Assessment of the incorporation of revascularized fibula grafts used for mandibular reconstruction with F-18-PET

G. Berding; H. Schliephake; van den J. Hoff; W. H. Knapp

doi:10.1055/s-0038-1623992

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2001; 40(02): 51-58
DOI: 10.1055/s-0038-1623992

Originalarbeiten – Original Articles

Schattauer GmbH

Assessment of the incorporation of revascularized fibula grafts used for mandibular reconstruction with F-18-PET

Untersuchung der Inkorporation zur Unterkieferrekonstruktion verwendeter, revaskularisierter Fibulatransplantate mit F-18-PET

G. Berding

¹Departments of Nuclear Medicine, University Medical School, Hannover, Germany

,

H. Schliephake

²Departments of Oral and Maxillofacial Surgery, University Medical School, Hannover, Germany

,

van den J. Hoff

¹Departments of Nuclear Medicine, University Medical School, Hannover, Germany

,

W. H. Knapp

¹Departments of Nuclear Medicine, University Medical School, Hannover, Germany

› Author Affiliations

Abstract

Summary

Aim: Determination of the range of regional blood flow and fluoride influx during normal incorporation of revascularized fibula grafts used for mandibular reconstruction. Evaluation, if healing complications are preceded by typical deviations of these parameters from the normal range. Assessment of the potential influence of using “scaled population-derived” instead of “individually measured” input functions in quantitative analysis. Methods: Dynamic F-l 8-PET images and arterialized venous blood samples were obtained in 11 patients early and late after surgery. Based on kinetic modeling regional blood flow (K₁) and fluoride influx (K_mlf) were determined. Results: In uncomplicated cases, early postoperative graft K₁ - but not K_mlf -exceeded that of vertebrae as reference region. K_mn values obtained in graft necrosis (n = 2) were below the ranges of values observed in uncomplicated healing (0.01 13-0.0745 ml/min/ml) as well as that of the reference region (0.0154-0.0748). K_nf values in mobile non-union were in the lower range - and those in rigid non-union in the upper range of values obtained in stable union (0.021 1-0.0694). If scaled population-derived instead of measured input functions were used for quantification, mean deviations of 23 ± 17% in K₁ and 12 ± 16% in K_mlf were observed. Conclusions: Normal healing of predominantly cortical bone transplants is characterized by relatively low osteoblastic activity together with increased perfusion. It may be anticipated that transplant necrosis can be identified by showing markedly reduced F⁻ influx. In case that measured input functions are not available, quantification with scaled population-derived input functions is appropriate if expected differences in quantitative parameters exceed 70%.

Zusammenfassung

Ziel: Definition von Normalbereichen des regionaler Blutflusses und Fluoridinfluxes bei der unkomplizierten Einheilung zur Unterkieferrekonstruktion verwendeter revaskularisierte Fibulatransplantate. Untersuchung, ob bei gestörter Einheilung typische Abweichungen dieser Parameter vom Normalbereich auftreten. Einschätzung des möglichen Einflusses der Verwendung einer »Scaled population-derived input function« anstelle einer individuell gemessenen Inputfunktion auf die Resultate der quantitativen Analyse. Methoden: Bei 11 Patienten wurden frühzeitig und im späteren Verlauf postoperativ dynamische F-l 8-PET-Studien mit simultanen pseudoarteriellen Blutentnahmen durchgeführt. Auf der Grundlage kinetischer Modelle wurden Blutfluss (K₁) und Fluoridinflux (K_mlf) regional bestimmt. Ergebnisse: Bei unkompliziert einheilenden Transplantaten lag K₁ - aber nicht K_mlf - in der Frühphase im Mittel signifikant höher als in Wirbelkörpern. Der Fluoridinflux lag bei Transplantatnekrose (n = 2) niedriger als bei unkomplizierter Heilung (Streubereich: 0,01130,0745 ml/min/ml) und in der Referenzregion (0,0154-0,0748). Ferner lagen bei mobiler Pseudarthrose die K_mlf Werte im unteren Streubereich - und bei straffer Pseudarthrose im oberen Streubereich der bei stabiler Heilung der Grenzregion (0.0211-0.0694) gemessenen Werte. Bei der Quantifizierung mit einer »Scaled population-derived input function« im Gegensatz zur gemessenen Inputfunktion fanden sich mittlere Abweichungen von 23 ± 17% bei den berechneten Kf und 12 ± 16% bei den K_mlf Werten. Schlussfolgerung: Die unkomplizierte Einheilung überwiegend kortikaler Knochentransplantate ist gekennzeichnet durch eine relativ niedrige osteoblastische Aktivität und eine gesteigerte Perfusion. Es ist zu erwarten, dass sich Trcinspiantatnekrosen frühzeitig durch den Nachweis eines stark reduzierten F^- influx identifizieren lassen. Falls eine gemessene Inputfunktion fehlt, scheint die Quantifizierung mit einer »Scaled population-derived input function« akzeptabel zu sein, sofern die erwarteten Unterschiede der quantitativen Parameter über 70% liegen.

Keywords

Bone grafts - F-l8-fluoride ion - positron emission tomography - osteonecrosis - bony non-union

Schlüsselwörter

Knochentransplantation - F-l8-Fluorid-lonen - Positronen-Emissions-Tomographie - Osteonekrose - Pseudarthrose

Full Text

References

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