Evaluation of Various Forms of Sinusitis Using Bone SPECT

Background: Computed tomography (CT), a standard diagnostic technique used to evaluate the extent of the sinus disease, fails to show bone involvement in patients with sinusitis. Bone scintigraphy is the gold standard procedure for detecting the bone involvement. Osteitis may be one of the reason of discrepancies between extent of the disease as evaluated by CT and symptom scores. The aim of the study was to determine whether or not nuclear scintigraphy is useful in the diagnosis and management of acute, complicated acute, and chronic sinusitis.

Methods: Forty patients with sinusitis were involved (9 acute, 4 complicated acute, 27 chronic sinusitis). 20 of the chronic sinusitis patients were with nasal polyps. All patients were evaluated with CT and SPECT (Single-photon emission tomography). 99Technetium-methylenediphosphate (99Tc-MDP) was administered for scintigraphic examination of the skull. Abnormal patterns of increased radionuclide uptake were identified and subjectively described. The mucosal involvement of sinusitis graded on Lund-Mackay Scale (LMS) was compared to degree of bone involvement evaluated by SPECT.

Results: While, SPECT uptakes were negative  (mean uptake index is less than about 2.5) in acute sinusitis, it’s highly positive (mean uptake index is more than about 4) in complicated acute sinusitis. In group of chronic sinusitis, a positive correlation between the SPECT uptakes and LMS grade was found (p < 0.05). 

Conclusions: In our view, the bone involvement as evaluated by SPECT correlates with the stage of chronic sinusitis. Poorer subjective response was observed in patients with positive SPECT. The clinical value of  scintigraphy, is limited to special indications.