KISEP Rhinology Korean J Otolaryngol 2001;44:392-8 만성부비동염환자에서의 99mTc-MDP 골 SPECT 를이용한골염의연구 장용주 1 구태우 1 박석건 2 정필상 1 Osteitis in Patients with Chronic P

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1 KISEP Rhinology Korean J Otolaryngol 2001;44:392-8 만성부비동염환자에서의 99mTc-MDP 골 SPECT 를이용한골염의연구 장용주 1 구태우 1 박석건 2 정필상 1 Osteitis in Patients with Chronic Paranasal Sinusitis Evaluated by 99mTc-MDP Bone SPECT Yong Ju Jang, MD 1, Tae Woo Koo, MD 1, Seok Gun Park, MD 2 and Phil Sang Chung, MD 1 1 Department of Otolaryngology-Head and Neck Surgery and 2 Nuclear Medicine, College of Medicine, Dankook University, Cheonan, Korea ABSTRACT Background and ObjectivesThe objective of this study is to investigate the incidence and clinical implication of osteitis in patients with chronic paranasal sinusitis. Materials and MethodsForty three patients diagnosed as chronic paranasal sinusitis were examined with 99mTc-MDP bone SPECT preoperatively and underwent endoscopic operation, and 6 volunteers were recruited and examined as a control group. Each SPECT image was semiquantitatively assigned one of three grades of 0, 1, 2 according to intensities of isotope uptake. Quantitative analysis of the uptake of the isotope was performed by computer. The incidence of osteitis was analyzed. The correlation between semiquantitative grades and quantitative uptake indices was evaluated, and degree of isotope uptake and the severity of mucosal pathology on CT was correlated. The degree of isotope uptake between the patients who had recurrence and had not was compared. ResultsQuantitative evaluation of uptake indices were significantly higher in the patient group than in the control group. Marked uptakes of isotope on the sinus areas, suggesting the presence of osteitis, were shown in the patient group by 53.5%. The semiquantitative grades and quantitative indices showed positive correlation, and SPECT and CT scan findings also showed significant correlation. The uptake indices of patients who had recurrence were significantly higher than those of patients who showed no recurrence in both ethmoid sinus areas. ConclusionsThe results of this study showed that significant proportion of patients with chronic paranasal sinusitis have osteitis, and patients with more severe osteitis represent poorer postoperative courses. Korean J Otolaryngol 2001;44:392-8 KEY WORDSChronic paranasal sinusitis Osteitis SPECT. 392

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만성부비동염 환자에서의 99m Tc-MDP 골 SPECT를 이용한 골염의 연구 부비동만의 정확한 섭취 값을 얻을 수는 없었기 때문이다.

따라 xon s rank sum test). 반정량적 판독에서 얻은 grade에 따 분류하였다. 1993년 Lund와 MacKay의 분류를 참고하여 각 라 환자군과 대조군을 비교하였다.

에 따라 grade 0을 보인 사람의 수, grade 1을 보인 사람의 를 grade 1, 부비동 내부가 완전히 연부조직음영으로 채워 수, 그리고 grade 2를 보인 사람의 수를 각각 전체 사람 수 6) 져 있을 때를 grade

검사 대상자 49명, 총 392곳의 부비동 영역에서 반정량 적 분석으로 얻어진 grade와 정량적 분석으로 구한 동위원 분 석 정량적으로 분석한 결과로 나타난 섭취 값의 평균으로 A B 소 섭취 값 사이의 상관관계를

The i mages of si ngl e pho-ton emission computed tomography (SPECT, A, B and C) compared with planar scintigraphy (D).

Each arrow (A, B and C) indicates same area (left maxillary sinus wall) providing precise information about the site and intensity

3 만성부비동염 환자에서의 99m Tc-MDP 골 SPECT를 이용한 골염의 연구 부비동만의 정확한 섭취 값을 얻을 수는 없었기 때문이다. 환자군과 대조군 각각 8곳의 부비동 영역의 동위원소 섭취 환자군 43명의 수술을 위하여 촬영되었던 OMU CT를 골 정도를 비교하였고 두 군 사이의 차이를 분석하였다(Wilco- 스캔 영상과 대조해 보기 위하여 점막병변의 중등도에 따라 xon s rank sum test). 반정량적 판독에서 얻은 grade에 따 분류하였다. 1993년 Lund와 MacKay의 분류를 참고하여 각 라 환자군과 대조군을 비교하였다. 즉, 8개 부비동 영역에 나 부비동에 대하여 부비동내 함기화가 잘 되어 있을 때를 grade 타난 동위원소 섭취 중에서 가장 강한 동위원소 섭취의 grade 0, 부분적인 연부조직음영(soft tissue density)이 있을 때 에 따라 grade 0을 보인 사람의 수, grade 1을 보인 사람의 를 grade 1, 부비동 내부가 완전히 연부조직음영으로 채워 수, 그리고 grade 2를 보인 사람의 수를 각각 전체 사람 수 6) 져 있을 때를 grade 2로 하였다(Fig. 3). 에 대한 빈도(%)를 구하여 환자군과 대조군을 비교하였다. 검사 대상자 49명, 총 392곳의 부비동 영역에서 반정량 적 분석으로 얻어진 grade와 정량적 분석으로 구한 동위원 분 석 정량적으로 분석한 결과로 나타난 섭취 값의 평균으로 A B 소 섭취 값 사이의 상관관계를 분석하였고(Spearman s C Fig. 1. The i mages of si ngl e pho-ton emission computed tomography (SPECT, A, B and C) compared with planar scintigraphy (D). SPECT offers more complete spatial information and improved image contrast. Each arrow (A, B and C) indicates same area (left maxillary sinus wall) providing precise information about the site and intensity of osteitis. Fi 2 Fi h i th D A 394 B C Fig. 2. Figures showing three different grades by semiquantitative analysis, grade 0, grade 1, and grade 2. A no specific finding suggesting osteitis (grade 0). Arrow-head indicates nonspecific uptake of isotope on the alveolar area. B Right maxillary sinus wall shows increased uptake of radioisotope (arrow, grade 1). C Right maxillary sinus wall shows intense uptake of radioisotope (arrow, grade 2). Korean J Otolaryngol 2001 ;44 :392-8

We gave grade 2 on right maxillary sinus, and grade 1 on left maxillary sinus and left ethomoid sinus respectively.

4 A B Fig. 3. An example of comparison between bone SPECT and OMU CT. AA bone SP- ECT image of one of the subjects showing isotope uptakes on both maxillary sinuses arrows and left ethmoid sinus open arrow. We gave grade 2 on right maxillary sinus, and grade 1 on left maxillary sinus and left ethomoid sinus respectively. BAn image of OMU CT of the same patient that shows soft tissue densities filling in both maxillary, and left ethmoid sinuses. This image was also graded as grade 1 on both maxillar sinus respectively, and grade 2 on left ethmoid sinus. Table 1. Comparison of quantitative uptake indices between patient group and control group Patient group n43 Control group n6 Maxillary sinus right* left* Ethmoid sinus Right left* Sphenoid sinus right* left* Frontal sinus right* left* *p0.01, Wilcoxon rank sum test p0.05, Wilcoxon rank sum test Table 2. Comparison of the semiquantitative gradings which indicates the highest grade found in each subject Patient group n43 Control group n6 Grade 0* 3 7.0% % Grade % % Grade % 0 0% *The Number of patients whose SPECT images were graded as 0 in all the sinus areas The Number of patients whose SPECT images were graded as 1 in the most intense uptake sinus area, while there was no grade 2 in their SPECT images The Number of patients whose SPECT images were graded as 2 in the most intense uptake sinus area 395

5 Fig. 4. Correlation between data from semiquantitative grades and those from quantitative uptake indices. Fig. 5. Correlation between CT grades and bone SPECT grades. *The numeric numbers on dots indicate the number of sinuses matching on the corresponding grade. Table 3. Comparison of quantitative uptake indices between patients who had recurrence and patients who showed no recurrence Recurrence n28 Recurrence n8 SPECT CT SPECT CT Maxillary sinus right left Ethmoid sinus right * left * Sphenoid sinus right left Frontal sinus right left *Significantly different p0.05, Wilcoxon rank sum test 396 Korean J Otolaryngol 2001;44:392-8

6 REFERENCES 1) Bergstadt HF, Carenfeldt C, Lind MG. Facial bone scintigraphy IV. Diagnosis of bone involvement by purulent sinusitis. Acta Radiol Diagn 1979;20: ) Gardiner LS. Complicated frontal sinusitis. Evaluation and management. Otolaryngol Head Neck Surg 1986;95: ) Kennedy DW, Senior BA, Gannon FH, Montone KT, Hwang P, Lanza DC. Histology and histomorphometry of ethmoid bone in chronic rhinosinusitis. Laryngoscope 1998;108: ) Javer AR, Stevens HE, Stillwell M, Jafar AM. Efficacy of nuclear scintigraphy in the diagnosis and management of sinusitis. J Otolaryngol 1996;25: ) Lee KB, Yum HY, Chun SG, Kim YG. Application on bone and bone marrow system. Nuclear Medicine: Komoonsa;1997. p

7 6) Lund V, MacKay I. Staging in rhinosinusitis. Rhinology 1993; 31: ) Mitnick RJ, Postley JE, Esser PD. Comparison of planar bone scintigraphy and single-photon emission computed tomography in evaluaton of patients with paranasal sinus disease. J Nucl Med 1983;24:58. 8) Israel O, Jerushalmi J, Frankel A, Kuten A, Front D. Normal and abnormal single photon emission computed tomography of the skull: Comparison with planar scintigraphy. J Nucl Med 1988;29: ) Collier BD, Hellman RS Jr, Krasnow AZ. Bone SPECT. Semin Nucl Med 1987;17: ) Shafer RB, Marlette JM, Browne GA, Elson MK. The role of Tc- 99m phosphte complexes and gallium-67 in the diagnosis and management of maxillo-facial disease. J Nucl Med 1981;22: ) Lisbona R, Rosenthall L. Observations on the sequential use of 99mTc-phosphate complex and 67Ga imaging in osteomyelitis, cellulitis, and spetic arthritis. Radiology 1977;123: ) Schauweeker DS, Park HM, Mock BH, et al. Evaluation of complication osteomyelitis with Tch-99m MDP, In-111 granulocytes, and Ga-67 citrate. J Nucl Med 1984;25: Korean J Otolaryngol 2001;44:392-8

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