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• W2039519745 abstract "StatementUnilateral condylar hyperactivity (UCH) is a rare postnatal growth abnormality of the temporo-mandibular joint. The resulting mandibular asymmetry often is responsible for malocclusion and functional problems. The etiology of condylar hyperactivity is controversial and not well understood, with hypotheses including neoplasia, trauma, infection, or abnormal loading. Surgical treatment of progressive UCH consists of a high condylectomy, thereby removing the principal mandibular growth site. In patients with normal condylar activity, however, condylectomy should be avoided. Consequently, adequate assessment of condylar activity is of the utmost importance. At present, condylar bone activity routinely is evaluated using bone scintigraphy (Hodder). This procedure, however, only provides an assessment of relative (ie left versus right) condylar activity. In contrast, positron emission tomography (PET) allows for quantitative in vivo measurements of biological processes. For example, quantitative uptake of 18F labeled fluoride (18F−) in bone, as measured using PET, is directly correlated with histomorphometric parameters of bone formation. Interestingly, some studies have shown coupling between bone metabolism and bone blood flow. At present, however, it is not known whether bone blood flow is abnormal in patients with UCH.Objective. To assess whether 18F− PET can distinguish between active and non-active growth centers in the condylar process, and, in addition, to study the role of bone blood flow in these processes.Materials and MethodsIn this pilot study, approved by the Medical Ethics Committee of the VU University Medical Center, 6 patients (age range 17 to 43 years) with progressive UCH were included. The diagnosis of UCH was established using clinical and standard radiological assessments, including planar and SPECT bone scans. PET studies were performed using an ECAT EXACT HR+ scanner (Siemens/CTI, Knoxville, USA). First a 10 min dynamic emission scan was acquired following injection of 1100 MBq H215O. After a ten minute period to allow for decay of H215O activity, a second 60 min dynamic emission scan was acquired following injection of around 100 MBq 18F−. Throughout both emission scans, arterial blood was withdrawn continuously and monitored using an on-line detection system. A summed 18F− image was used to define regions of interest (ROI) for left and right condylar regions. These ROI were projected on both dynamic scans thereby generating H215O and 18F− time-activity curves. Bone blood flow (BF) was obtained by fitting the H215O tissue time activity curves to the standard single tissue compartment model. In a similar fashion, the 18F− curves were fitted to an irreversible two tissue compartment model (Hawkins), providing the net fluoride influx rate Ki as a parameter of interest. The preliminary data are represented as mean values (± standard deviations) across patients.Method of Data AnalysisDescribed in material and methods.ResultsNet fluoride influx rate (Ki), representing bone metabolism, within the affected condyle was 0.0205 ± 0.0027 min-1, and was twofold higher compared to the contralateral condyle with a Ki of 0.0103 ± 0.0035 min-1. Mean bone blood flow in the affected, hyperactive condyle (0.104 ± 0.012 ml · min-1 · ml-1) was, however, similar to that on the contralateral side (0.101 ±0.015 ml · min-1 · ml-1).ConclusionWith 18F− PET a two fold increase in bone metabolism in the active condyle region was found in patients with suspected UCH. This increased bone metabolism appeared to be independent of bone blood flow, as no differences in blood flow between hyperactive and contralateral condylar regions were observed. StatementUnilateral condylar hyperactivity (UCH) is a rare postnatal growth abnormality of the temporo-mandibular joint. The resulting mandibular asymmetry often is responsible for malocclusion and functional problems. The etiology of condylar hyperactivity is controversial and not well understood, with hypotheses including neoplasia, trauma, infection, or abnormal loading. Surgical treatment of progressive UCH consists of a high condylectomy, thereby removing the principal mandibular growth site. In patients with normal condylar activity, however, condylectomy should be avoided. Consequently, adequate assessment of condylar activity is of the utmost importance. At present, condylar bone activity routinely is evaluated using bone scintigraphy (Hodder). This procedure, however, only provides an assessment of relative (ie left versus right) condylar activity. In contrast, positron emission tomography (PET) allows for quantitative in vivo measurements of biological processes. For example, quantitative uptake of 18F labeled fluoride (18F−) in bone, as measured using PET, is directly correlated with histomorphometric parameters of bone formation. Interestingly, some studies have shown coupling between bone metabolism and bone blood flow. At present, however, it is not known whether bone blood flow is abnormal in patients with UCH.Objective. To assess whether 18F− PET can distinguish between active and non-active growth centers in the condylar process, and, in addition, to study the role of bone blood flow in these processes. Unilateral condylar hyperactivity (UCH) is a rare postnatal growth abnormality of the temporo-mandibular joint. The resulting mandibular asymmetry often is responsible for malocclusion and functional problems. The etiology of condylar hyperactivity is controversial and not well understood, with hypotheses including neoplasia, trauma, infection, or abnormal loading. Surgical treatment of progressive UCH consists of a high condylectomy, thereby removing the principal mandibular growth site. In patients with normal condylar activity, however, condylectomy should be avoided. Consequently, adequate assessment of condylar activity is of the utmost importance. At present, condylar bone activity routinely is evaluated using bone scintigraphy (Hodder). This procedure, however, only provides an assessment of relative (ie left versus right) condylar activity. In contrast, positron emission tomography (PET) allows for quantitative in vivo measurements of biological processes. For example, quantitative uptake of 18F labeled fluoride (18F−) in bone, as measured using PET, is directly correlated with histomorphometric parameters of bone formation. Interestingly, some studies have shown coupling between bone metabolism and bone blood flow. At present, however, it is not known whether bone blood flow is abnormal in patients with UCH. Objective. To assess whether 18F− PET can distinguish between active and non-active growth centers in the condylar process, and, in addition, to study the role of bone blood flow in these processes. Materials and MethodsIn this pilot study, approved by the Medical Ethics Committee of the VU University Medical Center, 6 patients (age range 17 to 43 years) with progressive UCH were included. The diagnosis of UCH was established using clinical and standard radiological assessments, including planar and SPECT bone scans. PET studies were performed using an ECAT EXACT HR+ scanner (Siemens/CTI, Knoxville, USA). First a 10 min dynamic emission scan was acquired following injection of 1100 MBq H215O. After a ten minute period to allow for decay of H215O activity, a second 60 min dynamic emission scan was acquired following injection of around 100 MBq 18F−. Throughout both emission scans, arterial blood was withdrawn continuously and monitored using an on-line detection system. A summed 18F− image was used to define regions of interest (ROI) for left and right condylar regions. These ROI were projected on both dynamic scans thereby generating H215O and 18F− time-activity curves. Bone blood flow (BF) was obtained by fitting the H215O tissue time activity curves to the standard single tissue compartment model. In a similar fashion, the 18F− curves were fitted to an irreversible two tissue compartment model (Hawkins), providing the net fluoride influx rate Ki as a parameter of interest. The preliminary data are represented as mean values (± standard deviations) across patients. In this pilot study, approved by the Medical Ethics Committee of the VU University Medical Center, 6 patients (age range 17 to 43 years) with progressive UCH were included. The diagnosis of UCH was established using clinical and standard radiological assessments, including planar and SPECT bone scans. PET studies were performed using an ECAT EXACT HR+ scanner (Siemens/CTI, Knoxville, USA). First a 10 min dynamic emission scan was acquired following injection of 1100 MBq H215O. After a ten minute period to allow for decay of H215O activity, a second 60 min dynamic emission scan was acquired following injection of around 100 MBq 18F−. Throughout both emission scans, arterial blood was withdrawn continuously and monitored using an on-line detection system. A summed 18F− image was used to define regions of interest (ROI) for left and right condylar regions. These ROI were projected on both dynamic scans thereby generating H215O and 18F− time-activity curves. Bone blood flow (BF) was obtained by fitting the H215O tissue time activity curves to the standard single tissue compartment model. In a similar fashion, the 18F− curves were fitted to an irreversible two tissue compartment model (Hawkins), providing the net fluoride influx rate Ki as a parameter of interest. The preliminary data are represented as mean values (± standard deviations) across patients. Method of Data AnalysisDescribed in material and methods. Described in material and methods. ResultsNet fluoride influx rate (Ki), representing bone metabolism, within the affected condyle was 0.0205 ± 0.0027 min-1, and was twofold higher compared to the contralateral condyle with a Ki of 0.0103 ± 0.0035 min-1. Mean bone blood flow in the affected, hyperactive condyle (0.104 ± 0.012 ml · min-1 · ml-1) was, however, similar to that on the contralateral side (0.101 ±0.015 ml · min-1 · ml-1). Net fluoride influx rate (Ki), representing bone metabolism, within the affected condyle was 0.0205 ± 0.0027 min-1, and was twofold higher compared to the contralateral condyle with a Ki of 0.0103 ± 0.0035 min-1. Mean bone blood flow in the affected, hyperactive condyle (0.104 ± 0.012 ml · min-1 · ml-1) was, however, similar to that on the contralateral side (0.101 ±0.015 ml · min-1 · ml-1). ConclusionWith 18F− PET a two fold increase in bone metabolism in the active condyle region was found in patients with suspected UCH. This increased bone metabolism appeared to be independent of bone blood flow, as no differences in blood flow between hyperactive and contralateral condylar regions were observed. With 18F− PET a two fold increase in bone metabolism in the active condyle region was found in patients with suspected UCH. This increased bone metabolism appeared to be independent of bone blood flow, as no differences in blood flow between hyperactive and contralateral condylar regions were observed." @default.
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• W2039519745 title "PET as a Diagnositic Tool in Unilateral Condylar Hyperactivity" @default.
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