Figure 4
A representative case (patient 8), where there was intense swelling with redness in the left lower gingiva and discharge of pus from several fistulas at the baseline (arrows) (a). After anti-inflammatory therapy, the gingival swelling improved. The unification of fistula and exposure of the sequestrum was observed but pus was not observed (arrow) (b). CT at the baseline showed marked osteosclerotic changes of the lower left mandibular body and bone apposition on the outer surface of the cortical bone (c). Sequestrum was found in the coronal and oblique sagittal reconstruction images (arrow) (d, e). After pre-operative treatment, the sequestrum was removed by conservative surgical treatment and the patient reported no further recurrence. The 1st planar image showed a strong uptake in the lower left mandible (f) that remarkably decreased in the 2nd image (g). This 2nd image could not quantitatively represent the uptake intensity and volume. SPECT reconstructed the image by GI-BONE. The threshold for the volume of interest (VOI) was determined to be the value of the mean SUVmax of the right and left cranial bones plus three (1st/2nd round of SPECT) = (5.37/5.10). In the 1st SPECT imaging (h), adjusted SUVmax (aSUVmax) was caluculated SUVmax of lesion [L =18.20] - SUVmax of control [C =2.37] = 15.83. In the 2nd SPECT imaging (i), despite the short duration of 4.9 weeks, aSUVmax decreased sharply from 15.83 to 5.80. MBV also decreased sharply from 22.17 to 6.56 cm3.
