healthy jawbone (560 ± 328 HU vs. 282 ± 211 HU; &gt; 0.05), while 3/6 patients had cortical erosions. Bone marrow edema and gadolinium enhancement were documented in 5/6 patients. In affected jawbone, [18F]fluoride-uptake was increased in all patients compared to healthy jawbone (SUVmean 15.4 ± 4.2 vs. 2.1 ± 0.6; &lt; 0.05), and [18F]FDG-uptake was moderately higher (SUVmean 1.9 ± 0.7 vs. 0.7 ± 0.2; &gt; 0.05). The extent of regions with increased metabolic activity was less than the extent of morphologic changes in all patients. Information on jawbone metabolism and inflammation is different from morphologic changes and therefore has the potential to provide a more accurate and objective assessment of the extent and activity of OMJ.