Bone scintigraphy as a diagnostic method in unilateral hyperactivity of the mandibular condyles: a review and meta-analysis of the literature

Bone scan analyses and clinical assessment are used to diagnose unilateral condylar hyperactivity (UCH). This review compares the diagnostic accuracy of planar and SPECT bone scans. Studies diagnosing patients with possible UCH using bone scans, published between 1968 and 2008, were included in this review. Of 15 articles that met the inclusion criteria, 7 presented results in sufficient detail to calculate index test characteristics. Three control studies show that the difference in uptake values of the left and right condylar regions in the normal population does not exceed 10%. The pooled sensitivity of the planar bone scan (n = 130) was 0.71 (95% confidence interval: 0.57-0.82), which was significantly lower (p = 0.04) than that of the bone SPECT technique (n = 88), which was 0.90 (0.79-0.97). The pooled specificity of the SPECT scan was 0.95 (0.82-0.99), which did not significantly differ (p = 0.58) from that of the planar scan (0.92 (0.83-0.97)). Future studies should include a diagnostic analysis of the data, including two-by-two contingency tables, so the accuracy of the diagnostic test may be evaluated. Bone scans are best performed using SPECT, conducting a quantitative analysis by calculating the percentile differences between the left and right condylar regions.