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Koppula BR, Morton KA, Al-Dulaimi R, Fine GC, Damme NM, Brown RKJ. SPECT/CT in the Evaluation of Suspected Skeletal Pathology. ACTA ACUST UNITED AC 2021; 7:581-605. [PMID: 34698290 PMCID: PMC8544734 DOI: 10.3390/tomography7040050] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/10/2021] [Accepted: 09/16/2021] [Indexed: 01/16/2023]
Abstract
Dedicated multi-slice single-photon emission computed tomography/computed tomography (SPECT/CT) cameras have become widely available and are becoming a mainstay of clinical practice. The integration of SPECT and CT allow for precise anatomic location of scintigraphic findings. Fusion imaging with SPECT/CT can improve both sensitivity and specificity by reducing equivocal interpretation in comparison to planar scintigraphy or SPECT alone. This review article addresses the technique, basic science principles, and applications of integrated SPECT/CT in the evaluation of musculoskeletal pathology.
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Lee Y, Oh D, Han JH, Gong HS, Lee WW. Semiquantitative single-photon-emission computed tomography /computed tomography study to evaluate concomitant ulnar impaction syndrome in patients presenting with triangular fibrocartilage complex tears. PLoS One 2020; 15:e0244256. [PMID: 33362280 PMCID: PMC7757893 DOI: 10.1371/journal.pone.0244256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 12/06/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Patients presenting with tears of the triangular fibrocartilage complex (TFCC) can have ulnar positive variance, for which the clinical relevance to concomitant ulnar impaction syndrome (UIS) may be unclear. We hypothesized that maximum standardized uptake value (SUVmax), a semiquantitative single-photon-emission computed tomography/computed tomography (SPECT/CT) value, would distinguish between the traumatic TFCC tear and degenerative TFCC tear associated with the UIS. This study aimed to compare SUVmax between patients with TFCC tear only and patients with TFCC tear and UIS. Methods A total of 26 patients presenting with TFCC tears on magnetic resonance imaging (MRI) underwent semiquantitative SPECT/CT examinations. The diagnosis of concomitant UIS was made based on positive ulnar impaction tests and MRI findings. We compared the SUVmax between patients with and without concomitant UIS. We also calculated the cutoff value for the diagnosis of UIS using receiver operating characteristic curve analysis. Results Of 26 patients, 14 had concomitant UIS, and 12 had TFCC tears only. The SUVmax was significantly higher in patients with concomitant UIS than in those without UIS (p = 0.048). With a SUVmax cutoff value of 4.09 for UIS, sensitivity of 67% and specificity of 82% were obtained. Conclusions In the semiquantitative SPECT/CT examinations of patients with TFCC tears, those with concomitant UIS had a higher SUVmax than those without UIS. Semiquantitative SPECT/CT can be helpful in confirming concomitant UIS in patients with TFCC tears.
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Affiliation(s)
- Yohan Lee
- Department of Orthopaedic surgery, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dongkyu Oh
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Hee Han
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Sik Gong
- Department of Orthopaedic surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
- * E-mail: (HSG); (WWL)
| | - Won Woo Lee
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
- * E-mail: (HSG); (WWL)
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Single-photon emission computed tomography/computed tomography arthrography of wrist, ankle, and knee joints. Nucl Med Commun 2020; 41:182-188. [DOI: 10.1097/mnm.0000000000001132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mandegaran R, Dhillon S, Jen H. Beyond the bones and joints: a review of ligamentous injuries of the foot and ankle on 99mTc-MDP-SPECT/CT. Br J Radiol 2019; 92:20190506. [PMID: 31365277 DOI: 10.1259/bjr.20190506] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
99mTc-MDP-single photon emission computed tomography (SPECT)/CT has established itself as a useful modality in the assessment of the painful foot and ankle, owing to its ability to depict anatomical and functional information simultaneously. Despite its growing popularity, much of the literature describing the utility of 99mTc-MDP-SPECT/CT of the foot and ankle is limited to osseous and articular pathology, with descriptions of ligamentous pathology limited to just a handful of cases. Though assessment of soft tissues using a combination of bone tracer and CT is limited, with a sound understanding of the regional anatomy, it is certainly within the scope of 99mTc-MDP-SPECT/CT to accurately identify ligamentous injuries based on focal tracer uptake patterns and suspected ligamentous injuries should be reported as such. This article provides a case-based pictorial review of the 99mTc-MDP-SPECT/CT appearances of the various ligamentous injuries of the foot and ankle with case examples and MRI correlation where available, most of which have yet to be described. The typical patterns of bone tracer uptake and associated CT abnormalities that may be observed are discussed.
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Affiliation(s)
- Ramin Mandegaran
- Department of Radiology and Diagnostic Imaging Faculty of Medicine, Dentistry University of Alberta 8440 112 St. NW Edmonton, Alberta, Canada.,Medical Imaging Consultants, Edmonton, Alberta, Canada
| | - Sukhvinder Dhillon
- Department of Radiology and Diagnostic Imaging Faculty of Medicine, Dentistry University of Alberta 8440 112 St. NW Edmonton, Alberta, Canada.,Medical Imaging Consultants, Edmonton, Alberta, Canada
| | - Ho Jen
- Department of Radiology and Diagnostic Imaging Faculty of Medicine, Dentistry University of Alberta 8440 112 St. NW Edmonton, Alberta, Canada.,Medical Imaging Consultants, Edmonton, Alberta, Canada
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Strobel K, van der Bruggen W, Hug U, Gnanasegaran G, Kampen WU, Kuwert T, Paycha F, van den Wyngaert T. SPECT/CT in Postoperative Hand and Wrist Pain. Semin Nucl Med 2018; 48:396-409. [DOI: 10.1053/j.semnuclmed.2018.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Mohan HK, Strobel K, van der Bruggen W, Gnanasegaran G, Kampen WU, Kuwert T, Van den Wyngaert T, Paycha F. The role of hybrid bone SPECT/CT imaging in the work-up of the limping patient: a symptom-based and joint-oriented review. Eur J Hybrid Imaging 2018; 2:8. [PMID: 29782592 PMCID: PMC5954706 DOI: 10.1186/s41824-018-0026-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/17/2018] [Indexed: 12/30/2022] Open
Abstract
A vast spectrum of lower limb bone and joint disorders (hip, knee, ankle, foot) present with a common clinical presentation: limping. Too often this symptom generates an inefficient cascade of imaging studies. This review attempts to optimise the diagnostic effectiveness of bone scintigraphy using the hybrid SPECT/CT technique in relation to the diagnostic clues provided by other imaging modalities, discusses the appropriate clinical indications, optimal scintigraphic procedures and illustrates updated image pattern-oriented reporting. Frequent lower limb bone and joint pathologies that can now be reliably diagnosed using hybrid bone SPECT/CT imaging will be reviewed. Bone SPECT/CT can be an effective problem-solving tool in patients with persistent limping when careful history taking, clinical examination, and first-line imaging modalities fail to identify the underlying cause.
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Affiliation(s)
- H K Mohan
- Department of Nuclear Medicine, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, India
| | - K Strobel
- 2Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - W van der Bruggen
- 3Department of Radiology and Nuclear Medicine, Slingeland Hospital, Doetinchem, The Netherlands
| | - G Gnanasegaran
- 4Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - W U Kampen
- Nuclear Medicine Spitalerhof, Hamburg, Germany
| | - T Kuwert
- 6Clinic of Nuclear Medicine, University Hospital Erlangen, Erlangen, Germany
| | - T Van den Wyngaert
- 7Department of Nuclear Medicine, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium.,8Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - F Paycha
- 9Department of Nuclear Medicine, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
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Allgayer M, Hug U, Roos JE, del Sol Pérez Lago M, Wild D, Lehnick D, Strobel K. Prevalence and prognostic value of increased uptake in bone SPECT/CT in asymptomatic wrists. Eur J Hybrid Imaging 2018. [DOI: 10.1186/s41824-017-0020-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Bhure U, Roos JE, Pérez Lago MDS, Steurer I, Grünig H, Hug U, Strobel K. SPECT/CT arthrography. Br J Radiol 2017; 91:20170635. [PMID: 29099611 DOI: 10.1259/bjr.20170635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Single photon emission CT (SPECT)/CT arthrography, the combination of CT arthrography and late phase bone SPECT/CT, has been developed in 2011 and so far used in knee, ankle and wrist joints. SPECT/CT offers functional information about increased bone turnover in combination with morphological details. Compared with SPECT/CT alone, additional intra-articular contrast enables the assessment of cartilage, menisci, ligaments and loose bodies. SPECT/CT arthrography is a promising alternative technique for the evaluation of internal derangement of joints in patients with MR contraindications and/or metallic implants. In this article, we review and report our 5-year experience with this technique illustrated with patient examples and give a perspective for future applications.
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Affiliation(s)
- Ujwal Bhure
- 1 Nuclear Medicine and Radiology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Justus E Roos
- 1 Nuclear Medicine and Radiology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | | | - Isabelle Steurer
- 1 Nuclear Medicine and Radiology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Hannes Grünig
- 1 Nuclear Medicine and Radiology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Urs Hug
- 2 Department of Hand and Plastic Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Klaus Strobel
- 1 Nuclear Medicine and Radiology, Cantonal Hospital Lucerne, Lucerne, Switzerland
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Corre AL, Huynh KP, Dhaliwal RS, Bain GI. Development of a Protocol for SPECT/CT in the Assessment of Wrist Disorders. J Wrist Surg 2016; 5:297-305. [PMID: 27777821 PMCID: PMC5074841 DOI: 10.1055/s-0036-1583314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 03/28/2016] [Indexed: 10/21/2022]
Abstract
Background Single-photon emission computed tomography and computed tomography (SPECT/CT) is a hybrid diagnostic imaging modality that allows clinicians to integrate their diagnostic evaluations and deliver a definitive diagnosis in musculoskeletal disorders. Specifically, in identification of osseous pathology, the conventional bone scan delivers greater specificity compared with magnetic resonance imaging (MRI). However, use of SPECT/CT enhances the sensitivity and specificity. Use of this modality denotes the possibility to specify the lesion more accurately and precisely while grading the activity according to osseous structural changes. Purpose This study aimed to evaluate the clinical utility of SPECT/CT in the diagnoses and management of osseous wrist disorders. The objectives were to examine the value of SPECT/CT in the diagnosis of osseous-related wrist pain and whether the findings altered management. Patients and Methods A retrospective cohort study of 20 patients with such wrist pain was conducted. SPECT/CT was used in the diagnostic process for these patients. Results Following SPECT/CT imaging, the common final diagnoses were osteoarthritis (10; 50%) and avascular necrosis (5; 25%). Less common diagnoses included ulnar carpal impact syndrome, infection, malunion, complex regional pain syndrome, and carpal boss. Some presented with multiple pathologies. SPECT/CT changed the final diagnosis in 11 cases, resulting in nonoperative treatment (7; 63%) or surgery (4; 37%). Conclusion Findings from this study and the literature demonstrate the clinical utility of SPECT/CT in the assessment of osseous-related wrist disorders. We present an algorithm for the assessment of wrist pain with osseous pathology. This commences with clinical assessment and plane radiographs (first-line investigation). Some cases will require a second-line investigation (ultrasound, CT, and/or MRI). If the diagnosis remains unclear, SPECT/CT is recommended as a third-line investigation.
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Affiliation(s)
- Aude Le Corre
- Clinique Jeanne d'Arc, Institut de la Main, Nantes, France
| | - Kym Phuong Huynh
- School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | | | - Gregory Ian Bain
- School of Medicine, Flinders University, Adelaide, South Australia, Australia
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Hafezi-Nejad N, Carrino JA, Eng J, Blackmore C, Shores J, Lifchez SD, Farahani SJ, Demehri S. Scapholunate Interosseous Ligament Tears: Diagnostic Performance of 1.5 T, 3 T MRI, and MR Arthrography-A Systematic Review and Meta-analysis. Acad Radiol 2016; 23:1091-103. [PMID: 27426979 DOI: 10.1016/j.acra.2016.04.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 04/05/2016] [Indexed: 01/20/2023]
Abstract
RATIONALE AND OBJECTIVES The study aimed to perform a systematic review and meta-analysis for evaluating the diagnostic accuracy of 1.5 Tesla and 3.0 Tesla magnetic resonance imaging (MRI), and magnetic resonance arthrography (MRA), in the detection of scapholunate interosseous ligament (SLIL) injury. MATERIALS AND METHODS A literature search was performed (until July 2015) using the PubMed (MEDLINE), Embase, ISI Web of Science, Scopus, and conference proceedings. Original studies evaluating the diagnostic accuracy of MRI or MRA in the detection of SLIL injuries using arthroscopy or open surgery as the reference standard were included. RESULTS Of the initial 930 published records and 103 conference proceedings, 24 studies (1902 MRI examinations) were included (median SLIL injury prevalence: 33% [interquartile range: 25-42]). Heterogeneity was detected for 1.5 T MRI (chi-square: 47.93, P < 0.001) but not for 3.0 T MRI (chi-square: 8.00, P value: 0.09) and MRA (chi-square: 14.54, P value: 0.34) studies. The sensitivities of 1.5 T MRI, 3.0 T MRI, and MRA for detection of SLIL injury were 45.7% (95% confidence interval: 40.1-51.4), 75.7% (66.8-83.2), and 82.1% (76.1-87.2), respectively. The specificities of 1.5 T MRI, 3.0 T MRI, and MRA for detection of SLIL injury were 80.5% (77.3-83.4), 97.1% (89.8-99.6), and 92.8% (90.2-94.9), respectively. The diagnostic odds ratios of 1.5 T MRI, 3.0 T MRI, and MRA for detection of SLIL injury were 5.56 (2.71-11.39), 23.23 (3.16-171.00), and 65.04 (32.89-128.62) (P value < 0.001), respectively. The results were consistent after addressing publication bias and sensitivity analyses. CONCLUSIONS MRA is superior to 3.0 T MRI, and 3.0 T MRI is superior to 1.5 T MRI in terms of diagnostic performance. 3.0 T MRI has the highest specificity for the detection of SLIL injuries.
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Affiliation(s)
- Nima Hafezi-Nejad
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 601 N Caroline St, JHOC 4240, Baltimore, MD 21287.
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - John Eng
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 601 N Caroline St, JHOC 4240, Baltimore, MD 21287
| | - Craig Blackmore
- The Center for Healthcare Improvement Science and Department of Radiology, Virginia Mason Medical Center, Seattle, Washington
| | - Jaimie Shores
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Scott D Lifchez
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Sahar Jalali Farahani
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 601 N Caroline St, JHOC 4240, Baltimore, MD 21287
| | - Shadpour Demehri
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 601 N Caroline St, JHOC 4240, Baltimore, MD 21287
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Bhure U, Hug U, Huellner MW, Grünig H, Zander A, del Sol Pérez Lago M, Strobel K. The value of SPECT/CT in carpal boss. Eur J Nucl Med Mol Imaging 2015; 42:1883-90. [DOI: 10.1007/s00259-015-3151-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/20/2015] [Indexed: 11/28/2022]
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