Abstract
PurposeBioactive glass has been successfully used for surgical treatment of chronic infections in bone and bone cavities. Besides infection control, new bone formation is induced by the bioactive glass which is considered to have osteoconductive properties. Evaluation of postsurgical changes after bone graft surgery is generally performed with conventional radiographs or CT/MR imaging, but 18F-NaF PET/CT might be more suitable since it has a high and rapid bone uptake, accompanied by a fast blood clearance leading to a high bone to background ratio.CaseObliteration with S53P4 bioactive glass of the mastoid and middle ear was performed in a patient suffering from chronic otitis media. Control of the chronic otitis media was achieved, and follow-up imaging after 3 years with 18F-NaF PET/CT showed increased uptake in the obliterated cavity indicating new bone formation.Conclusion18F-NaF PET/CT is able to detect new bone formation after obliteration of the mastoid with S53P4 bioactive glass.
Highlights
The use of bioactive glass for treatment of bone infections and infected bone cavities is a novel and promising approach for surgical control of chronic infections
The osteostimulative capacity of bioactive glass is attributed to a silica gel layer which is formed on the granules after obliteration, attracting calcium phosphate
The 18F-Sodium fluoride (NaF) uptake in the obliterated mastoid in our patient was considered to represent active bone formation 3 years after surgery where the mastoid was obliterated with bioactive glass S53P4. 18F-NaF Positron emission tomography (PET)/Computed tomography (CT) has been studied in benign bone disorders like in the evaluation of bone fractures or Paget’s disease and offers increased specificity, sensitivity, and diagnostic accuracy as compared to conventional bone scintigraphy and Single photon emission computed tomography (SPECT)/CT (Li et al 2012)
Summary
The use of bioactive glass for treatment of bone infections and infected bone cavities is a novel and promising approach for surgical control of chronic infections. Bioactive glasses are composed of silica and calcium phosphate and have two main features: bacterial growth inhibition and stimulation of bone formation. The stimulation of bone formation is based on two characteristics of the bioactive glass: osteostimulation and osteoconduction. Autogenous cancellous or cortical bone grafts have an extra feature to stimulate bone formation, i.e., osteoinduction. This is the process through which pluripotent mesenchymal cells from surrounding tissue are stimulated by growth factors within the graft to migrate and differentiate into osteoblasts. Assessing bone grafts in patients using imaging, either conventional radiographs, CT, MR, or bone scintigraphy, SPECT, and PET, requires knowledge about these phenomena (Beaman et al 2006)
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