technetium-tc-99m-medronate and Temporomandibular-Joint-Disorders

Topics: Acquired Hyperostosis Syndrome; Bone Neoplasms; Face; Fluorodeoxyglucose F18; Head and Neck Neoplasms; Humans; Hyperplasia; Infections; Mandibular Condyle; Maxilla; Osteitis Deformans; Periodontitis; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radiopharmaceuticals; Sjogren's Syndrome; Technetium Tc 99m Medronate; Technology, Dental; Temporomandibular Joint Disorders; Tomography, X-Ray Computed

Temporomandibular joint (TMJ) patients with disc displacement without reduction have a misaligned disc-condyle structural relation. As the condition becomes chronic, painful osteoarthritic changes may occur. For these patients, splint therapy may help to position the condyle to a more structurally compatible and functional position and to decrease the loading force of articular surfaces. The aim of this study was (1). to evaluate osseous reactions and pain relief in patients with disc displacement without reduction after splint therapy and (2). to use single photon emission tomography (SPECT) bone imaging to compare the results with the opposite joint of the patient.. Twelve patients, who presented with pain involving the TMJ and limited mouth opening and were confirmed by soft tissue imaging as having disc displacement without reduction, were included in the study. Each patient underwent bone SPECT imaging, after which semiquantitative evaluation of transaxial images was conducted. The ratios of affected TMJ to nonaffected TMJ, affected TMJ to occipital bone, and nonaffected TMJ to occipital bone were calculated. After 6 months of splint therapy, bone SPECT examinations were repeated.. Before splint therapy, the ratios of affected TMJ to nonaffected TMJ and of affected TMJ to occipital bone were found to be significantly higher than the ratios after splint therapy (P < 0.005).. Six-month splint therapy has a positive effect on the osseous reaction and pain related to internal derangements of TMJs.

Topics: Adolescent; Adult; Facial Pain; Female; Humans; Joint Dislocations; Male; Occlusal Splints; Technetium Tc 99m Medronate; Temporomandibular Joint; Temporomandibular Joint Disorders; Tomography, Emission-Computed, Single-Photon; Treatment Outcome

The use of bone scintigraphy (bone scan) in the diagnosis of temporomandibular joint (TMJ) disease has been infrequent, as compared with traditional radiographic techniques. Bone scans have the potential to detect active bone remodeling whereas corresponding radiographs may be normal or document past structural change in the joint. Traditional radiographic findings and relevant clinical signs and symptoms correlated with bone scans may aid in the diagnosis of TMJ disease and possibly affect treatment and prognosis of individual cases. The use of bone scans as an additional tool in diagnosing TMJ disease was assessed in this series of patients.. Thirty consecutive subjects with TMJ tenderness were selected for bone scintigraphy using technetium diphosphonate 99 mTc and single photon emission computerized tomography. These subjects received bone scans as well as other selected imaging modalities for diagnostic purposes.. The findings on bone scan were evaluated and a change in preliminary clinical diagnosis or treatment was made in 60% of cases because of the findings on bone scintigraphy. Bone scintigraphy may be valuable to assess progress of TMJ inflammation or remodeling, and may affect diagnosis and treatment of patients with TMJ tenderness.

Topics: Adult; Aged; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate; Temporomandibular Joint Disorders; Tomography, X-Ray; Tomography, X-Ray Computed

The study aims to evaluate whether bone scintigraphy is effective in diagnosing temporomandibular joint (TMJ) osteoarthritis (OA) in juvenile patients. A retrospective study was conducted with 356 consecutive patients with TMJ-OA who were clinically assessed according to the Research Diagnostic Criteria for Temporomandibular Disorders. Patients were assigned to three groups based on their ages: Group 1: aged 12-16 years; Group 2: aged 17-19 years; and Group 3: aged 20 years. Additionally, we performed qualitative and quantitative analyses of bone scintigraphy images for the TMJ uptake ratio of the involved joint. The diagnostic rate of TMJ-OA (

Topics: Adolescent; Arthralgia; Child; Cone-Beam Computed Tomography; Female; Humans; Male; Osteoarthritis; Pain Measurement; Radiography, Panoramic; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Medronate; Temporomandibular Joint Disorders; Young Adult

Purpose To evaluate the diagnostic accuracy of the quantitative parameter standardized uptake value (SUV) at single photon emission computed tomography (SPECT)/computed tomography (CT) for the evaluation of temporomandibular joint (TMJ) disorder (TMD). Materials and Methods This study was approved by the institutional review board, and the need for informed consent was waived. Forty-four TMJs in 22 patients with TMD (five men and 17 women; mean age ± standard deviation, 30.0 years ± 12.1) were evaluated. The patients underwent planar bone scintigraphy and SPECT/CT 3-4 hours after injection of technetium 99m hydroxymethylene diphosphonate. The planar scintigraphy parameter of relative ratio (RR) and SPECT/CT parameters mean SUV (SUVmean) and maximum SUV (SUVmax) were compared for the visual assessment of TMD on planar scintigraphy images and for the presence of TMJ arthralgia. Group comparisons, receiver operating characteristic analysis, and Pearson correlation analysis were conducted. Results SUVmax gradually increased from normal (2.82 ± 0.73) to mild or moderately abnormal (3.56 ± 0.76, P < .05) and then to severely abnormal (4.86 ± 1.25, P < .05). However, RR and SUVmean did not vary significantly according to visual grade (P > .05). On the other hand, SUVmax was significantly greater in arthralgic TMJs (4.15 ± 1.11) than in nonarthralgic TMJs (2.97 ± 0.75, P < .001), as was SUVmean (1.63 ± 0.42 vs 1.30 ± 0.31, respectively; P = .005). However, there was no significant difference in RR (3.61 ± 0.57 vs 3.76 ± 0.68, P = .45). In receiver operating characteristic curve analyses for arthralgic TMJ, SUVmax had the greatest area under the curve (area of 0.815). Conclusion SUVmax derived from bone SPECT/CT may be useful for the evaluation of TMD. (©) RSNA, 2016 Online supplemental material is available for this article.

Topics: Adult; Female; Humans; Male; Middle Aged; Multimodal Imaging; Radiopharmaceuticals; Retrospective Studies; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate; Temporomandibular Joint Disorders

The purpose of this study was to compare the clinical utility of fluoride-18 positron emission tomography (¹⁸F-PET)/CT with that of conventional (99m)Tc-methylene diphosphonate (MDP) bone scan in temporomandibular disorder (TMD) with osteoarthritis.. 24 patients with TMD who underwent both ¹⁸F-PET/CT and (99m)Tc-MDP bone scans for diagnostic work-up were enrolled. The temporomandibular joint (TMJ)-to-skull uptake ratio, TMJ-to-muscle uptake ratio and TMJ-to-spine uptake ratio on ¹⁸F-PET/CT and the TMJ uptake ratio on bone scan were measured.. Of the 48 TMJs in 24 patients, 35 TMJs were diagnosed as TMD with osteoarthritis, 8 TMJs as TMD with anterior disc displacement (ADD), and the remaining 5 TMJs showed no evidence of TMD (NED). All three uptake ratios on ¹⁸F-PET/CT and the TMJ uptake ratio on the bone scan tended to be higher in TMD with osteoarthritis than in TMD with ADD or NED. Receiver operating characteristic (ROC) curve analysis for detecting TMD with osteoarthritis indicated that the TMJ-to-skull uptake ratio, TMJ-to-muscle uptake ratio and TMJ-to-spine uptake ratio on PET/CT (0.819, 0.771 and 0.813, respectively) showed higher area under the ROC curve value than the TMJ ratio on bone scan (0.714). The TMJ-to-skull uptake ratio on PET/CT showed the highest sensitivity (89%) and accuracy (81%) of all uptake ratios.. ¹⁸F-PET/CT can help diagnose TMD with osteoarthritis with superior diagnostic ability and is a suitable alternative modality to a conventional (99m)Tc-MDP bone scan.

Topics: Adult; Area Under Curve; Cervical Vertebrae; Female; Fluorodeoxyglucose F18; Humans; Joint Dislocations; Male; Muscle, Skeletal; Osteoarthritis; Parietal Bone; Positron-Emission Tomography; Radiopharmaceuticals; ROC Curve; Sensitivity and Specificity; Technetium Tc 99m Medronate; Temporal Bone; Temporomandibular Joint; Temporomandibular Joint Disc; Temporomandibular Joint Disorders

The objective of this study was to evaluate the usefulness of bone scan procedures for the diagnosis of temporomandibular joint (TMJ) osteoarthritis.. From February 2009 to June 2009, 22 patients (4 males and 18 females) from Seoul National University Bundang Hospital, Republic of Korea, were diagnosed with TMJ disorder. They were examined by clinical examination, plain radiograph and bone scan and were categorized into three groups: normal, internal derangement and osteoarthritis. TMJ uptake ratios and asymmetrical indices were calculated.. There were no significant differences in uptake ratios associated with pain and bone change. However, significant results were obtained when comparing uptake ratios between the osteoarthritis and non-osteoarthritis groups.. It was concluded from this study that bone scans may help to diagnose osteoarthritis when increased uptake ratios are observed.

Topics: Adolescent; Adult; Aged; Arthralgia; Facial Pain; Female; Humans; Image Processing, Computer-Assisted; Joint Dislocations; Male; Middle Aged; Osteoarthritis; Parietal Bone; Physical Examination; Radiography, Panoramic; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Temporomandibular Joint Disorders; Young Adult

Quantitative bone SPECT studies have several advantages over qualitative studies for evaluating a temporomandibular joint (TMJ), yet in certain cases additional images are still needed. Accordingly, the current study developed a new easy SPECT quantification method for the bone tracer uptake in a TMJ and evaluated its usefulness and inter-observer variability in patients with TMJ pain.. Sixty-six adult patients (11 males, 55 females) with a mean age of 31 years (range 22-79 years) suffering from TMJ pain were questioned regarding the history of their condition, and then subjected to an oromaxillofacial examination and bone SPECT. New quantitative data for TMJs (TMJ index) were calculated from a formula using TMJ and skull counts.. TMJs with spontaneous pain had higher TMJ indices than those without spontaneous pain (8.87 vs. 6.87, P = 0.032). TMJs with mouth-opening pain or palpatory pain also exhibited higher TMJ indices than those without such pains, although the differences were not statistically significant. Positive TMJs, according to a visual SPECT interpretation, had much higher TMJ indices than the negative ones (8.99 vs. 5.37, P < 0.001). The reference skull count, mean TMJ count and TMJ index obtained using the proposed TMJ quantification method demonstrated an excellent correlation based on two independent observers (r = 0.996, r = 0.993 and r = 0.989, respectively; P < 0.001).. The current results indicate that the proposed quantitative TMJ bone SPECT is easy to perform, plus the resulting TMJ index has a lower inter-observer variability, making it an effective TMJ evaluation method for patients with painful TMJs, and especially useful for serial studies.

Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Observer Variation; Pain; Radioactive Tracers; Reproducibility of Results; Skull; Technetium Tc 99m Medronate; Temporomandibular Joint; Temporomandibular Joint Disorders; Tomography, Emission-Computed, Single-Photon; Young Adult

This study compares quantitative analysis of planar bone scintigrams with visual interpretation in patients having unilateral condylar hyperplasia (UCH) and normal control subjects. The possibility of using a bony structure in a region near the condyle as an objective measurement of bone activity is assessed.. Planar bone scintigrams from 20 subjects suspected of having active UCH were analyzed both qualitatively and quantitatively. Bone activity was assessed in both condyles as well as in reference sites in the cervical spine and the skull. Percentile activities for both condyle regions and ratios using condyle activity versus reference regions were assessed.. All UCH patients had unilateral increased activity on qualitative visual interpretation of the bone scan. The mean percentile activities of the affected and unaffected condyles in the UCH group were significantly different at 55.3% and 44.7%, respectively (P < .001). No significant difference was found in the control group, with the ratios between left and right condyle being 49.5% and 50.5%, respectively (P = .46). In the ratios between the region of interest (ROI) in the condyles versus the ROIs selected for the cervical spine and the skull, a significant difference was noticed in the UCH group; however, there was a considerable overlap between condyle and reference ROI ratios. Symmetrical uptake of diphosphonate reliably excluded continued asymmetrical growth of the condyles.. Quantitative analysis of planar scintigrams in unilateral condylar hyperplasia patients was not found to be superior to qualitative visual interpretation of the scans. Because of a considerable overlap in condyle/reference ROI ratios, quantified ratios did not seem to be clinically helpful in the differentiation of a hyperplastic condyle from a normal condyle. In the case of unilateral increased condylar uptake of diphosphonate, clinical assessment is mandatory.

Topics: Adult; Case-Control Studies; Cervical Vertebrae; Facial Asymmetry; Female; Humans; Hyperplasia; Male; Mandibular Condyle; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Skull; Technetium Tc 99m Medronate; Temporomandibular Joint Disorders

Topics: Adult; Ankylosis; Diagnosis, Differential; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Spondylitis, Ankylosing; Technetium Tc 99m Medronate; Temporomandibular Joint Disorders

Bone scanning is a commonly used technique in the assessment of patients with facial asymmetry. Uptake in the temporomandibular joints can be assessed quantitatively, either as a right-to-left ratio or as the uptake in the joint relative to some other bony structure. We used image registration techniques in the development of an automatic method of quantitative analysis and compared this with a manual region of interest method. Both image warping and region warping were studied. Normal ranges were established in a series of 25 subjects with no evidence of temporomandibular disorder. The results of this study indicate that, by using image registration and standard regions of interest, the results from normal subjects show a smaller standard deviation and improved correlation between observers when compared with manual analysis.

Topics: Adolescent; Adult; Humans; Image Processing, Computer-Assisted; Radiopharmaceuticals; Reference Values; Technetium Tc 99m Medronate; Temporomandibular Joint; Temporomandibular Joint Disorders; Tomography, Emission-Computed, Single-Photon

Diagnosis of temporomandibular joint disease in the horse presents a challenge to the equine veterinarian. This case report illustrates a combined imaging approach using radiography, scintigraphy and ultrasonography in a horse with severe arthropathy of the left temporomandibular joint. Radiographs were inconclusive. Scintigraphy with Tc99m methylenediphosphonate localised, but failed to characterise the disease process; ultrasonography was the only imaging method which both localised and characterised the lesion. Ultrasonography proved to be a relatively cheap, technically easy to perform and non-invasive method for the assessment of the disease.

Topics: Animals; Female; Horse Diseases; Horses; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate; Temporomandibular Joint; Temporomandibular Joint Disorders; Ultrasonography

Three-dimensional bone scintigraphic images were made and their usefulness and limitations discussed.. After usual bone scan procedures, single-photon emission computed tomography (SPECT) data were taken and reconstructed into three-dimensional images. Volume rendering methods were used.. Three cases of three-dimensional bone scintigraphy were obtained; one of a normal patient, one of a case of transplanted kidney and incomplete fracture of the left femoral head, and one of a case of degenerative joint disease (DJD) on the left temporomandibular joint (TMJ). The three-dimensional structure of the skeletal system was depicted more clearly by the three-dimensional images than by a conventional bone scan.. Three-dimensional bone scintigraphs were thought to provide additional information for better understanding of the nature of bone lesions. Some technical improvements including automated threshold level determination and feature extraction for detecting abnormal high uptake are required before routine use can be envisaged.

Topics: Adult; Bone and Bones; Female; Femur Head; Hip Fractures; Humans; Image Processing, Computer-Assisted; Kidney Transplantation; Middle Aged; Technetium Tc 99m Medronate; Temporomandibular Joint Disorders; Tomography, Emission-Computed, Single-Photon

Scintigaphy using 99mTc-MDP is widely advocated as a method of diagnosis and presurgical assessment of patients with condylar hyperplasia. A previous study has demonstrated that hyperplasia of the mandibular condyle is characterized histologically by the presence of an uninterrupted layer of undiffentiated germinative mesenchyme cells, a layer of hypertrophic cartilage and the presence of islands of chondrocytes in the subchondral trabecular bone. This study was undertaken to determine whether there was any association between the degree of 99mTc-MDP uptake and the histological features of condylar hyperplasia. The parameters examined were trabecular bone volume, depth of cartilage islands and the presence of forming and resorbing surfaces. The images were analyzed by three experienced observers, who ranked the images according to degree of asymmetry between sides and the degree of uptake on the affected side. There was a significant correlation between the proportions of resorbing and osteoid covered bone surfaces and scintigraphic appearances. The rank correlations were rs = 0.55 (P = 0.3) between the resorptive surfaces and degree of symmetry and rs = 0.53 (P = 0.04) between the osteoid surfaces and absolute uptake. The correlation was higher for both methods (rs = 0.64 in each case) when the osteoid surface and resorptive surface measurements were combined. The results indicate that visual examination of radioisotope bone scans by experienced observers is a valid form of assessment of bone activity in condylar hyperplasia.

Topics: Adolescent; Adult; Female; Humans; Hyperplasia; Male; Mandibular Condyle; Mandibular Diseases; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate; Temporomandibular Joint Disorders

Topics: Adult; Female; Humans; Male; Osteoarthritis; Radionuclide Imaging; Technetium Tc 99m Medronate; Temporomandibular Joint; Temporomandibular Joint Disorders

Panoramic radiographs of the temporomandibular joints of patients with orofacial pain were examined for evidence of pathology by three different groups of four dental specialists and by a group of four general dentists. Bone scans of the same joints were used as the "gold standard" for identification of disorder and indicated a low rate of correct readings by the four professional groups. When the symptomatic side of the complaint was used as the gold standard, there was no statistically significant association with the bone scan observations. Comparative analysis of other patient symptoms showed little agreement with panoramic radiographs and scintigraphs. Reliability estimates may be highly variable, even among clinical experts. These results show that neither radiologic technique would be definitive for diagnosis of TM disorders.

Topics: Adolescent; Adult; Aged; Bias; Diagnosis, Differential; Female; General Practice, Dental; Humans; Male; Middle Aged; Observer Variation; Pathology, Oral; Prosthodontics; Radiography, Panoramic; Radionuclide Imaging; ROC Curve; Sensitivity and Specificity; Single-Blind Method; Surgery, Oral; Technetium Tc 99m Medronate; Temporomandibular Joint; Temporomandibular Joint Disorders

Digital subtraction radiography, tomosynthesis, bone uptake of radionuclide, and arthroscopy were evaluated for detection and quantification of bony lesions induced unilaterally in the condyles of six dogs. A stereotaxic head-holder facilitated acquisition of reproducible radiographs suitable for subtraction and for circular tomosynthesis. Bone uptake of technetium-99m methylene diphosphonate was measured with a hand-held collimated miniature detector. Arthroscopy was performed with an arthroscope of 2.4 mm diameter. Bone defect mass determined by subtraction radiography correlated highly (r = 0.92, p less than 0.001) with the calcium content of removed bone measured by atomic spectroscopy. Both subtraction radiography and tomosynthesis indicated reshaping of the condyle into a more anterior position over a 10-week follow-up period. Radionuclide uptake was significantly elevated (p less than 0.04) from 2 to 10 weeks after surgery and correlated (r = 0.73, p less than 0.05) with regained bone mass measured by subtraction radiography. Arthroscopy revealed progressive degeneration of cartilage with denudation in the fossa. Both radiographic techniques demonstrated the lesions and bone remodeling, but only subtraction provided quantitative results. Radionuclide uptake predicted quantitatively future bone mass changes, and arthroscopy revealed cartilage and soft tissue status not otherwise observable.

Topics: Animals; Arthroscopy; Bone Remodeling; Dogs; Evaluation Studies as Topic; Female; Mandibular Condyle; Radiographic Image Enhancement; Radionuclide Imaging; Subtraction Technique; Technetium Tc 99m Medronate; Temporomandibular Joint Disorders; Tomography, X-Ray

Regional uptake of technetium 99m-labeled methylene diphosphonate was measured serially over time to follow the healing course of surgically generated lesions, induced unilaterally in the condyles of beagles. A small portable cadmium telluride probe was used for radiation detection, with and without a gold collimator attached. Radioactivity was measured at six periarticular sites on both the operated and the contralateral control sides and expressed as a ratio with respect to a reference site over the sagittal suture. The use of a collimator was crucial to separate the activity associated with bone mineralization in the condylar head from that arising in the adjoining bones. The uptake in the condylar region increased 2 weeks after surgery and remained at a constant level above the presurgery baseline (p less than 0.05) until termination of the study (10 weeks). Postmortem histologic examinations confirmed the high bone turnover level by revealing newly formed bone as well as the presence of osteoclasts. The time course of nuclide uptake in the temporomandibular joint is different from the general pattern of rise and fall of activity displayed in other bones and indicates the persistence of bone remodeling processes during a prolonged period of at least 10 weeks.

Topics: Adult; Analysis of Variance; Animals; Arthroscopy; Bone Regeneration; Bone Resorption; Dogs; Female; Humans; Mandibular Condyle; Osteogenesis; Radionuclide Imaging; Technetium Tc 99m Medronate; Temporomandibular Joint Disorders; Time Factors

Topics: Female; Humans; Male; Technetium Tc 99m Medronate; Temporomandibular Joint Disorders; Tomography, Emission-Computed

The temporomandibular joints (TMJs) of 60 patients with arthrographically confirmed internal derangements and 30 volunteers were examined with single photon emission computed tomography (SPECT). Semiquantitative evaluation was done by forming a quotient from the counts of a constantly sized TMJ-ROI relative to the overall counts of the cranium. The TMJ/cranium quotient depended on the age of the subject, with younger patients showing a larger quotient than older ones. Normal joints were separated from the afflicted ones by means of a discriminant analysis. Sensitivity of semiquantitative evaluation was 78% (disc displacements with reduction) and 89% (disc displacements without reduction). Correct visual evaluation was made in 53% of the reducing and 75% of the nonreducing discs. Semiquantitative SPECT of the TMJs provides important information on the extent of osseous changes in afflicted joints and is suitable for follow-up of splint therapy. It may also be helpful as a screening method in detecting clinically normal joints before arthrography is carried out and in assessing the presumptive response to treatment with a splint.

Topics: Adolescent; Adult; Age Factors; Aged; Cartilage, Articular; Female; Humans; Joint Dislocations; Male; Middle Aged; Technetium Tc 99m Medronate; Temporomandibular Joint; Temporomandibular Joint Disorders; Tomography, Emission-Computed