Clinical utility of SPECT/CT and CT-dacryocystography-enhanced dacryoscintigraphy in the imaging of lacrimal drainage system obstruction

Adam Kemeny-Beke,Kornel Kukuts,Ildiko Garai,Rudolf Gesztelyi,Laszlo Toth,Sandor Barna

doi:10.1007/s12149-019-01385-2

Abstract

PurposeEpiphora is commonly caused by a relative or complete occlusion in the lacrimal drainage system (LDS), principally a nasolacrimal duct obstruction (NLDO). Dacryoscintigraphy (DSG), an extensively assessed imaging technique in diagnosing its abnormalities, can provide only planar images, according to which it needs to be improved. Our aim was to evaluate clinical utility of simultaneous DSG and single-photon emission computed tomography/computed tomography (SPECT/CT) combined with computed tomographic dacryocystography (CT-DCG) in the evaluation of LDS.MethodsDynamic imaging with DSG was performed, and tracer radioactivity was detected by a gamma camera. Successively, SPECT/CT images of the involved region were gained, followed by CT-DCG, during which a contrast medium was syringed into the affected LDS, and finally contrast CT scans were obtained again from the same region.ResultsFifty-seven patients, mean age 54.25 (± 18.26) years all with unilateral NLDO and 32 control subjects, all with patent LDS, mean age 49.88 (± 18.61) years were evaluated in the study. Delayed outflow of tearing eyes was exposed to DSG compared to the fellow and control eyes. The highest value for sensitivity was observed for SPECT/CT, followed by CT-DCG and DSG techniques, while combining DSG with SPECT/CT, DSG with CT-DCG, and SPECT/CT with CT-DCG, the sensitivity increased to 96.49%, 92.98%, and 94.73%, respectively.ConclusionsAlthough DSG is a sensitive nuclear medicine method, it only provides useful clinical data when simultaneously supplemented with SPECT/CT and CT-DCG trials as they jointly can offer valuable information about the localization of an abnormality and verify stenosis or obstruction.

Highlights

Excessive tearing known as epiphora, a common complaint in ophthalmological practice, especially in the elderly, is due to an imbalance between production and drainage of tears
The diagnosis of nasolacrimal duct obstruction (NLDO) was made based on detailed ophthalmic investigations that included slit lamp examination, tear break-up time, and Schirmer tests, syringing to assess lacrimal drainage system (LDS) patency, as well as otorhinolaryngological endoscopic evaluation of the nasal cavity
Afterward simultaneous use of DSG and SPECT/CT combined with DCG was described by our team, where we identified the discrepancy between the passive DSG and actively executed DCG [10]

Summary

Introduction

Excessive tearing known as epiphora, a common complaint in ophthalmological practice, especially in the elderly, is due to an imbalance between production and drainage of tears. Annals of Nuclear Medicine (2019) 33:746–754 pathologic reasons, such as congenital malformations, infections of the eye or nose, traumatic disruption, most frequently by idiopathic inflammatory obstruction [2]. These disorders are clinically characterized by epiphora, purulent discharge, and more or less frequently by sterile or infected dacryocystitis. Scantiness of diagnostic utilizations is unambiguously underpinned by a survey carried out among the members of the American Society of Plastic and Reconstructive Surgery revealing that less than 5% of them applied any pre-operative imaging procedure on patients with assumed nasolacrimal duct obstruction (NLDO) [6]

Objectives

Methods

Results

Discussion

Conclusion