Open-Mouth Bone Scintigraphy Is Better than Closed-Mouth Bone Scintigraphy in the Diagnosis of Temporomandibular Osteoarthritis

Abstract

Purpose Closed-mouth bone scintigraphy (CM scan) and closed-mouth single-photon emission computed tomography (CM SPECT) are used for conventional evaluation of osteoarthritis of the temporomandibular joint (TMJ). However, the adequacy of open-mouth bone scintigraphy (OM scan) has not yet been evaluated. Therefore, the purpose of this study was to compare the diagnostic performance of CM scan, CM SPECT, and OM scan. Methods Thirty-six patients with suspicion of an abnormality of the TMJ and who underwent a 99m Tc-HDP CM scan, CM SPECT, and an OM scan were enrolled. The scans were assessed visually for the presence of positive focal uptake in the TMJ. Osteoarthritis was defined as arthralgia plus crepitus or radiologic signs of arthrosis. Results Of 72 TMJs, 21 (29.2 %) were diagnosed with osteoarthritis. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 90.5 %, 49.0 %, 42.2 %, 92.6 % and 61.1 % for the CM scan, 81.0 %, 58.8 %, 44.7 %, 88.2 % and 65.3 % for CM SPECT, and 81.0 %, 82.4 %, 65.4 %, 91.3 % and 81.9 % for the OM scan, respectively. The accuracy of the OM scan was higher than that of CM SPECT and the CM scans (p = 0.004 and p < 0.001, respectively). Conclusions The OM scan was more accurate than the conventional CM scan and even CM SPECT for diagnosing TMJ osteoarthritis.

Temporomandibular Disorders: Current Concepts and Controversies in Diagnosis and Management

“…Ultrasound has the advantages of being non-invasive, cheap, and widely available in many health institutions, yet the effectiveness as a diagnostic method remains to be confirmed [ 15 ]. For some inflammatory conditions of the TMJ, such as osteoarthritis and joint inflammation, bone scintigraphy may be of value as a diagnostic tool [ 39 , 40 , 41 , 42 , 43 ]. Moreover, bone scintigraphy has been proposed as a method for the evaluation of active TMJ condylar growth, but it has been shown that both the sensitivity and specificity are low for this indication [ 44 ].…”

Diagnostic Imaging in Temporomandibular Joint Disorders - A Review

“…[44,45] Open-mouth bone scintigraphy was proved to be better than closed-mouth bone scan in patients with temporomandibular osteoarthritis as it is difficult to differentiate physiologic bone uptake in a condyle and glenoid fossa of temporal bone in closed-mouth position. [46] bone scintigraphy is not a routinely used technique but studies show that it is useful in diagnosing osteoarthritis of TMJ.…”

Advanced TMJ Imaging-A Review

“…There were significant differences in uptake ratios between the osteoarthritis and non-osteoarthritis groups thus leading to a conclusion that bone scans may help to diagnose osteoarthritis when uptake ratios are increased. Open-mouth bone scintigraphy was proved to be better than closed-mouth bone scan in patients with temporomandibular osteoarthritis as it is difficult to differentiate physiologic bone uptake in a condyle and glenoid fossa of temporal bone in closed-mouth position [39].…”