Skip to main content
Log in

Detection of anaerobic odontogenic infections by fluorine-18 fluoromisonidazole

  • Original Article
  • Published:
European Journal of Nuclear Medicine Aims and scope Submit manuscript

Abstract

Odontogenic infections are a potential risk for patients who receive cervicofacial radiotherapy and should be treated before irradiation. Anaerobic microbial infections are the most common causes. This study assessed the value of the hypoxic imaging agent fluorine-18 fluoromisonidazole (FMISO) in detecting anaerobic odontogenic infections. Positron emission tomography (PET) imaging was performed at 2 h after injection of 370 MBq (10 mCi) of FMISO in 26 nasopharyngeal carcinoma patients and six controls with healthy teeth. Tomograms were interpreted visually to identify hypoxic foci in the jaw. All patients received thorough dental examinations as a pre-radiotherapy work-up. Fifty-one sites of periodontitis, 15 periodontal abscesses, 14 sites of dental caries with root canal infection, 23 sites of dental caries without root canal infection, and seven necrotic pulps were found by dental examination. Anaerobic pathogens were isolated from 12 patients. Increased uptake of FMISO was found at 45 out of 51 sites of periodontitis, all 15 sites of periodontal abscess, all 14 sites of dental caries with root canal infection, all seven sites of necrotic pulp and 15 sites of dental caries without obvious evidence of active root canal infection. No abnormal uptake was seen in the healthy teeth of patients or in the six controls. The diagnostic sensitivity, specificity, positive and negative predictive values, and accuracy of FMISO PET scan in detecting odontogenic infections were 93%, 97%, 84%, 99% and 96%, respectively.18F-fluoride ion bone scan done in three patients showed that18F-fluoride ion plays no role in the demonstration of anaerobic odontogenic infection. FMISO PET scan is a sensitive method for the detection of anaerobic odontogenic infections, and may play a complementary role in the evaluation of the dental condition of patients with head and neck tumours prior to radiation therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Newman MG, Goodman AD. Oral and dental infections. In: Finegold SM, George WL, eds.Anaerobic infections in humans. San Diego: Academic Press; 1989: 233–259.

    Google Scholar 

  2. Brogden RN, Heel RC, Speight TM, Avery GS. Metronidazole in anaerobic infections: a review of its activity, pharmacokinetics and therapeutic use.Drugs 1978; 16: 387–417.

    PubMed  Google Scholar 

  3. Goldstein EJ, Sutter VL, Finegold SM. Comparative susceptibilities of anaerobic bacteria to metronidazole, amidazole, and SC-28538.Antimicrob Agents Chemother 1978; 14: 609–613.

    PubMed  Google Scholar 

  4. Head TW, Bentley KC, Millar EP, deVoies JA. A comparative study of the effectiveness of metronidazole and penicillin V in eliminating anaerobes from postextraction bacteremias.Oral Surg 1984; 58: 152–155.

    PubMed  Google Scholar 

  5. Asquith JC, Foster JL, Willson RL. Radiosensitization of hypoxic cells by metronidazole (Flagyl).Br J Radiol 1973; 46: 648.

    Google Scholar 

  6. Adams GE, Flockhart IR, Smithen CE, Stratford IJ, Wardman P, Watts ME. Electron-affinic sensitization. VII. A correlation between structures, one-electron reduction potentials, and efficiencies of nitroimidazoles as hypoxic cell radio sensitizers.Radiat Res 1976; 67: 9.

    PubMed  Google Scholar 

  7. Grunbaum Z, Freauff SJ, Krohn KA, Wilbur DS, Magee S, Rasey JS. Synthesis and characterization of congeners of misonidazole for imaging hypoxia.J Nucl Med 1987; 28: 68–75.

    PubMed  Google Scholar 

  8. Rasey JS, Koh WJ, Grierson JR, Grunbaum Z, Krohn KA. Radiolabeled fluoromisonidazole as an imaging agent for tumor hypoxia.Int J Radiat Oncol Biol Phys 1989; 17: 985–992.

    PubMed  Google Scholar 

  9. Tubis M, Krishnamurthy G, Endow JS, Stein RA, Suwanik R, Blahd WH. Labeled metronidazoles as potential agents for amebic hepatic abscess imaging.J Nucl Med 1975; 14: 163–171.

    Google Scholar 

  10. Liu RS, Yeh SH, Chang CP, Chu LS, Lui MT, Chou KL, Wu C. Detection of odontogenic infections by F-18 luoromisonidale (FMISO) [abstract].J Nucl Med 1994; 35: 113p.

  11. Hoh CK, Hawkins RA, Dahlbom M, Glaspy JA, Seeger LL, Choi Y, Schiepers CW, Huang SC, Satyamurthy N. Barrio JR, Phelps ME. Whole body skeletal imaging with [18F]fluoride ion and PET.J Comp Assist Tomogr 1993; 17: 34–41.

    Google Scholar 

  12. Peters LJ, Withers HR, Thames HD, Fletcher GH. Keynote address: the problem — tumor radioresistance in clinical radiotherapy.Int J Radiat Oncol Biol Phys 1982; 8: 101–108.

    PubMed  Google Scholar 

  13. Cherif A, Yang DJ, Tansey W, Kim EE, Wallase S. Synthesis of [F-18]fluoromisonidazole.Pharm Res 1994; 11: 466–469.

    PubMed  Google Scholar 

  14. Koh WJ, Rasey JS, Evans ML, et al. Imaging of hypoxia in human tumors with [F-18]fluoromisonidazole.Int J Radiat Oncol Biol Phys 1992; 22: 199–212.

    PubMed  Google Scholar 

  15. Yeh SH, Wu LC, Liu RS, Yang DJ, Yen SH, Yu TW. Fluorine-18 fluoromisonidazole tumor:muscle retention ratio in detecting hypoxia in nasopharyngeal carcinoma [abstract].J Nucl Med 1994; 25: 142p.

  16. Finegold SM. Anaerobic bacteria: their role in infection and their management.Postgrad Med 1987; 81: 141–147.

    Google Scholar 

  17. Finegold SM. Therapy of anaerobic infections. In: Finegold SM, George WL, eds.Anaerobic infection in humans. San Diego: Academic Press; 1989: 793–818.

    Google Scholar 

  18. Edwards DI. The action of metronidazole on DNA.J Antimicrob Chemother 1977; 3: 43–48.

    Google Scholar 

  19. Murray CG, Herson J, Daly TE, Zimmerman S. Radiation necrosis in the mandible: a 10-year study. I. Factors influencing the onset of necrosis.Int J Radiat Oncol Biol Phys 1980; 6: 541.

    Google Scholar 

  20. Levinson SL, Barondess JA. Occult dental infection as a cause of fever of obscure origin.Am J Med 1979; 66: 463–467.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Liu, RS., Chu, LS., Yen, SH. et al. Detection of anaerobic odontogenic infections by fluorine-18 fluoromisonidazole. Eur J Nucl Med 23, 1384–1387 (1996). https://doi.org/10.1007/BF01367596

Download citation

  • Received:

  • Revised:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01367596

Key words

Navigation