Utility of Single-Photon Emission Computed Tomography/Computed Tomography in Suspected Unilateral Condylar Hyperplasia: A Histopathologic Validation Study.

J Oral Maxillofac Surg

Assistant Professor and Consultant of Nuclear Medicine, Nuclear Medicine Unit, South Egypt Cancer Institute, Assiut University, Assiut, Egypt and Postdoctoral Scholar, Department of Radiology, University of California Davis, Sacramento, CA. Electronic address:

Published: May 2021

AI Article Synopsis

  • The study aimed to assess the effectiveness of hybrid SPECT/CT imaging with technetium-99m methylene diphosphonate in diagnosing active unilateral condylar hyperplasia (UCH) by comparing results to histopathology.
  • Twenty-four patients with suspected UCH underwent SPECT/CT, with evaluations achieving high interobserver agreement and confirming all surgeries performed led to a UCH diagnosis.
  • SPECT/CT showed slightly higher sensitivity than planar scintigraphy for UCH diagnosis, while both methods had similar specificity; quantitative metrics were less sensitive than qualitative assessments.

Article Abstract

Purpose: The purpose of this study is to evaluate the utility of hybrid single-photon emission computed tomography (SPECT) and computed tomography (CT) with technetium-99m methylene diphosphonate in patients with suspected active unilateral condylar hyperplasia (UCH) using histopathology as the reference standard.

Methods: Twenty-four patients with suspected active UCH prospectively underwent technetium-99m methylene diphosphonate planar bone scintigraphy with SPECT/CT of the mandible. Qualitative and quantitative readings for growth activity were performed by 3 nuclear medicine physicians and the final diagnosis was derived from postoperative histopathological examination. Readings were reported as positive, equivocal, or negative. Total, maximum, and mean counts were recorded for each condyle on SPECT/CT images. The uptake of the index (suspected) condyle was expressed as a count ratio (R, R, R), a percentage uptake (P, P, P), background-corrected counts (B, B, B), as well as CT-based condylar diameters (R,P) relative to the contralateral condyle.

Results: Interobserver agreement was 0.79 and 0.83 for planar bone scintigraphy and SPECT/CT, respectively, with a total of 5 and 1 equivocal readings from the respective modalities. Surgery was performed in 22 patients; all of them had pathologically proven UCH. SPECT/CT was slightly more sensitive than planar bone scintigraphy (91 vs 78%) with identical specificity (96%). R, R P, and P demonstrated area under the curve between 84% and 86%. Metrics based on CT diameters and background-corrected counts were not associated with UCH diagnosis.

Conclusions: Quantitative approaches based on total or mean count ratio or relative count percentage were equally predictive for UCH diagnosis; however, they were slightly less sensitive compared with qualitative technetium-99m methylene diphosphonate SPECT/CT evaluation. SPECT/CT evaluation has the potential to decrease the equivocal readings.

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Source
http://dx.doi.org/10.1016/j.joms.2020.11.020DOI Listing

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