title: Correlation of bone SPECT scintigraphy with histopathology of the ethmoid bulla: preliminary investigation.
abstract: OBJECTIVE
  Reports in the rhinology literature suggest that osteitis of the ethmoid bone may be responsible for refractory and/or recurrent sinusitis. If so, bone scanning technologies capable of detecting osteitis may be useful in diagnosing this condition and its response to treatment. The objective of this prospective cohort study was to determine the correlation of single photon emission computed tomography (SPECT) bone scintigraphy with the histopathology of the ethmoid bulla.
  
  
  METHODS
  Thirty-six patients with a diagnosis of chronic sinusitis who were scheduled to undergo sinus surgery underwent a presurgical SPECT bone scan using technetium 99m-methylene diphosphonate. All bone scans were done within 5 days of surgery. During the procedure, bone samples from the face of the ethmoid bulla were obtained and examined by a pathologist blinded to the bone scan result. In this study, histopathology consistent with osteitis was defined as a change from lamellar to woven bone. A positive bone scan was defined by the presence of increased radiotracer uptake in the ethmoid sinuses.
  
  
  RESULTS
  Thirty-two of the 36 patients had a positive bone scan on SPECT imaging, and 31 specimens demonstrated histopathologic bone changes consistent with osteitis, for a sensitivity of 93.9%. An additional 4 patients had a negative bone scan on SPECT imaging, and osteitis was identified in 2 of the 4. The specificity was 66.7%, and the positive predictive value was 96.9%.
  
  
  CONCLUSIONS
  We found that SPECT bone scanning with technetium 99m-methylene diphosphonate is a highly sensitive test for identifying osteitis in patients with chronic rhinosinusitis. It may be a useful tool in the armamentarium of the otolaryngologist to better define this disease process.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Lahey Clinic, Burlington, MA 01805, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Catalano
authors.forename: Robert
authors.initials: R
authors.lastname: Dolan
authors.forename: John
authors.initials: J
authors.lastname: Romanow
authors.forename: Spencer C
authors.initials: SC
authors.lastname: Payne
authors.forename: Mark
authors.initials: M
authors.lastname: Silverman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D002908:Chronic Disease; D004164:Diphosphonates; D005004:Ethmoid Bone / Q000000981:diagnostic imaging* / Q000473:pathology*; D015521:Ethmoid Sinusitis / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D004164:Diphosphonates; D015609:Organotechnetium Compounds; C114890:technetium 99m methylene bisphosphonate