BACKGROUND: Sternal resection and reconstruction with cryopreserved allografts provides a safe alternative to traditional methods of anterior chest wall reconstruction. Despite favorable results, successful integration of the graft sternum has never been demonstrated due to the invasiveness of bone biopsy. We describe our experience of using 18F-sodium fluoride PET/CT scans as a non-invasive method of evaluating graft integration.METHODS: Seven patients underwent surgery and radiological follow-up. Surgical indications were sternal metastases (n=5) and sternal dehiscence (n=2). Sternal reconstruction was performed using a cryopreserved cadaveric sternal allograft fixed in place with titanium plates and screws. Follow-up with 18F-NaF PET/CT scans was performed at 1 and 2 years after surgery.RESULTS: Three patients underwent total sternectomy; 2 partial upper sternectomy involving the manubrium, clavicle (only 1 patient) and upper sternal body; and 2 partial sternectomy of the sternal body and xiphoid process. Focal tracer accumulation occurred at the junctions between native bone and graft bone. The median SUVmax at 1 year was 16.8 (range: 11.2-37.9; P25-P75 13.6-19.4) while at 2 years it was 10.8 (range: 6.1-30.2; P25-P75 8.9-15.1). In 6 cases accumulation was lower at the second scan while in one patient the accumulation was higher at the second scan.CONCLUSIONS: Sternal reconstruction with cryopreserved allograft is safe and well-tolerated. 18F-NaF PET/CT scans are a useful and promising non-invasive method of demonstrating the metabolic activity of the graft and its incorporation into the host skeleton during follow-up.
Long-term metabolic assessment of cryopreserved sternal allograft: a case series
Dell'Amore, Andrea;
2020
Abstract
BACKGROUND: Sternal resection and reconstruction with cryopreserved allografts provides a safe alternative to traditional methods of anterior chest wall reconstruction. Despite favorable results, successful integration of the graft sternum has never been demonstrated due to the invasiveness of bone biopsy. We describe our experience of using 18F-sodium fluoride PET/CT scans as a non-invasive method of evaluating graft integration.METHODS: Seven patients underwent surgery and radiological follow-up. Surgical indications were sternal metastases (n=5) and sternal dehiscence (n=2). Sternal reconstruction was performed using a cryopreserved cadaveric sternal allograft fixed in place with titanium plates and screws. Follow-up with 18F-NaF PET/CT scans was performed at 1 and 2 years after surgery.RESULTS: Three patients underwent total sternectomy; 2 partial upper sternectomy involving the manubrium, clavicle (only 1 patient) and upper sternal body; and 2 partial sternectomy of the sternal body and xiphoid process. Focal tracer accumulation occurred at the junctions between native bone and graft bone. The median SUVmax at 1 year was 16.8 (range: 11.2-37.9; P25-P75 13.6-19.4) while at 2 years it was 10.8 (range: 6.1-30.2; P25-P75 8.9-15.1). In 6 cases accumulation was lower at the second scan while in one patient the accumulation was higher at the second scan.CONCLUSIONS: Sternal reconstruction with cryopreserved allograft is safe and well-tolerated. 18F-NaF PET/CT scans are a useful and promising non-invasive method of demonstrating the metabolic activity of the graft and its incorporation into the host skeleton during follow-up.Pubblicazioni consigliate
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