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Increased jaw radioactivity on bone imaging
GAMUT
Increased Jaw Radioactivity on Bone Imaging Marc B. d'Avignon and Sheldon Baum
HE visualization of increased radioactivity in the jaw region of patients undergoing skeletal imaging is a frequent occurrence. Most bone imaging is performed to help detect metastases and, since the mandible and maxilla are unlikely sites of such lesions, there is a tendency to dismiss these areas of increased activity as due to "prior dental disease." Uniformly increased activity in the jaws is most often due to inflammatory lesions of edentulous ridges in patients wearing complete dentures. ~However, uniformly increased radioactivity, but of greater intensity may also be seen with fibrous dysplasia involving the jaws (Fig. 1).2-5 Localized areas of increased radioactivity are most commonly seen in association with dental pathology, such as apical periodontitis and changes associated with dental surgery. 6
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CAUSES OF UNIFORMLY INCREASED J A W RADIOACTIVITY
Common causes are: (1) Inflammation of edentulous ridges; (2) Free pertechnetate adhering to dentures; (3) Acute gingival disease. Uncommon causes are: (1) Fibrous dysplasia; (2) Paget's disease; (3) Chronic osteomyelitis. Rare causes are: (1) Radiation osteitis; (2) Infantile cortical hyperostosis (Caffey's Disease); (3) Hyperparathyroidism.
Fig. 1. Increased jaw radioactivity due to fibrous dysplasia in both the mandibles and maxillae as seen in the anterior and left lateral positions. Imaging was performed 3 hours following injection of 15 mCi of T c - 9 9 m methylene diphosphonate. R e p e a t i m a g i n g 2 4 hr l a t e r w a s unchanged.
Seminars in Nuclear Medicine, Vol. XII, No. 2 (April), 1982
CAUSES OF FOCAL AREAS OF INCREASED J A W ACTIVITY
Common causes are: (l) Apical periodontitis; (2) Tooth extraction (within 18 mo); (3) Root canal surgery (within 18 mo); (4) Fracture; (5) Malignancy; (6) Retained roots; (7) Impactions; (8) Site of biopsy or surgery. Uncommon causes are: (1) Ossifying fibroma; (3) Odontoma; (3) Residual osteitis. Rare causes are: (1) Osteomyelitis; (2) Enchondroma; (3) Osteoma (Gardner's Syndrome); (4) Actinomycosis; (5) Lymphoma. l~ REFERENCES 1. Garcia DA, Tow DE, Sullivan TM, et al: The appearances of common dental diseases on radionuclide bone images of the jaws. J Dent Res 58:1040-1046, 1979 2. Shuster HL, Sadowsky D, Friedman JM: Radionuclide bone imaging as an aid in the diagnosis of fibrous dysplasia: report of case. J Oral Surg 37:267-270, 1979 3. El Deeb M, Waite DE, Jaspers MT: Fibrous dysplasia of the jaws. Oral Surg 47:312-318, 1979 4. Boysen ME, Olving JH, Vatne K, et al: Fibro-osseous lesions of the crani~facial bones. J. Laryngol Otol 93:793807, 1979 5. Eversole LR, Rovin S: Differential radiographic diagnosis of lesions of the jawbones. Radiology 105:277 284, 1972 6. Lyons KP, Jensen JL: Dental lesions causing abnormalities on skeletal scintigraphy. Clin Nucl Med 4:509-512, 1979 7. Bergstedt HF: Bonescintigraphy of facial skeleton with Tc 99m~liphosphonate. Acta Radiol Diag 16:337-341, 1975 8. Alexander JM: Radionuclide bone scanning in the diagnosis of lesions of the maxillofacial region. J Oral Surg 34:249-256, 1976 9. Gates GF, Goris ML: Maxillary-facial abnormalities assessed by bone imaging. Radiology 121:677 682, 1976 10. Noyek A, Zizmor J: Lymphoma and leukemia upper airway and Orbot. Sem Roent 15:251-260, 1980 From the Division of Nuclear Medicine, Milton S. Hershey Medical Center, Hershey, Pa. Address reprint requests to Sheldon Baum, M.D., Division of Nuclear Medicine, Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033. 9 1982 by Grune & Stratton, Inc. 0001-2998/82/1202~9008501.00/0
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Increased Jaw Radioactivity on Bone Imaging Marc B. d'Avignon and Sheldon Baum
HE visualization of increased radioactivity in the jaw region of patients undergoing skeletal imaging is a frequent occurrence. Most bone imaging is performed to help detect metastases and, since the mandible and maxilla are unlikely sites of such lesions, there is a tendency to dismiss these areas of increased activity as due to "prior dental disease." Uniformly increased activity in the jaws is most often due to inflammatory lesions of edentulous ridges in patients wearing complete dentures. ~However, uniformly increased radioactivity, but of greater intensity may also be seen with fibrous dysplasia involving the jaws (Fig. 1).2-5 Localized areas of increased radioactivity are most commonly seen in association with dental pathology, such as apical periodontitis and changes associated with dental surgery. 6
T
CAUSES OF UNIFORMLY INCREASED J A W RADIOACTIVITY
Common causes are: (1) Inflammation of edentulous ridges; (2) Free pertechnetate adhering to dentures; (3) Acute gingival disease. Uncommon causes are: (1) Fibrous dysplasia; (2) Paget's disease; (3) Chronic osteomyelitis. Rare causes are: (1) Radiation osteitis; (2) Infantile cortical hyperostosis (Caffey's Disease); (3) Hyperparathyroidism.
Fig. 1. Increased jaw radioactivity due to fibrous dysplasia in both the mandibles and maxillae as seen in the anterior and left lateral positions. Imaging was performed 3 hours following injection of 15 mCi of T c - 9 9 m methylene diphosphonate. R e p e a t i m a g i n g 2 4 hr l a t e r w a s unchanged.
Seminars in Nuclear Medicine, Vol. XII, No. 2 (April), 1982
CAUSES OF FOCAL AREAS OF INCREASED J A W ACTIVITY
Common causes are: (l) Apical periodontitis; (2) Tooth extraction (within 18 mo); (3) Root canal surgery (within 18 mo); (4) Fracture; (5) Malignancy; (6) Retained roots; (7) Impactions; (8) Site of biopsy or surgery. Uncommon causes are: (1) Ossifying fibroma; (3) Odontoma; (3) Residual osteitis. Rare causes are: (1) Osteomyelitis; (2) Enchondroma; (3) Osteoma (Gardner's Syndrome); (4) Actinomycosis; (5) Lymphoma. l~ REFERENCES 1. Garcia DA, Tow DE, Sullivan TM, et al: The appearances of common dental diseases on radionuclide bone images of the jaws. J Dent Res 58:1040-1046, 1979 2. Shuster HL, Sadowsky D, Friedman JM: Radionuclide bone imaging as an aid in the diagnosis of fibrous dysplasia: report of case. J Oral Surg 37:267-270, 1979 3. El Deeb M, Waite DE, Jaspers MT: Fibrous dysplasia of the jaws. Oral Surg 47:312-318, 1979 4. Boysen ME, Olving JH, Vatne K, et al: Fibro-osseous lesions of the crani~facial bones. J. Laryngol Otol 93:793807, 1979 5. Eversole LR, Rovin S: Differential radiographic diagnosis of lesions of the jawbones. Radiology 105:277 284, 1972 6. Lyons KP, Jensen JL: Dental lesions causing abnormalities on skeletal scintigraphy. Clin Nucl Med 4:509-512, 1979 7. Bergstedt HF: Bonescintigraphy of facial skeleton with Tc 99m~liphosphonate. Acta Radiol Diag 16:337-341, 1975 8. Alexander JM: Radionuclide bone scanning in the diagnosis of lesions of the maxillofacial region. J Oral Surg 34:249-256, 1976 9. Gates GF, Goris ML: Maxillary-facial abnormalities assessed by bone imaging. Radiology 121:677 682, 1976 10. Noyek A, Zizmor J: Lymphoma and leukemia upper airway and Orbot. Sem Roent 15:251-260, 1980 From the Division of Nuclear Medicine, Milton S. Hershey Medical Center, Hershey, Pa. Address reprint requests to Sheldon Baum, M.D., Division of Nuclear Medicine, Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033. 9 1982 by Grune & Stratton, Inc. 0001-2998/82/1202~9008501.00/0
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