Radionuclide imaging modalities for temporomandibular joint disorders: A systematic review

Temporomandibular joint disorders are prevalent, multifactorial conditions that present significant diagnostic challenges. Conventional clinical evaluation and anatomical radiographic imaging provide essential structural information. However, conventional imaging, such as panoramic radiography, CBCT, and MRI, effectively depict anatomical alterations may not identify early metabolic or functional changes of disease. Nuclear medicine imaging serves as a complementary tool, providing functional and molecular insights that allow earlier identification of active pathological changes and improve diagnostic accuracy. Therefore, this review focuses specifically on radionuclide techniques to clarify their distinct diagnostic contribution within the broader TMJ imaging pathway.

This systematic review evaluates the role of nuclear medicine imaging modalities, including bone scintigraphy (planar 2D imaging, SPECT, and SPECT/CT) and molecular imaging (PET and PET/CT), in the diagnosis and activity assessment of TMJ disorders, focusing on imaging patterns, uptake ratios, radiopharmaceutical agents used, and their potential side effects.

A comprehensive literature search was conducted across PubMed, Cochrane, Scopus, Google Scholar, Web of Science, and Science Direct. Clinical trials and related studies published on radionuclide imaging in TMJ disorders were included. Data were analysed with emphasis on study population, imaging modalities, radiopharmaceuticals, and diagnostic outcomes.

Twenty studies met the inclusion criteria, involving participants aged 8 to 66 years, with a higher prevalence in females. Condylar hyperplasia was the most frequently investigated condition. Planar 2D imaging was the most widely employed technique and consistently demonstrated increased condylar uptake as a key diagnostic indicator. Its frequent use reflects its broad availability, relatively low cost, and high sensitivity for detecting early metabolic activity in the condyle. Advanced modalities such as SPECT, SPECT/CT, PET, and PET/CT were also applied, offering improved localization and molecular-level visualization.

Nuclear medicine imaging modalities significantly enhance diagnostic accuracy in TMJ disorders by providing functional and molecular insights beyond conventional imaging. Planar 2D imaging remains the most cost-effective screening tool, while hybrid imaging techniques (SPECT/CT and PET/CT) improve diagnostic precision and should be integrated with clinical expertise to guide effective management strategies.