Predicting Vascularized Bone Graft Viability Using 1-Week Postoperative Bone SPECT/CT After Maxillofacial Reconstructive Surgery

Hyunji Kim; Koeun Lee; Sejin Ha; Eonwoo Shin; Kang-Min Ahn; Jee-Ho Lee; Jin-Sook Ryu

doi:10.1007/s13139-020-00670-7

Predicting Vascularized Bone Graft Viability Using 1-Week Postoperative Bone SPECT/CT After Maxillofacial Reconstructive Surgery

Nucl Med Mol Imaging. 2020 Dec;54(6):292-298. doi: 10.1007/s13139-020-00670-7. Epub 2020 Oct 19.

Authors

Hyunji Kim¹, Koeun Lee¹, Sejin Ha¹, Eonwoo Shin¹, Kang-Min Ahn², Jee-Ho Lee², Jin-Sook Ryu¹

Affiliations

¹ Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 Republic of Korea.
² Department of Oral and Maxillofacial Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 Republic of Korea.

Abstract

Purpose: We aimed to evaluate the performance of hybrid bone single-photon emission computed tomography (SPECT)/computed tomography (CT) in predicting bone graft viability after maxillary or mandibular reconstructive surgery with vascularized bone grafts.

Methods: We retrospectively reviewed 46 bone planar scintigraphy and SPECT/CT images of 45 adult patients taken at 1 week (5-8 days) after maxillary or mandibular reconstructive surgery with vascularized bone grafts. By visual analysis, two nuclear medicine physicians scored the uptake degrees of each bone graft segment compared with the calvarium uptake on planar bone scintigraphy and SPECT/CT, respectively (0 = absence of uptake, 1 = less uptake, 2 = similar uptake, and 3 = more uptake). The imaging results were compared with clinical follow-up for assessing bone graft viability.

Results: During follow-up, five bone graft segments were surgically removed and confirmed as nonviable-one had a score of 0, although the other four had a score of 1-3 on planar bone scintigraphy. All five bone graft segments were scored 0 on SPECT/CT and eventually confirmed as nonviable. All other graft segments with a score of > 1 on SPECT/CT were viable and uneventful. The anatomical CT information on SPECT/CT images was helpful in discriminating bone graft uptake from adjacent bone or soft tissue uptake.

Conclusions: The absence of tracer uptake by the vascularized bone graft on bone SPECT/CT at 1 week after maxillary or mandibular reconstructive surgery can predict graft failure. Bone SPECT/CT can be used to predict vascularized bone graft viability postoperatively.

Keywords: Bone scintigraphy; Graft viability; Maxillary or mandibular reconstruction; Single-photon emission computed tomography; Vascularized bone graft.