COMPLEX RADIALOGICAL DIAGNOSTICS IN DRUG-DEPENDENT PATIENTS WITH PHOSPHORUS OSTEONECROSIS OF THE FACIAL SKELETON AT THE PREOPERATIVE STAGE

The purpose. To determine the role of complex radiological diagnostics and diagnostic effectiveness of various radiological methods in drug-dependent patients with phosphorous osteonecrosis of the facial skeleton at the preoperative stage.

Materials and methods. The study included 85 drug addicted patients with a diagnosis of toxic phosphorus osteonecrosis of the facial skeleton. In the preoperative period all patients underwent full clinical and radiological examination. Orthopantomography (OPG), skull x-ray, multislice computed tomography (MSCT), cone-beam computed tomography (CBCT) were performed in 85 patients (100%) at the preoperative stage. Also, 19 patients (22.4 %) underwent radionuclide diagnostics, which included planar scintigraphy and single-photon emission computed tomography (SPECT). Further, all patients underwent surgical treatment to the extent of complete or partial resection of the jaws and other bones of the facial skeleton.

Results. According to the data of complex radiological examination at the preoperative stage it was revealed that in 48% (n = 41) cases the osteonecrosis zones were localized in the lower jaw, in 24% (n = 20) in the upper jaw, in 28% (24) patients the pathological process captured both jaws. Also, MSCT and CBCT data revealed the spread of the pathological process to other bones of the facial, in some cases, the brain part of the scull in 25 patients (29.5%). The data of radionuclide diagnostics allowed to reveal the zones of radiopharmaceutical accumulation both in the bones of the skull and outside it. Based on the results of the analysis of the data obtained, the role of complex radiation diagnosis was determined, as well as the diagnostic effectiveness of radiation methods (OPG, X-ray of the skull, MSCT, CBCT) in the examination of drug-dependent patients with phosphoric osteonecrosis of the facial skeleton at the preoperative stage.

Conclusion. The complex radiological diagnostics with application of high informative modern methods (MSCT, CBCT, radionuclide diagnostics) is the required step in the evaluation of patients with osteonecrosis of the facial skeleton at the preoperative stage. The diagnostic efficiency parameters for MSCT were: sensitivity – 98.1%, specificity – 99.6%, the accuracy – 98.8%, for CBCT: sensitivity – 97.3%, specificity – 99.1%, accuracy – 98.4%, for OPG: sensitivity – 78.6%, specificity – 76.3%, accuracy – 77.4%, for radiography of the skull: sensitivity – 61.1%, specificity – 59.2%, accuracy – 60.2%.

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