Utility of quantitative standardized uptake value from pre-operative bone SPECT/CT for predicting post-surgical MRONJ healing response

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a challenging condition often associated with long-term use of anti-resorptive medications. Accurate diagnosis is essential, but predicting the prognosis is particularly difficult due to the high likelihood of recurrence after surgery. This study assesses the utility of quantitative values from bone SPECT/CT as predictors of surgical outcomes in MRONJ patients. Materials and methods: We analyzed a cohort of 57 MRONJ patients who underwent surgical treatment. Preoperative bone SPECT/CT scans were used to obtain the maximal SUV (SUVmax) of MRONJ lesions and the ratio of the SUVmax to the mean SUV of a reference region (rSUVmax). Logistic regression analysis was performed to evaluate the relationship between preoperative SUVmax and rSUVmax and surgical outcomes, adjusting for confounders such as age, sex, diabetes, type of bone-modifying agent, MRONJ-affected sites, and stage. Results: Both SUVmax and rSUVmax values increased with the progression from MRONJ stage 1 to stage 3 and were higher in the No Resolution group compared to the Complete Resolution group. Multivariate logistic regression analysis revealed that higher rSUVmax values were significantly associated with poor surgical outcomes (OR, 1.51; 95% CI, 1.07–2.14), whereas SUVmax values were not significantly associated (OR, 1.05; 95% CI, 0.98–1.13). Preoperative MRONJ stages did not significantly predict MRONJ resolution. Conclusion: rSUVmax from bone SPECT/CT may serve as a valuable prognostic tool for assessing MRONJ severity and predicting surgical outcomes. Incorporating rSUVmax measurements into clinical practice could enhance decision-making and improve patient management. Clinical trial registration: None.