Study On The Osteogenesis Effect Of Postoperative Jaw Cystic Disease By SPECT

Objectives:SPECT bone imaging technology is currently being used in oral clinical practice to monitor tumor growth and bone metastasis,assess bone graft survival,and examine metabolic bone disease in the temporomandibular joint.There is no report on the diagnosis and treatment of cystic jaw lesions at home and abroad.This study will discuss the application value of SPECT in the postoperative treatment of maxillocystic disease,and compare it with CBCT to evaluate the feasibility,prospective,sensitivity,and specificity of SPECT,providing a new imaging option for the diagnosis of clinical maxillocystic lesions.Methods: 1.A total of 23 patients with cystic lesions of the jaws attending the Department of Oral and Maxillofacial Surgery,Qujing Hospital,Kunming Medical University,from March 2021 to December 2022 were included in this study.All of them signed informed consent and underwent either curettage or open window decompression following the guidelines of the clinical practice.All patients had CBCT and SPECT scans preoperatively and 1 month postoperatively,and the CBCT scan was re-examined at 3months postoperatively and delayed to 6 and 12 months if there was no evidence of bone formation.We exported the CBCT data,reconstructed it with Mimics 21.0,and measured the HU values and volumes of cystic lesions in the jaws preoperatively,early postoperatively,and postoperatively.Qualitative analysis is used for the interpretation of SPECT,two nuclear medicine doctors read the film independently and decided whether osteogenesis occurred.When the result was inconsistent,the decision was discussed with the supervising physician.The difference between the HU value and volume in the early postoperative period and postoperative period and the preoperative results were tested for normality respectively.The data conforming to the normal distribution were conducted for paired sample t-test,and the data not conforming to that for rank sum test of multiple related samples to compare the differences between sets of data.The SPECT interpretation score was compared with the score measured by the most recent postoperative CBCT using the paired chi-square test,and the coefficient of concordance was calculated.2.A total of 93 patients with small cystic lesions of the jaws in the Department of Endodontics,Qujing Hospital Dental Hospital,Kunming Medical University from January2018 to December 2022 were included in the retrospective review.All of them were treated with root canal therapy alone,and apical radiographs were taken preoperatively,immediately postoperatively,and at postoperative review.Two experienced physicians independently reviewed the films and rated them according to Rud’s grading criteria.Patients without clinical symptoms and imaging evaluation of complete or incomplete healing(scar healing)were recorded as having a successful outcome,whereas those with clinical symptoms or imaging evaluation of uncertain healing or failure were recorded as having failed.If the film review results were inconsistent,the decision was discussed with the supervising physician.Finally,we calculated the final success rate of small cystic lesions of the jaw treated with root canal therapy in our hospital.Results: 1.Early postoperative HU values were analyzed by exploring the differences from the preoperative HU values(P>0.05),and the differences were consistent with a normal distribution by paired sample t-test(P>0.05).2.Postoperative(more than 3 months)HU values were found to be significantly different from preoperative HU values by exploratory difference analysis(P>0.05),and differences conformed to a normal distribution by paired-samples t-test(P<0.05).23 patients with cystic lesions of the jaws were found to have a significant increase in HU values of107.65±138.19(t=3.74,P<0.05)in the lesions at 3 months postoperatively.3.For the exploration of differences(P<0.05 for both),volumes in the early postoperative period and volumes in the postoperative period(more than 3 months)were analyzed separately from preoperative volumes,and the differences were not found to be consistent with a normal distribution.For data from all three groups,the rank sum test was used for correlated multiple samples(P<0.001),indicating that the cystic lesion volumes of the jaws were statistically significantly different overall at three-time points: preoperatively,early postoperatively,and postoperatively(more than 3 months).Pairwise comparisons of preoperative and early postoperative cystic lesion volumes were not statistically different at a P>0.05 level(Bonferroni correction),and the pairs comparing preoperative and postoperative cystic lesion volumes(more than 3 months)were statistically significantly different at P<0.001(Bonferroni correction).4.The SPECT interpretation scores were compared to the scores measured by the most recent postoperative CBCT using a paired chi-square test(P > 0.05),and there was no significant difference between the two groups.Kappa=0.623 consistency score(P<0.05),100% specificity,and 90.48% sensitivity.5.Apical radiographs were evaluated for complete healing in 24 cases,incomplete healing in 52 cases,uncertain healing in 13 cases,and failure in 4 cases.A total of 76 cases were assessed for complete and incomplete healing without clinical symptoms and were recorded as successful,while the remaining 17 cases were recorded as unsuccessful.In our hospital,the success rate for small cystic lesions of the jaw treated with the simple root canal method was 81.72%,which was similar to the success rate for mid-and large-sized cystic lesions of the jaw treated with combined surgery(82.61%).Conclusions: 1.CBCT at 3 months postoperatively has some reference value when assessing the osteogenic effect of cystic lesions of the jaw with the HU method or with the use of volumetric measurement,and it is recommended that the timing of CBCT examination at the time of the shooting should be 3 months after surgery.2.SPECT can predict whether there is new restorative bone formation in the early postoperative period of cystic jaw lesions,which is prospective compared to CBCT and may be applied in the verification of early osteogenic effect.3.Patients who have no osteogenic response on early postoperative SPECT should be vigilant,followed closely,have a timely adjustment of treatment strategy,and be promptly intervened upon.