Maximum standardized uptake value of F-18 sodium fluoride PET/CT for the evaluation of temporomandibular joint disorder

Objectives The aim of this study was to investigate the usefulness of quantitative parameter [standardized uptake value (SUV)] of F-18 sodium fluoride (F-18 NaF) PET/CT for the evaluation of temporomandibular joint disorder (TMD).

Methods One hundred fifty-four temporomandibular joints (TMJs) of 77 TMD patients (male:female, 14:63; age, 40.0 ± 17.0 years) were evaluated in this study. F-18 NaF PET/CT parameters (SUVmean and SUVmax) were compared for the presence of TMJ arthralgia (pain on movement and/or TMJ tenderness) (arthralgic=85, and non-arthralgic=69), and clinical subtypes, diagnosed based on Research Diagnostic Criteria for TMD (TMD subtype 4=50, and non-TMD subtype 4=104). Additionally, the TMD4 patients (n=50) were subgrouped according to the presence of TMJ arthralgia (arthralgic TMD4=35, and non-arthralgic TMD4=15).

Results SUVmax (6.70 ± 3.58 versus 4.16 ± 1.35, p < 0.001) and SUVmean (1.73 ± 0.42 versus 1.50 ± 0.28, p = 0.007) were significantly greater in arthralgic TMJs than non-arthralgic TMJs. In receiver-operating characteristic (ROC) curve analyses for arthralgic TMJ, SUVmax had the greater area-under-the-curve (AUC=0.765) than SUVmean (AUC=0.659) (p=0.0058). SUVmax cutoff 4.46 for detection of arthralgic TMJ, yielded the sensitivity of 75.29% and the specificity of 69.57%. SUVmax was significantly greater in TMD4 than non-TMD4 subtypes (6.58 ± 3.91 versus 5.07 ± 2.45, p=0.0486) but SUVmean was not significantly different between TMD4 and non-TMD4 subtypes (1.65 ± 0.46 versus 1.61 ± 0.34, p=0.8395). In the subgroup analysis of TMD4 with or without arthralgia, SUVmax (7.66 ± 4.11 versus 4.05 ± 1.68, p < 0.001) and SUVmean (1.75 ± 0.47 versus 1.39 ± 0.31, p = 0.009) were significantly greater in arthralgic TMD4 than non-arthralgic TMD4. In ROC curve analyses for arthralgic TMD4, SUVmax showed greater diagnostic performance (AUC=0.803) than SUVmean (AUV=0.776, p = 0.5847) without a statistical significance.

Conclusions SUVmax derived from F-18 NaF PET/CT showed greater diagnostic capability than SUVmean for identification of TMJ arthralgia, TMD subtype 4 and arthralgic TMD subtype 4. F-18 NaF PET/CT may be useful for evaluation of TMD.