Evaluation of three analysis methods for 99mTc MDP SPECT scintigraphy in the diagnosis of unilateral condylar hyperplasia

Rushinek, Heli; Tabib, Rami; Fleissig, Yoram; Klein, Martine; Tshori, Sagi

doi:10.1016/j.ijom.2016.07.002

Cited by 25 publications

(9 citation statements)

References 16 publications

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“…13,14 ROC analysis showed that the SPECTaver had the highest AUC of 0.899, which is consistent with a prior study using the same ROI method in which the AUC was 0.866 with the mean ROI method. 8 Moreover, the present study also showed that SPECT/CT and SPECT had similar diagnostic performance in the SPECTaver, SPECTmax, and SPECTCTmax methods (P > .05), but not in SPECTCTaver, which showed a significantly smaller AUC compared with the others (P < .05).…”

Section: Discussionsupporting

confidence: 68%

Is Single-Photon Emission Computed Tomography/Computed Tomography Superior to Single-Photon Emission Computed Tomography in Assessing Unilateral Condylar Hyperplasia?

Liu

Shi

2019

Journal of Oral and Maxillofacial Surgery

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Purpose: Single-photon emission computed tomography (SPECT) with technetium-99m diphosphates plays an important role in assessing unilateral condylar hyperplasia (UCH). The aim of this study was to evaluate whether quantification methods of SPECT plus CT (SPECT/CT) based on precise region-ofinterest (ROI) drawings made under the guide of CT images were more accurate than conventional SPECT methods in the assessment of UCH growth. Materials and Methods:This study is a nonblinded retrospective case series. Patients with UCH who had undergone SPECT/CT were enrolled. CT images were used to guide ROI drawings around the anatomic contour of the affected and contralateral condyles on SPECT/CT images versus fixed ROIs on conventional SPECT images. Mean and maximum values within the ROIs were recorded to compute percentile ratios. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic (ROC) curves were calculated separately for SPECT-based methods (SPECTaver, SPECTmax) and SPECT/CT methods (SPECTCTaver, SPECTCTmax). The area under the ROC curve of each method was calculated and compared pairwise.Results: Fifty-six patients (30 patients with progressive and 26 patients with nonprogressive mandibular asymmetry) were evaluated. SPECTmax had the highest sensitivity of 83.3%, followed by SPECTCTmax, SPECTaver, and SPECTCTaver. In contrast, SPECTaver, SPECTCTmax, and SPECTmax had similar specificities, PPVs, and NPVs. Nonetheless, SPECTCTaver had the lowest specificity, PPV, and NPV among all methods. ROC analysis also showed similar diagnostic performances among SPECTaver, SPECTmax, and SPECTCTmax (P > .05) and poorer diagnostic performance of SPECTCTaver compared with the other 3 methods (P < .05).Conclusions: The method of using ROIs drawn around the contour of the condyle on SPECT/CT images does not show improved accuracy over conventional SPECT-fixed ROI methods in assessing UCH.

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Section: Discussionsupporting

confidence: 68%

Is Single-Photon Emission Computed Tomography/Computed Tomography Superior to Single-Photon Emission Computed Tomography in Assessing Unilateral Condylar Hyperplasia?

Liu

Shi

2019

Journal of Oral and Maxillofacial Surgery

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“…Chan et al . compared planar scintigraphy with SPECT in 23 patients with UCH and 16 healthy subjects, finding an uptake difference between normal condyles of 7% in SPECT and 5% in planar scintigraphy ( 10 ), and determining that the use of SPECT was the technology of choice in the diagnosis of UCH activity and being corroborated by various authors ( 26 - 30 ), who furthermore concluded that the sensitivity of SPECT is between 88 and 95% and specificity between 61.1 and 77% ( 29 , 30 ).…”

Section: Discussionmentioning

confidence: 91%

Active unilateral condylar hyperplasia: Assessment of the usefulness of single photon emission computed tomography

et al. 2020

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Background This study aims to evaluate whether the uptake difference by the condyles evaluated using single photon emission computed tomography (SPECT) examination is useful for predicting the activity of the feature and the advance of this pathology. Material and Methods An observational and prospective study has been carried out on nine patients affected by unilateral condylar hyperplasia (UCH) with complete bone maturation, with a follow-up over 18 months. At the beginning of the study, a test-battery was conducted including dental casts, articular examination, teleradiography and cephalometry, computed tomography and SPECT, creating two groups of patients from a difference in uptake between both condyles greater than 10% over the follow-up period. Evolution of data obtained with the rest of the diagnostic tests were compared to confirm UCH activity predicted by SPECT. Results The comparison of both groups did not show hardly any significant differences, with little clinical significance. Deviation of the mandibular line, the size of the branches or condyles behaved similarly in both study groups. Conclusions From the data obtained in our study, we can conclude that the use of the difference in uptake between both condyles by applying the SPECT technique is not a valid approach for predicting clinical activity in cases of UCH. Key words: Temporomandibular joint, facial asymmetry, single photon emission computed tomography, scintigraphy, condylar hyperplasia.

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“…Kaban et al 11 and Pogrel 17 used planar imaging and Kajan et al used SPECT 14 to study the differences in activity between condyles in normal individuals, reporting a value of less than 10% as a reference. Rushinek et al 7 , in a group of 41 patients, reported normal values in terms of the percentage of relative condyle uptake, finding a non-normal distribution of the data and a mean value of 51%. Fahey et al 18 used technetium 99 m-methylene diphosphonate ( 99m Tc-MDP) SPECT and reported a consistent and reproducible quantitative method involving the calculation of maximum pixel counts normalized to the clivus in a sample of 32 normal subjects.…”

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confidence: 96%

“…The treatment of mandibular asymmetry is primarily surgical and consists of two types of intervention, depending on the condylar activity: (1) high condylectomy of the affected side during the active phase of the disease, and (2) orthognathic surgery to correct any residual occlusal and facial asymmetry. If orthognathic surgery is performed while condylar activity persists, further asymmetry may develop; for this reason, an accurate assessment of the metabolic status of the affected condyle is mandatory in order to avoid any disruption to the temporomandibular joint (TMJ) that could affect the occlusion 7 . The ultimate surgical strategy will depend on the patient's age, the severity of the dentofacial discrepancy, and the metabolic status of the condyle 8 .…”

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confidence: 99%

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Quantitative bone SPECT analysis of mandibular condyles in an asymptomatic population: an approach to normal reference values

Rodríguez

Mut

2021

International Journal of Oral and Maxillofacial Surgery

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Bone scintigraphy is an extremely valuable technique in diagnosis and treatment planning for patients with condylar hyperplasia (CH). The main objective of this study was to develop an approach to determine normal activity values in the mandibular condyles, adjusted to age and sex, through quantitative analysis of bone single-photon emission computed tomography (SPECT) on a condyle-by-condyle basis and to compare these values with those of a control group comprising patients with confirmed CH. Technetium 99 m-methylene diphosphonate ( 99m Tc-MDP) SPECT studies of the mandibular condyles were performed in patients with no mandibular pathology for quantitative analysis. Regions of interest were drawn on slices representing the upper, middle, and inferior thirds of each condyle and on the summation of transaxial slices representing the whole condyle (three-dimensional approach). The clivus was used for internal validation and the condyle to clivus ratios were calculated. These ratios were compared between 'normal' and 'diseased' condyles. A total 144 condyles in normal patients and 25 in confirmed CH patients were analysed. Differences between the ratios were evaluated through the coefficient of variation. In normal patients, the ratios to the clivus on the summed condyle image showed the lowest variability: range 0.3-1.28 (median 0.74). The quantile regression model showed significant differences with respect to sex, but not to age. The Mann-Whitney test showed significant differences in the ratios to clivus between normal and diseased condyles (P < 0.0001).

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Evaluation of three analysis methods for 99mTc MDP SPECT scintigraphy in the diagnosis of unilateral condylar hyperplasia

Cited by 25 publications

References 16 publications

Is Single-Photon Emission Computed Tomography/Computed Tomography Superior to Single-Photon Emission Computed Tomography in Assessing Unilateral Condylar Hyperplasia?

Is Single-Photon Emission Computed Tomography/Computed Tomography Superior to Single-Photon Emission Computed Tomography in Assessing Unilateral Condylar Hyperplasia?

Active unilateral condylar hyperplasia: Assessment of the usefulness of single photon emission computed tomography

Quantitative bone SPECT analysis of mandibular condyles in an asymptomatic population: an approach to normal reference values

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