18F-NaF PET/CT for the evaluation of temporomandibular joint disorder

Abstract

AIM: To investigate the usefulness of a quantitative parameter ( maximum standardised uptake value [ SUVmax]) of F-18-sodium fluoride ( NaF) positron-emission tomography ( PET)/computed tomography ( CT) for the evaluation of temporomandibular joint ( TMJ) disorder ( TMD). MATERIALS AND METHODS: Seventy-six TMD patients ( male: female_14: 62, age_40.3 +/- 17.1 years, bilateral: unilateral = 40:36) with 152 TMJs were enrolled. The F-18-NaF PET/CT parameter ( SUVmax) was compared with the presence of TMJ arthralgia ( arthralgic = 86, nonarthralgic = 66) and clinical subtypes based on the Research Diagnostic Criteria for TMD Axis I ( TMD osteoarthritis = 49, non-TMD osteoarthritis = 67, and asymptomatic TMJ = 36). Splint therapy was applied to 48 patients for 6 months without considering F-18-NaF PET/CT findings. Post-splint therapy F-18-NaF PET/CT was performed in 32 patients and clinical responses to the therapy were classified into improvement ( n = 33), no change ( n = 10), or aggravation ( n = 7) for 50 TMJs excluding asymptomatic TMJs ( n = 14). RESULTS: SUVmax was significantly greater in arthralgic TMJs than in non-arthralgic TMJs ( 6.62 + 3.56 versus 4.32 + 1.53, p<0.0001). SUVmax was also significantly greater in TMD osteoarthritis ( 6.75 +/- 3.85) than in non-TMD osteoarthritis ( 5.21 +/- 2.70) and asymptomatic TMJs ( 4.86 +/- 1.99; p = 0.0386). After splint therapy, SUVmax was significantly increased in aggravated TMJs ( from 7.80 +/- 3.72 to 11.00 +/- 5.74, p = 0.0156), whereas no significant change in SUVmax was observed in improved ( from 6.16+2.68 to 6.09+2.60, p = 0.4915) and unchanged ( from 6.46 +/- 4.19 to 6.77 +/- 4.32, p = 0.3223) TMJs. CONCLUSIONS: F-18-NaF PET/CT is a useful imaging tool for TMD evaluation because SUVmax showed a fair diagnostic performance for arthralgic TMJ and TMD osteoarthritis, and a correlation with the therapeutic response. (C) 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.