Analysis of bone single-photon emission CT/CT and diffusion-weighted MR imaging in medication-related osteonecrosis of the jaw: focusing on the correlation between standardized uptake values and apparent diffusion coefficient values.

The purpose of this study is to investigate bone SPECT/CT and diffusion-weighted MR imaging (DWI) in medication-related osteonecrosis of the jaw (MRONJ), focusing on the correlation between standardized uptake values (SUVs) and apparent diffusion coefficient (ADC) values. Twenty-nine patients with MRONJ who underwent SPECT/CT and DWI were included in this study. SUVs (maximum and mean) with SPECT/CT, and ADC values (maximum, mean and minimum) with DWI were analyzed on characteristics in MRONJ, such as stage, location, medication and underlying disease, by Mann-Whitney U test. Furthermore, the correlation between SUVs and ADC values for characteristics in MRONJ were assessed by Spearman's rank correlation test for nonparametric data. A p-value lower than 0.05 was considered as statistically significant. SUVs and ADC values have no significant differences for all characteristics in MRONJ. Negative correlations were found in all cases and in stage 2 cases, and no correlations were found in stage 3 cases. In addition, negative correlations were found in maxillary cases, mandibular cases, non-bisphosphonate cases, osteoporosis cases, and malignant tumor cases. In conclusion, this study found multiple correlations between SUVs and ADC values in MRONJ, especially in stage 2. Suggesting that ADC values and SUVs may change with disease progression and the possibility of predicting MRONJ progression by SUVs and ADC values.

Evaluation of jaw pathologies of patients with medication-related osteonecrosis of the jaw using a computer program to assess the bone scan index: comparison of standardized uptake values with bone SPECT/CT.

OBJECTIVES: The aim of this study is to investigate the jaw pathologies of patients with medication-related osteonecrosis of the jaw (MRONJ) using a computer program to assess the bone scan index (BSI), especially comparison of standardized uptake values (SUVs) with bone single-photon emission-computed tomography/computed tomography (SPECT/CT). METHODS: Sixty-three patients with MRONJ underwent bone SPECT/CT in this prospective study. BSI and high-risk hot spot as bone metastases in the patients with MRONJ were evaluated using a computer program for BSI that scanned SPECT/CT and automatically defined the data. The maximum and mean SUVs with SPECT/CT were obtained using commercially available software. Statistical analyses were performed by Pearson chi-square test, Mann-Whitney U-test, or one-way analysis of variance with Tukey's honestly significant difference test. A P value lower than 0.05 was considered statistically significant. RESULTS: The maximum and mean SUVs for a high-risk hot spot of the jaw with MRONJ [28.2 ± 10.2 and 11.7 ± 3.8; n = 6 (6/63 : 9.5%)] were significantly higher than those for a low-risk hot spot [18.5 ± 6.4 and 6.2 ± 1.9; n = 23 (23/63 : 36.5%)] and no-risk hot spot [14.2 ± 9.4 and 5.3 ± 5.1; n = 34 (34/63 : 54.0%)], respectively. CONCLUSION: The computer program for BSI indicated that 9.5% of the jaw with MRONJ were false positive of bone metastases. The study suggests that high-risk hot spots of the jaw with MRONJ depend on the SUVs.

A case of radicular cyst on deciduous tooth in a 7-year-old child.

Radicular cysts are the most common cystic lesions in the oral cavity, and have a rare occurrence in the primary dentition. We report a case of radicular cyst of mandible in child by multimodal imaging including panoramic radiography, CT, and MR imaging. A 7-year-old girl presented with swelling and without pain, and hypoesthesia on the right side of the mandible. On clinical examination, an expansive lesion with undulation was found to the buccal cortex of the right side of the mandible. Panoramic radiograph showed a unilocular radiolucency with well-defined margin, displaced tooth, and root resorption in the right mandible. Regarding CT imaging, axial soft tissue algorithm CT and bone tissue algorithm CT showed a low-attenuation internal structure and expansion of the buccal cortex of the right side of the mandible. Three-dimensional-CT showed expansion of the buccal cortex of the right side of the mandible. Multiplanar reformation imaging showed displaced tooth, root resorption, and expansion of the buccal cortex of the right side of the mandible. On T1-weighted image, the expansive lesion showed low signal intensity, and T2-weighted and STIR images revealed high signal intensity. A partial biopsy of the mandibular region was performed. Histopathological diagnosis was radicular cyst caused by apical periodontitis with abscess. This case suggests that multimodal imaging, especially CT and MR imaging, could be effective for evaluating mandibular lesions in child.

A case of odontogenic keratocyst in the buccal space: characterization by multimodality imaging including computed tomography, diffusion-weighted magnetic resonance imaging, and ultrasonography.

Odontogenic keratocyst (OKC) is a relatively common non-inflammatory jaw lesion. OKC is known to occur most often in the mandibular angle and mandibular ramus, but rarely outside the bone. In this report, we describe characteristic multimodality imaging of OKC in the buccal space, especially diffusion-weighted MR imaging (DWI) with apparent diffusion coefficient (ADC) mapping, extra-oral and intra-oral ultrasonography. On clinical examination, an approximately 20 mm in diameter mass with elastic hardness was found the left side of the buccal area. Contrast-enhanced CT showed areas of internal non-contrast lesions in the left buccal space. On T1-weighted image, the mass showed multilocular high signal intensity, and homogeneous internal. T2-weighted images revealed high signal at the marginal part and slightly median signal in the internal part. STIR images revealed a heterogeneous high signal in the interior. Furthermore, DWI and ADC map showed high signal and moderate-to-low signal intensity, respectively. ADC value of the lesion was 1.55 × 10-3 mm2 s-1. On extra-oral ultrasonography, the tumor showed clear boundary, hypoechoic, homogeneous internal architecture and vascular signals, and heterogeneous hard of the lesion. On intra-oral ultrasonography also showed clear boundary, hypoechoic, homogeneous internal architecture, heterogeneous hard of the tumor, and back echo enhance. The histopathologic diagnosis based on a full excisional specimen was odontogenic keratocyst. This case suggests that multimodality imaging, especially MR imaging with ADC and DWI, and extra and intra-oral ultrasonography with color Doppler imaging and elastography, could be effective for evaluating buccal lesions.

Evaluation of the efficacy of diffusion-weighted magnetic resonance imaging and apparent diffusion coefficients in the diagnosis of maxillary diseases.

OBJECTIVE: We investigated the efficacy of using diffusion-weighted imaging (DWI) with quantitative apparent diffusion coefficient (ADC) mapping in the diagnosis of maxillary diseases. STUDY DESIGN: We evaluated 146 cases of maxillary diseases (32 malignant tumors, 11 benign tumors, 28 maxillary cysts, 60 cases of maxillary sinusitis, and 15 maxillary sinus retention cysts) that had been examined using magnetic resonance imaging. The DWI sequence was obtained with b values of 0 and 800 s/mm2 and ADC values were calculated. We used one-way analysis of variance and the Tukey honestly significant difference test to identify differences within and between the types of diseases. RESULTS: Mean ADC values for malignant tumors (1.07 × 10-3 mm2 s-1) were significantly lower than ADCs for benign tumors (1.85 × 10-3 mm2 s-1), maxillary cysts (1.77 × 10-3 mm2 s-1), maxillary sinusitis (2.34 × 10-3 mm2 s-1), and maxillary sinus retention cysts (2.52 × 10-3 mm2 s-1), with P < 0.001.   Mean ADC differed significantly between all disease types except between maxillary sinusitis and maxillary sinus retention cysts. ADC values also significantly differed between specific lesions within the malignant tumor and maxillary cyst groups. CONCLUSIONS: The use of ADC values can be useful in the differential diagnosis of malignant maxillary diseases, benign lesions, cysts, and inflammatory and reactive conditions.

A computer program to assess the bone scan index for Tc-99m hydroxymethylene diphosphonate: evaluation of jaw pathologies of patients with bone metastases using SPECT/CT

PURPOSE: This study aimed to evaluate the jaw pathologies of patients with bone metastases using a computer program to assess the bone scan index (BSI) for Tc-99m hydroxymethylene diphosphonate (HMDP) with single-photon emission computed tomography/computed tomography (SPECT/CT). METHODS: Ninety-seven patients with jaw pathologies (24 with bone metastases and 73 without) were evaluated. High-risk hot spots and BSI in the patients were evaluated using the VSBONE BSI (ver.1.1) analysis software for Tc-99m HMDP that scanned SPECT/CT and automatically defined the data. The two groups were compared using the Pearson chi-square test and Mann-Whitney U test for high-risk hot spots and BSI, respectively. A P value of <0.05 was considered statistically significant. RESULTS: High-risk hot spot occurrence was significantly correlated to bone metastases [sensitivity, 21/24 (87.5%); specificity, 40/73 (54.8%); accuracy, 61/97 (62.9%); P < 0.001]. The number of high-risk hot spots was higher in patients with bone metastases (5.96 ± 10.30) than in those without (0.90 ± 1.50; P < 0.001). Furthermore, the BSI for patients with bone metastases (1.44 ± 2.18%) was significantly higher than for those without (0.22 ± 0.44%; P < 0.001). CONCLUSION: A computer program that assessed BSI for Tc-99m HMDP may be useful in the evaluation of patients with bone metastases using SPECT/CT.

Characteristic multimodal imaging of palatal follicular lymphoma: a case report on effectiveness of CT, diffusion-weighted MR imaging and intraoral ultrasonography.

Oral lymphomas are relatively uncommon. Follicular lymphoma is the second most common subtype of non-Hodgkin lymphoma. We report characteristic multimodal imaging of palatal follicular lymphoma, especially CT, diffusion-weighted MR imaging (DWI) and intraoral ultrasonography. A 67-year-old woman presented with swelling on the right side of the palate within 2 months. On clinical examination, an approximately 35 × 20 mm mass lesion with elastic soft was found to overlay the right side of the palate. Contrast-enhanced CT image showed a mass with homogeneous enhancement on the right side of the palate, and bone tissue algorithm CT showed focal erosion of the right posterior maxilla. Regarding MR imaging, on T1-weighted image, the mass showed low signal intensity and homogeneous enhancement, and T2-weighted and STIR images revealed intermediate and high signal intensity, respectively. Furthermore, DWI and apparent diffusion coefficient (ADC) map showed high and low signal intensity, respectively. ADC value of the mass was 0.60 × 10-3 mm2s-1. On intraoral ultrasonography, the mass showed clear boundary, hypoechoic echogenicity, homogeneous internal architecture, vascular signals using color Doppler imaging and heterogeneous hard using strain elastography. A partial biopsy of the palatal region was performed. Histopathological diagnosis was follicular lymphoma. This case suggests that multimodal imaging, especially CT, DWI with ADC map and intraoral ultrasonography with color Doppler imaging and strain elastography, could be effective for evaluating palatal lesions.

Study of clinical factors, focus score, lymphocyte type and NF-κB pathway in Sjögren's syndrome.

Sjögren's syndrome (SS) is an autoimmune disease that occurs predominantly in middle-aged and older women. Although focus score (FS) and lesion grade are determined at pathological diagnosis, few reports have examined whether these results reflect clinical symptoms. In this study, we examined and compared the results of comprehensive immunohistochemical staining of lymphocytes and NF-κB pathway in labial gland biopsies, clinical test data, and radionuclide imaging findings. One hundred labial gland biopsy specimens obtained from 20 female patients with primary SS (5 specimens per patient) were studied. Hematoxylin-eosin-stained specimens were reviewed and FS were calculated. Immunohistochemical staining of CD4, CD8, CD20, CD25, Foxp3, NF-κB, TNFAIP3 and IκBα was performed, and the results were compared with anti-SS-A/Ro (SS-A), anti-SS-B/La (SS-B) and antinuclear antibodies (ANA), and salivary gland scintigraphy findings. FS were significantly higher in the SS-A-, SS-B- and ANA-positive groups than in the respective -negative groups (p < 0.05). Of eight SS-A-positive and SS-B-negative cases, mean FS was 1.9 (seven cases: FS ≥ 1.0) and six cases were ANA-positive. In four SS-A-positive and SS-B-positive cases, mean FS was 3.2 (all cases: FS ≥ 1.0) and all cases were ANA-positive. In immunohistochemical staining, CD4-positive T cells tended to be more abundant than CD8-positive T cells. Small numbers of Foxp3-positive cells were found in all cases. NF-κB, TNFAIP3 and IκBα were positive in the acini, ductal epithelium, and lymphocytes in all cases. The above findings indicated a relationship between FS and clinical test data, and the association of NF-κB pathway with the pathophysiology of primary SS.

Comparison of maximum and mean standardized uptake values of jaw pathologies with bone SPECT/CT: an especial focus on medication-related osteonecrosis of the jaw.

OBJECTIVES: To investigate the comparison of maximum and mean standardized uptake values (SUVs) of jaw pathologies with bone Single-photon emission computed tomography/computed tomography (SPECT/CT), and a special focus on medication-related osteonecrosis of the jaw (MRONJ). METHODS: Eighty-nine patients with jaw pathologies (63 MRONJ, 13 chronic osteomyelitis, 11 osteoradionecrosis and 2 primary intraosseous carcinoma) underwent bone SPECT/CT scans acquisition at 4 h after intravenous injection of Tc-99m hydroxymethylene diphosphonate in this prospective study. The evaluation of mean and maximum SUVs of jaw pathologies were performed using Q. Metrix and Xeleris workstation and defined the data automatically. Statistical analyses were performed by Pearson's correlation coefficient for comparison of maximum and mean SUVs and Mann-Whitney U-test for SUVs of MRONJ. A P value lower than 0.05 was considered to indicate statistical significance. RESULTS: Maximum SUVs of MRONJ, chronic osteomyelitis, osteoradionecrosis and primary intraosseous carcinoma were 17.6 ± 8.4, 21.7 ± 7.1, 11.9 ± 4.8 and 26.6 ± 7.0, respectively. Mean SUVs of MRONJ, chronic osteomyelitis, osteoradionecrosis and primary intraosseous carcinoma were 10.1 ± 4.9, 11.9 ± 3.3, 7.0 ± 2.8 and 10.1 ± 4.5, respectively. The maximum SUV of jaw pathologies was significantly correlated with the mean SUV (Y = 0.494X + 1.228; R2 = 0.786; P < 0.001). Furthermore, maximum and mean SUVs of MRONJ had significant differences in underlying diseases, medication and staging. CONCLUSION: The maximum and mean SUVs with bone SPECT/CT can be an effective tool for the quantitative evaluation of jaw pathologies, especially MRONJ.

Volumetric analysis of mandibular lesions with SPECT/CT: a pilot clinical study of maximum standardized uptake value.

Purpose: This study was designed to investigate mandibular lesions using volumetric analysis with bone single-photon emission computed tomography/computed tomography (SPECT/CT). Material and methods: Eight patients with mandibular lesions underwent SPECT/CT scan acquisition 4 hours after injection of Tc-99m hydroxymethylene diphosphonate (HMDP). Regarding volumetric analysis, maximum standar-dized uptake value (SUV) was obtained using software and a workstation (Q.Volumetrix MI and GEniE-Xeleris 4 DR, respectively). The localization and size of the volume of interest (VOI) can be drawn over the lesion, mesial, distal, and opposite side as normal using the CT, SPECT, and SPECT/CT transaxials, coronals, and sagittals as the anatomical reference. Q.Volumetrix MI can analyse SUV of lesions by organ segmentation using optional pan and zoom imaging. Then, the dosimetry software provided multiple quantitative data for a given VOI. Statistical analyses for the maximum SUV were performed by Mann-Whitney U test. A p-value lower than 0.05 was considered as statistically significant. Results: Maximum SUVs for medication-related osteonecrosis of the jaw (n = 4, 25.4 ± 4.9), chronic osteomyelitis (n = 3, 14.6 ± 3.1), and squamous cell carcinoma (n = 1, 31.7) were significantly higher than those of the opposite side as normal mandible (3.8 ± 0.7, 4.6 ± 1.8, and 7.4, respectively; p = 0.000). Conclusions: Volumetric analysis with SPECT/CT could be useful for the evaluation of mandibular lesions, such as detecting and surgical planning.

AI-based computer-aided diagnosis for panoramic radiographs: Quantitative analysis of mandibular cortical morphology in relation to age and gender.

OBJECTIVE: This study aimed to investigate AI-based computer-aided diagnosis (AI-CAD) for panoramic radiographs, especially quantitative evaluation of mandibular cortical morphology in relation to age and gender. METHODS: 321 patients with jaw lesions who underwent panoramic radiography were prospectively included. The mandibular cortical morphology was analyzed with an AI-CAD that evaluated the degree of deformation of mandibular inferior cortex and mandibular cortical index (MCI) automatically. Those were analyzed in relation to age and gender, such as younger (≦ 20 years), middle (21-60 years) and older group (≧ 61 years) in men and women. RESULTS: The degree of deformation in older men (33.0 ± 18.5) was higher than those of middle (25.0 ± 15.3, p = 0.030) and younger (32.5 ± 16.9, p = 0.993), and those in older women (46.2 ± 22.5) was higher than those of middle (19.4 ± 16.5, p < 0.001) and younger (22.4 ± 14.5, p < 0.001). The MCI of women was a significant difference for aging (p < 0.001), although those of men was not significant difference for aging (p = 0.189). CONCLUSION: The AI-CAD could be a useful tool for the quantitative analysis of mandibular cortical morphology.

Odontogenic Infection Pathway to the Parapharyngeal Space: CT Imaging Assessment.

Introduction: Parapharyngeal space infection may lead to severe and potentially life-threatening complications. The aim of this study was to assess the odontogenic infection pathway to the parapharyngeal space using CT imaging. Materials and Methods: Nineteen patients in mandibular odontogenic infections with abscess who underwent contrast-enhanced CT were evaluated in this study. We reviewed the location of abscess and spread of odontogenic infections to the different components of the buccal space, submandibular space, sublingual space, masticator space and parapharyngeal space using CT imaging. The location of abscess and spread of odontogenic infections were analyzed with the Pearson Chi-square test. Results: Regarding the odontogenic infection pathway to parapharyngeal space, the masticator space (100%) was the most frequent, followed by the buccal space (85.7%), submandibular space (85.7%) and sublingual space (57.1%), while those without parapharyngeal space, the submandibular space (83.3%) was the most frequent, followed by the buccal space (75.0%), masticator space (58.3%) and sublingual space (33.3%). The masticator space was significant space in patients with/without parapharyngeal space infection (P = 0.047). Conclusion: CT imaging could be an effective method in assessment of odontogenic infection pathway to the parapharyngeal space. The odontogenic infection in masticator space tends to display spread of parapharyngeal space.

Maximum standardized uptake value of normal structures in the head and neck with bone SPECT/CT.

INTRODUCTION: The quantitative parameter was successfully derived from the quantitative bone SPECT/CT images. The aim of this study was to evaluate maximum standardized uptake value (SUV) of normal structures in the head and neck with bone SPECT/CT. METHODS: Fifty-three patients with jaw lesions (11 chronic osteomyelitis, eight osteoradionecrosis and 34 medication-related osteonecrosis of the jaw) who had bone SPECT/CT were prospectively included. The maximum SUV of normal structures including vertebrae, sternal body, parietal bone and hyoid bone were analysed. Statistical analyses for the maximum SUV were performed by Pearson's rank correlation test. A P value lower than 0.05 was considered statistically significant. RESULTS: The maximum SUVs of vertebrae, sternal body, parietal bone and hyoid bone of all patients were 8.10 ± 3.72, 5.16 ± 2.05, 3.67 ± 1.55 and 1.44 ± 0.56, respectively. Furthermore, the maximum SUV of vertebrae was significantly correlated with that of sternal body (Y = 0.527X + 5.388 (R2 = 0.084, P = 0.035)). CONCLUSIONS: Maximum SUV with bone SPECT/CT should be useful for characterization of normal structures in the head and neck. Furthermore, the data reported herein can be used for reference in future studies and in clinical settings for head and neck lesions.

Medication-related osteonecrosis of the jaw in a patient with multiple myeloma: an unusual case with tumor in the surgical specimen.

Multiple myeloma is characterized by a neoplastic proliferation of plasma cells primarily in the bone marrow. Neoplastic plasma cells stimulated osteoclasts, and destroy bone tissue, causing bone pain, pathological fractures, paralysis due to spinal cord compression, and hypercalcemia. Bisphosphonates are used as supportive therapy in the management of multiple myeloma. Medication-related osteonecrosis of the jaw (MRONJ) is a well-known complication of treatment with bisphosphonates, denosumab, and other drugs, such as anti-angiogenic agents and novel anti-cancer drugs. We report MRONJ in a patient with multiple myeloma, especially an unusual case with tumor in the surgical specimen. A 73-year-old woman presented with pain on the left side of the mandible within 3 months. On clinical examination, an exposed bone without purulent drainage presented on the left side of the mandible. Before 2 years, she received chemotherapy of zoledronate for multiple myeloma at another hospital. Panoramic imaging showed radiopacities of bone in the left side of the mandibular molar area. Multidetector computed tomography (MDCT) with axial, multiplanar reformation (MPR) and three-dimensional (3D) images showed the sequestrum without periosteal reaction. She was diagnosed as MRONJ, and underwent surgery. Finally, the surgical specimen was diagnosed as multiple myeloma in the sequestrum. This case suggests that the evaluation of the surgical specimen of MRONJ could be essential for detection of primary tumor.

Analysis of medication-related osteonecrosis of the jaw with bone SPECT/CT: relationship between patient characteristics and maximum standardized uptake value.

OBJECTIVE: To analyze medication-related osteonecrosis of the jaw (MRONJ) with bone single photon emission computed tomography (SPECT)/CT, especially relationship between patient characteristics and maximum standardized uptake value (SUV). METHODS: 48 patients with MRONJ who underwent bone SPECT/CT were prospectively included. MRONJ patients were included 34 osteoporosis and 14 bone metastases from 6 lung cancer, 6 breast cancer and 2 rectal cancer. The maximum SUV of the MRONJ patient characteristics were analyzed such as gender, location, underlying disease, medication and staging of MRONJ by Mann-Whitney U test. P-values lower than 0.05 indicate significant differences. RESULTS: Regarding underlying disease, maximum SUV of patients with osteoporosis (18.69 ± 8.57) were significantly higher than those with bone metastases (12.28 ± 4.32, p = 0.005). Furthermore, maximum SUV of MRONJ was a significant difference for medication (denosumab: 13.62 ± 5.70 and minodronate: 22.98 ± 11.73, p = 0.009) and staging of MRONJ (Stage 2: 15.59 ± 8.06 and Stage 3: 21.51 ± 7.15, p = 0.014). CONCLUSION: Maximum SUV assessed by SPECT/CT was significantly increased in MRONJ patients with osteoporosis and Stage 3. Bone SPECT/CT could be an effective tool for the analysis of MRONJ.

Bone single-photon emission computed tomography-CT peak standardized uptake value for chronic osteomyelitis, osteoradionecrosis and medication-related osteonecrosis of the jaw.

INTRODUCTION: Recently, standardized uptake value (SUV) has been applied for the evaluation of SPECT-CT. This study was performed to investigate the bone SPECT-CT peak SUV for chronic osteomyelitis, osteoradionecrosis and medication-related osteonecrosis of the jaw (MRONJ). METHODS: Sixty-five patients with jaw lesions (12 chronic osteomyelitis, 12 osteoradionecrosis and 41 MRONJ) underwent SPECT-CT after injection of technetium-99m hydroxymethylene diphosphonate. The peak SUV was compared for the chronic osteomyelitis with osteoradionecrosis and MRONJ using GI-BONE software. Statistical analyses for the peak SUV were performed by one-way repeated measures analysis of variance with Tukey's HSD test. A P-value lower than 0.05 was considered as statistically significant. RESULTS: Peak SUV for chronic osteomyelitis (15.6 ± 4.4) was significantly higher than those for osteoradionecrosis (6.7 ± 2.1, P = 0.000) and MRONJ (10.7 ± 6.1, P = 0.019). CONCLUSION: The SPECT-CT peak SUV using GI-BONE software can be useful for the evaluation of jaw lesions, such as chronic osteomyelitis, osteoradionecrosis and MRONJ.

Gallium-67 SPECT-CT for the evaluation of head and neck: preliminary study on maximum standardised uptake value in lesions, and in the parotid and submandibular glands.

PURPOSE: The aim of this study was to investigate the gallium-67 (67Ga) single-photon emission-computed tomography (SPECT-CT) for the evaluation of head and neck, especially maximum standardised uptake value (SUVmax) in lesions, and in the parotid and submandibular glands. MATERIAL AND METHODS: Fourteen patients with head and neck lesions who underwent SPECT-CT at 72 hours after injection of 67Ga were included in this study. The 67Ga SPECT-CT parameters SUVmax were compared between the parotid glands and submandibular glands. Statistical analyses for the SUVmax were performed by Mann-Whitney U test. A p value lower than 0.05 was considered as statistically significant. RESULTS: Of all 14 patients, 67Ga SPECT-CT was positive for two cases (one malignant lymphoma and one osteomyelitis). The SUVmax for malignant lymphoma and osteomyelitis were 11.21 and 10.95, respectively. Furthermore, SUVmax for parotid glands and submandibular glands of all patients were 4.86 ± 1.89 and 4.64 ± 1.64, respectively (p = 0.694). CONCLUSIONS: This study investigated the 67Ga SPECT-CT for the evaluation of head and neck, especially SUVmax of lesions, and the parotid and submandibular glands. 67Ga SPECT-CT may be an effective technique for the evaluation of maxillofacial lesions.

Characteristics of patients with temporomandibular joint osteoarthrosis on magnetic resonance imaging.

INTRODUCTION: Temporomandibular joint (TMJ) dysfunction is a common condition that is best evaluated with magnetic resonance (MR) imaging. The aim of this study was to investigate the characteristics of the patients with TMJ osteoarthrosis on MR imaging. METHODS: The MR images of 206 TMJs of 103 patients with temporomandibular disorders (TMD) were evaluated retrospectively in this study. The relationship between osteoarthrosis and age, gender, TMJ pain and MR imaging findings, such as disc displacement with or without reduction and TMJ effusion, was analysed. RESULTS: The patients with TMJ osteoarthrosis (mean: 51.6 years) were significantly older than those without osteoarthrosis (mean: 44.8 years, P = 0.027). The incidence of the patients with TMJ osteoarthrosis was significantly different between with (10.0 %) and without reduction (57.0 %, P < 0.001). Logistic multivariate regression analysis demonstrated that disc displacement without reduction was significant in patients with TMJ osteoarthrosis (odds ratio = 12.285, P < 0.001). CONCLUSIONS: This study suggests that characteristics of the patients with TMJ osteoarthrosis on MR imaging include older and disc displacement without reduction.

Strain elastography of palatal tumors in conjunction with intraoral ultrasonography, computed tomography, and magnetic resonance imaging: 2 case reports.

Computed tomography (CT) and magnetic resonance imaging (MRI) can be useful for the evaluation of palatal lesions, and strain elastography (performed together with intraoral ultrasonography) is a relatively new sonographic imaging modality. This report describes 2 clinical cases in which strain elastography was used to assess palatal tumors in conjunction with intraoral ultrasonography, CT, and MRI. In the first case, diagnosed as a myoepithelioma, the strain was determined to be 0.000% (strain of normal tissue, 0.556%). In the second case, diagnosed as an adenoid cystic carcinoma, the determined strain was 0.000% (strain of normal tissue, 1.077%). Therefore, we conclude that intraoral strain elastography can be useful for evaluating palatal lesions.

Forming temperature of ethylene vinyl acetate sheets for fabrication of vacuum-formed mouthguards.

BACKGROUND/AIMS: The appropriate heating temperature for the fabrication of mouthguards using ethylene vinyl acetate sheets is reported to be 80-120°C. However, the measurement side of the heating temperature has not been determined. The aim of this study was to investigate the influence of the measurement side of the heating temperature when fabricating mouthguards. MATERIALS AND METHODS: Mouthguard sheets of 3.8 mm ethylene vinyl acetate were vacuum-formed on working models until the sheet was heated to 120°C. The sheet temperature was measured at the upper side and the lower side. The thickness of the mouthguard was measured at the labial surface of the central incisor, and the buccal and occlusal surfaces of the first molar. The fit of the mouthguard was examined at the central incisor and the first molar by measuring the distance between the mouthguard and the cervical margin of the working model. Differences in the thickness and fit of the mouthguards were analyzed by two-way analysis of variance. RESULTS: Mouthguard thickness varied among the measured regions of the central incisors and first molars (P < .01). The thicknesses at the labial surface of the central incisor and buccal surface of the first molar were larger when the sheet temperature measured at the lower side was 120°C compared to when the sheet temperature measured at the upper side was 120°C (P < .01). The fit of the mouthguard was better when the sheet temperature measured at the lower side was 120°C (P < .05). CONCLUSIONS: The sheet temperature should be measured at the lower side of the sheet and it should be 120°C for fabricating mouthguards.