Nadia M Mostafa1, Shaimaa Moustafa2, Marwa T Hussien3, Wageeh A Ali4, Mohammed H Osman5, Mohammed S Shahine6, Yasser G Abdelhafez7. 1. Lecturer and Consultant of Nuclear Medicine, Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt. 2. Assistant Lecturer and Specialist of Nuclear Medicine, Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt. 3. Lecturer and Consultant of Oncologic Pathology, Department of Oncologic pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt. 4. Lecturer and Consultant of Radiology, Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Assiut University, Assiut, Egypt. 5. Assistant Professor and Consultant of Maxillofacial Surgery, Maxillofacial Surgery Unit, General Surgery Department, Faculty of Medicine, Assiut University, Assiut, Egypt. 6. Lecturer and Consultant of Maxillofacial Surgery, Maxillofacial Surgery Unit, General Surgery Department, Faculty of Medicine, Assiut University, Assiut, Egypt. 7. 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: yabdelhafez@ucdavis.edu.
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 (Rtotal, Rmean, Rmax), a percentage uptake (Ptotal, Pmean, Pmax), background-corrected counts (Btotal, Bmean, Bmax), as well as CT-based condylar diameters (RCT,PCT) 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%). Rtotal, Rmean, Ptotal, and Pmean 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.
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 (Rtotal, Rmean, Rmax), a percentage uptake (Ptotal, Pmean, Pmax), background-corrected counts (Btotal, Bmean, Bmax), as well as CT-based condylar diameters (RCT,PCT) 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%). Rtotal, Rmean, Ptotal, and Pmean 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.