Fig. 2

Depiction of a representative case (Patient 1). Patient 1 was a 75-year-old man who had been treated for multiple myeloma at our hospital. Zoledronate was administered four times, and denosumab was administered nine times. Swelling and drainage of pus from the fistula in the buccal gingiva of the second premolar of the right mandible (black arrow) (a). In the panoramic radiograph, periapical lesions are seen in five teeth (16, 21, 26, 35, and 45) (black arrows) (b). In the 2-h image from the first SPECT, strong accumulation in the right mandible, moderate accumulation in the left mandible, and weak accumulation in the maxilla are observed at three sites (c). There is an equivalence between the findings of the 3-h and 2-h images for the first SPECT (d). In the 2-h image for the second SPECT (conducted 3 months later), the strong accumulation in the right mandible has improved to moderate accumulation (e). There is an equivalence between the 3-h and 2-h images for the second SPECT (f). SPECT, single-photon emission computed tomography