Monitoring of graft perfusion and osteoblast activity in revascularised fibula segments using [18F]-positron emission tomography

https://doi.org/10.1016/S0901-5027(99)80081-2Get rights and content

Abstract

The aim of the present study was to evaluate healing of revascularised fibula grafts used for mandibular reconstruction using [18F]fluoride ion and positron emission tomography (PET). Sixteen PET studies in 11 fibula grafts were analysed to determine both blood flow and fluoride influx as a measure of vascularisation and osteogenic activity. Two graft failures and three non-unions were encountered and were compared to the succesfully healed grafts. In uneventful graft healing, early PET studies (on average 19 days after grafting) showed a significantly increased blood flow to the grafted bone and to the union between the grafts and the mandibles when compared to the reference region of the cervical spine. In contrast, fluoride influx was significantly lower in the grafts when compared to the plating area and the cervical spine. Six months after grafting, blood flow to the grafted bone and the mandibular bone had returned to a level comparable with the reference region. Fluoride influx remained significantly lower in the grafts than in the plating areas or cervical spines. Graft failures were associated with negligible fluoride influx near zero in early PET studies. These results suggest that revascularised fibula grafts provide a low osteogenic potential, presumably due to the pre-existing lack of cancellous bone. The relatively high frequency of non-unions makes meticulous adaptation of the graft and the mandible mandatory, particularly in patients with compromised viability of the recipient bone.

References (30)

  • FlemmingAF et al.

    Mandibular reconstruction using vascularised fibula grafts

    Br J Plast Surg

    (1990)
  • KärcherH et al.

    Bone scintigraphy of vascularised bone transfer in maxillofacial surgery

    Oral Surg

    (1988)
  • LukashFN et al.

    Long-term fate of the vascularised iliac crest bone graft for mandibular reconstruction

    Am J Surg

    (1990)
  • AcerhaltRE et al.

    A comparative study of three 99mTC-labelled phosphorus compounds and 18F-fluoride for skeletal imaging

    J Nucl Med

    (1974)
  • BerdingG et al.

    Bone scintigraphy in the evaluation of bone grafts used for mandibular reconstruction

    Eur J Nucl Med

    (1994)
  • BerdingG et al.

    Evaluation of the incorporation of bone grafts used in maxillofacial surgery with [18F]fluoride ion and dynamic positron emission tomography

    Eur J Nucl Med

    (1995)
  • BerdingG et al.

    [18F]fluoride PET indicates reduced bone formation in severe glucocorticoid-induced osteoporosis

    Nuklearmedizin

    (1998)
  • BergerA

    Mikrovaskuläre Transplantation osteokutaner Lappen

    Chirurg

    (1985)
  • BomqvistG

    On the construction of functional maps in positron emission tomography

    J Cereb Blood Flow Metab

    (1984)
  • FrancisMD et al.

    99mTc diphosphonate uptake mechanism on bone

  • GrynpasMD

    Fluoride effects on bone crystals

    J Bone Miner Res

    (1990)
  • HawkinsRA et al.

    Evaluation of skeletal kinetics of fluorine-18-fluoride ion with PET

    J Nucl Med

    (1992)
  • HidalgoDA

    Fibula free flap: a new method of mandible reconstruction

    Plast Reconstr Surg

    (1989)
  • HidalgoDA

    Aesthetic improvements in free-flap mandible reconstruction

    Plast Reconstr Surg

    (1991)
  • HohCK et al.

    Whole body skeletal imaging with [18F]fluoride ion and PET

    J Comput Assist Tomogr

    (1993)

    • Cited by (31)

    • <sup>18</sup>F-fluoride PET/computed tomography imaging

      2014, PET Clinics
      Citation Excerpt :

      18F-Fluoride PET seemed to be more sensitive than 18F-FDG in detecting this abnormality, although the latter was better for monitoring response to therapy.29,30 Quantitative 18F-fluoride PET imaging has also been used also to assess the perfusion and osteoblastic activity of revascularized fibular grafts for mandibular reconstruction, and was found to be valuable in differentiating uneventful graft healing, early failure, and nonunion.31–33 In the vertebral column and pelvic bones, several articles have addressed the role of 18F-fluoride PET in patients with back pain, with or without previous back surgery.

    • <sup>18</sup>F-fluoride PET in osteoporosis

      2010, PET Clinics

    • Repair of a segmental long bone defect in human by implantation of a novel multiple disc graft

      2010, Bone
      Citation Excerpt :

      A callus distraction would have taken more time than our approach and it would have been inconvenient for the patient with a considerable risk of infection [25]. Vascularised fibula grafts were demonstrated to have a low osteogenic potential, presumably due to the small amount of trabecular bone [33]. The long-term recovery of our patient was uneventful, reporting no infection, failure of the graft, or loosening of the implants.

    • <sup>18</sup>F-Fluoride Positron Emission Tomography and Positron Emission Tomography/Computed Tomography

      2007, Seminars in Nuclear Medicine
      Citation Excerpt :

      Quantitative 18F-fluoride PET imaging also has been used for the assessment of perfusion and osteoblastic activity of revascularized fibular grafts for mandibular reconstruction. The technique was found valuable in separating between uneventful graft healing, early failure and nonunion.11,14,21 Early diagnosis of delayed union or nonunion of fractures is a challenging imaging task.

    • Epithelial-myoepithelial carcinoma of the submandibular gland with a high uptake of <sup>18</sup>F-FDG: a case report and image diagnosis

      2007, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology
      Citation Excerpt :

      The high signal of FDG-PET was caused mainly by accumulation of FDG by the blood supply and metabolic trapping in the cells.11 For glucose to be taken up and used by cancer cells, an adequate blood supply is needed12; therefore, FDG-PET is assessed by not only the glucose metabolism but also the blood supply in various tissues in lung tumors,13,14 breast cancer,15,16 liver metastasis of colorectal carcinoma,12 and revascularized fibula grafts.17 In our case report, the image findings obtained by the contrast-enhanced CT suggested that this high FDG accumulation was partly a result of the physiologically rich blood supply for the tumor or the highly vascularized characteristics of EMC.

    • Critical Role of 18F-Labeled Fluorodeoxyglucose PET in the Management of Patients with Arthroplasty

      2007, Radiologic Clinics of North America
      Citation Excerpt :

      Similarly, conventional nuclear medicine modalities possess suboptimal spatial resolution in assessing the viability of small grafts. [ 18F]-fluoride PET is proven to be able to monitor the viability of osseous structures [68,69]. For this reason, dynamic fluoride PET has been used with great success for the evaluation of bone allograft viability and metabolism [70,71].

    View all citing articles on Scopus
    *

    Address: Priv.-Doz. Dr. Dr. Henning Schliephake Department of Oral and Maxillofacial Surgery University Medical School of Hannover Carl Neuberg Str. 1, 30625 Hannover Germany

    View full text
    Copyright © 1999 Published by Elsevier Ltd.