title: Performance of orthopantomography, planar scintigraphy, CT alone and SPECT/CT in patients with suspected osteomyelitis of the jaw.
abstract: OBJECTIVE
  The aim of this study was to evaluate the performance of a novel flat-panel single photon emission computed tomography (SPECT)/CT in patients with suspicion of osteomyelitis (OM) of the jaw in comparison with conventional orthopantomography (OPT), planar bone scintigraphy (PS) and CT alone.
  
  
  METHODS
  Forty-two patients (21 female, 21 male, mean age 52, range 10-84 years) with suspected OM (n = 38) or exacerbation of a known OM (n = 4) were investigated with OPT, CT alone, PS and combined SPECT/CT. Images were separately reviewed by a nuclear physician/radiologist and jaw surgeon regarding presence of OM. Additionally, the different methods were rated regarding their usefulness for diagnosis (5-point scale: from 1 = diagnostic to 5 = useless). Biopsy served as the standard of reference in 30 patients and clinical/imaging follow-up of at least 6 months in 12 patients.
  
  
  RESULTS
  In 35 of 42 patients the final diagnosis of OM was established according to the reference standard. Sensitivity, specificity and accuracy for OPT was 59, 100 and 66 %, for CT alone 77, 86 and 79 %, for PS 100, 71 and 95 % and for SPECT/CT 100, 86 and 98 %. SPECT/CT was significantly more accurate compared with CT alone (p = 0.0078) and OPT (p = 0.001). SPECT/CT was rated as the most useful imaging modality (mean value 1.2) compared with PS (2.2), CT (2.5) and OPT (3.2).
  
  
  CONCLUSIONS
  SPECT/CT is an accurate method to assess the presence of OM of the jaw and superior to CT alone and OPT. SPECT/CT slightly improved the specificity of PS. However, SPECT/CT in this study was not significantly more accurate compared with PS and whether the advantages to the patient of a one-stop study as opposed to doing separate CT and PS justifies its routine use in terms of cost requires further study.
authors.affiliation: Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.
authors.forename: Carmen
authors.initials: C
authors.lastname: Bolouri
authors.forename: Michael
authors.initials: M
authors.lastname: Merwald
authors.forename: Martin W
authors.initials: MW
authors.lastname: Huellner
authors.forename: Patrick
authors.initials: P
authors.lastname: Veit-Haibach
authors.forename: Johannes
authors.initials: J
authors.lastname: Kuttenberger
authors.forename: Marisol
authors.initials: M
authors.lastname: Pérez-Lago
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.forename: Klaus
authors.initials: K
authors.lastname: Strobel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D007571:Jaw Diseases / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D010019:Osteomyelitis / Q000000981:diagnostic imaging*; D010020:Osteonecrosis / Q000000981:diagnostic imaging; D049268:Positron-Emission Tomography; D011862:Radiography, Panoramic; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D051598:Whole Body Imaging; D055815:Young Adult