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European Journal of Nuclear Medicine and Molecular Imaging

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01-02-2013 | Original Article

Performance of orthopantomography, planar scintigraphy, CT alone and SPECT/CT in patients with suspected osteomyelitis of the jaw

Authors: Carmen Bolouri, Michael Merwald, Martin W. Huellner, Patrick Veit-Haibach, Johannes Kuttenberger, Marisol Pérez-Lago, Burkhardt Seifert, Klaus Strobel

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 3/2013

Abstract

Purpose

The aim of this study was to evaluate the performance of a novel flat-panel single photon emission computed tomography (SPECT)/CT in patients with suspicion of osteomyelitis (OM) of the jaw in comparison with conventional orthopantomography (OPT), planar bone scintigraphy (PS) and CT alone.

Methods

Forty-two patients (21 female, 21 male, mean age 52, range 10–84 years) with suspected OM (n = 38) or exacerbation of a known OM (n = 4) were investigated with OPT, CT alone, PS and combined SPECT/CT. Images were separately reviewed by a nuclear physician/radiologist and jaw surgeon regarding presence of OM. Additionally, the different methods were rated regarding their usefulness for diagnosis (5-point scale: from 1 = diagnostic to 5 = useless). Biopsy served as the standard of reference in 30 patients and clinical/imaging follow-up of at least 6 months in 12 patients.

Results

In 35 of 42 patients the final diagnosis of OM was established according to the reference standard. Sensitivity, specificity and accuracy for OPT was 59, 100 and 66 %, for CT alone 77, 86 and 79 %, for PS 100, 71 and 95 % and for SPECT/CT 100, 86 and 98 %. SPECT/CT was significantly more accurate compared with CT alone (p = 0.0078) and OPT (p = 0.001). SPECT/CT was rated as the most useful imaging modality (mean value 1.2) compared with PS (2.2), CT (2.5) and OPT (3.2).

Conclusion

SPECT/CT is an accurate method to assess the presence of OM of the jaw and superior to CT alone and OPT. SPECT/CT slightly improved the specificity of PS. However, SPECT/CT in this study was not significantly more accurate compared with PS and whether the advantages to the patient of a one-stop study as opposed to doing separate CT and PS justifies its routine use in terms of cost requires further study.

Baltensperger M, Grätz K, Bruder E, Lebeda R, Makek M, Eyrich G. Is primary chronic osteomyelitis a uniform disease? Proposal of a classification based on a retrospective analysis of patients treated in the past 30 years. J Craniomaxillofac Surg. 2004;32:43–50.PubMedCrossRef

Baltensperger M, Eyrich GK, Marx RE. Osteomyelitis of the jaws. Berlin: Springer; 2009.

Kuijpers SC, de Jong E, Hamdy NA, van Merkesteyn JP. Initial results of the treatment of diffuse sclerosing osteomyelitis of the mandible with bisphosphonates. J Craniomaxillofac Surg. 2011;39:65–8. doi:10.1016/j.jcms.2010.03.014.

Schuknecht BF, Carls FR, Valavanis A, Sailer HF. Mandibular osteomyelitis: evaluation and staging in 18 patients, using magnetic resonance imaging, computed tomography and conventional radiographs. J Craniomaxillofac Surg. 1997;25:24–33.PubMedCrossRef

Yoshiura K, Hijiya T, Ariji E, Sa’do B, Nakayama E, Higuchi Y, et al. Radiographic patterns of osteomyelitis in the mandible. Plain film/CT correlation. Oral Surg Oral Med Oral Pathol. 1994;78:116–24.PubMedCrossRef

Köhnlein S, Brinkmann G, Körner T, Kreusch T, Bohuslavizki KH, Heller M. Magnetresonanztomographie zur Diagnostik von Unterkieferosteomyelitiden. Fortschr Roentgenstr. 1997;167(1):52–7.CrossRef

Körner T, Kreusch T, Bohuslavizki KH, Brinkmann G, Köhnlein S. Magnetic resonance imaging vs. three-dimensional scintigraphy in the diagnosis and monitoring of mandibular osteomyelitis. Mund Kiefer Gesichtschir. 1997;1:324–7.PubMedCrossRef

Hardt N. Osteomyelitis: scintigraphy. Bone scintigraphic studies in osteomyelitis of the jaws. Schweiz Monatsschr Zahnmed. 1991;101:318–27.PubMed

Rohlin M. Diagnostic value of bone scintigraphy in osteomyelitis of the mandible. Oral Surg Oral Med Oral Pathol. 1993;75:650–7.PubMedCrossRef

10.

Eyrich GK, Harder C, Sailer HF, Langenegger T, Bruder E, Michel BA. Primary chronic osteomyelitis associated with synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO syndrome). J Oral Pathol Med. 1999;28:456–64.PubMedCrossRef

11.

Buck AK, Nekolla SG, Ziegler SI, Beer A, Krause BJ, Herrmann K, et al. SPECT/CT. J Nucl Med 2008;49:1305–19. doi:10.2967/jnumed.109.061937.

12.

Boronat-Ferrater M, Simó-Perdigó M, Cuberas-Borrós G, Aguadé-Bruix S, Dellepiane-Clarke F, Torrent-Llongarriu E, et al. Bone scintigraphy and radiolabeled white blood cell scintigraphy for the diagnosis of mandibular osteomyelitis. Clin Nucl Med 2011;36:273–6. doi:10.1097/RLU.0b013e31820a9ed5

13.

Dore F, Filippi L, Biasotto M, Chiandussi S, Cavalli F, Di Lenarda R. Bone scintigraphy and SPECT/CT of bisphosphonate-induced osteonecrosis of the jaw. J Nucl Med 2009;50:30–5. doi:10.2967/jnumed.109.064634.

14.

Strobel K, Burger C, Seifert B, Husarik DB, Soyka JD, Hany TF. Characterization of focal bone lesions in the axial skeleton: performance of planar bone scintigraphy compared with SPECT and SPECT fused with CT. AJR Am J Roentgenol 2007;188:W467–74. doi:10.2214/AJR.06.1215.PubMedCrossRef

15.

Utsunomiya D, Shiraishi S, Imuta M, Tomiguchi S, Kawanaka K, Morishita S, et al. Added value of SPECT/CT fusion in assessing suspected bone metastasis: comparison with scintigraphy alone and nonfused scintigraphy and CT. Radiology 2006;238:264–71. doi:10.1148/radiol.2373041358.PubMedCrossRef

16.

Hakim SG, Bruecker CW, Jacobsen H, Hermes D, Lauer I, Eckerle S, et al. The value of FDG-PET and bone scintigraphy with SPECT in the primary diagnosis and follow-up of patients with chronic osteomyelitis of the mandible. Int J Oral Maxillofac Surg 2006;35:809–16. doi:10.1016/j.ijom.2006.03.029.PubMedCrossRef

17.

Wilde F, Steinhoff K, Frerich B, Schulz T, Winter K, Hemprich A, et al. Positron-emission tomography imaging in the diagnosis of bisphosphonate-related osteonecrosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:412–9. doi:10.1016/j.tripleo.2008.09.019.PubMedCrossRef

18.

Robinson CB, Higginbotham-Ford EA. Determination of sequestrum activity by SPECT with CT correlation in chronic osteomyelitis of the head and neck. J Otolaryngol 1986;15:279–81.PubMed

Title: Performance of orthopantomography, planar scintigraphy, CT alone and SPECT/CT in patients with suspected osteomyelitis of the jaw
Authors: Carmen Bolouri
Michael Merwald
Martin W. Huellner
Patrick Veit-Haibach
Johannes Kuttenberger
Marisol Pérez-Lago
Burkhardt Seifert
Klaus Strobel
Publication date: 01-02-2013
Publisher: Springer-Verlag
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 3/2013
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-012-2285-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Performance of orthopantomography, planar scintigraphy, CT alone and SPECT/CT in patients with suspected osteomyelitis of the jaw

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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