Diagnostic value of spect bone scintigraphy for odontogenic maxillary sinusitis

The aim of this study was to assess the diagnostic value of bone SPECT for odontogenic maxillary sinusitis and bone activity in the alveolar process to clarify the pathophysiologic nature of the disease.

Computed tomography and bone SPECT with Tc-99m HMDP were performed in 28 patients with odontogenic maxillary sinusitis. Based on the findings of the computed tomographic images, the inflammatory changes in the maxillary sinus mucosa (mucosal lesions) were evaluated horizontally and vertically. For the initial diagnosis, visualization of the causative site by bone SPECT was compared with conventional radiographic and planar findings. SPECT data were used to assess bone activity by calculating the mean count ratios of the alveolar process over the cervical vertebrae. The relation of bone activity to the structure of the mucosal lesions, the presence of clinical symptoms, mucosal changes around the maxillary ostium (ostial lesions), and conventional radiolucent images around the causative teeth (periapical lesions) were assessed.

Identification of the causative site was sufficiently specific in bone SPECT images. Bone activity was significantly correlated with the structure of the mucosal lesions, both horizontally and vertically, and with the presence of infraorbital symptoms, ostial lesions, and periapical lesions.

It is important to view odontogenic maxillary sinusitis as a bone disease in which the bone activity associated with alveolar osteitis affects the pathophysiologic nature of the disease. Bone SPECT is valuable to make a more precise diagnosis, thereby allowing more appropriate treatment of the disease.