Clinical interest of quantitative bone SPECT-CT in the preoperative assessment of knee osteoarthritis

Laroche, Romain; Simon, Erwan; Suignard, Nicolas; Williams, Thomas; Henry, M.; Robin, Philippe; Abgral, Ronan; Bourhis, David; Salaun, Pierre–Yves; Dubrana, F.; Querellou, Solène

doi:10.1097/md.0000000000011943

Cited by 28 publications

(19 citation statements)

References 22 publications

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“…The added radiation dose from the low-dose CT is typically not significant. With newer SPECT/CT machines, calculation of Standardized Uptake Values (SUV) is feasible and could further enhance quantitative assessment (22,23).…”

Section: Discussionmentioning

confidence: 99%

Feasibility of dual-phase 99mTc-MDP SPECT/CT imaging in rheumatoid arthritis evaluation

Abdelhafez

Godinez

Sood³

et al. 2021

Quant Imaging Med Surg

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Background: To prospectively demonstrate the feasibility of performing dual-phase SPECT/CT for the assessment of the small joints of the hands of rheumatoid arthritis (RA) patients, and to evaluate the reliability of the quantitative and qualitative measures derived from the resulting images.Methods: A SPECT/CT imaging protocol was developed in this pilot study to scan both hands simultaneously in participants with RA, in two phases of 99m Tc-MDP radiotracer uptake, namely the softtissue blood pool phase (within 15 minutes after radiotracer injection) and osseous phase (after 3 hours).Joints were evaluated qualitatively (normal vs. abnormal uptake) and quantitatively [by measuring a newly developed metric, maximum corrected count ratio (MCCR)]. Qualitative and quantitative evaluations were repeated to assess reliability.Results: Four participants completed seven studies (all four were imaged at baseline, and three of them at follow-up after 1-month of arthritis therapy). A total of 280 joints (20 per hand) were evaluated. The MCCR from soft-tissue phase scans was significantly higher for clinically abnormal joints compared to clinically normal ones; P<0.001, however the MCCR from the osseous phase scans were not different between the two joint groups. Intraclass Correlation Coefficient (ICC) for MCCR was excellent [0.9789, 95% confidence interval (CI): 0.9734-0.9833]. Intra-observer agreement for qualitative SPECT findings was substantial for both the soft-tissue phase (kappa =0.78, 95% CI: 0.72-0.83) and osseous-phase (kappa =0.70, 95% CI: 0.64-0.76) scans.Conclusions: Extracting reliable quantitative and qualitative measures from dual-phase 99mTc-MDP SPECT/CT hand scans is feasible in RA patients. SPECT/CT may provide a unique means for assessing both synovitis and osseous involvement in RA joints using the same radiotracer injection.

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Section: Discussionmentioning

confidence: 99%

Feasibility of dual-phase 99mTc-MDP SPECT/CT imaging in rheumatoid arthritis evaluation

Abdelhafez

Godinez

Sood³

et al. 2021

Quant Imaging Med Surg

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“…It provides incremental values in the evaluation of knee pain over other radionuclide imaging, such as a planar bone scan or SPECT alone, and now increasingly used in patients who present with knee pain or considered the candidate of arthroplasty. [ 18 ]…”

Section: Discussionmentioning

confidence: 99%

Predicting outcome of repair of medial meniscus posterior root tear with early osteoarthritis using bone single-photon emission computed tomography/computed tomography

et al. 2020

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Repair of medial meniscus posterior root tear (MMPRT) is considered as an effective early intervention strategy for osteoarthritis. We aimed at evaluating whether or not single-photon emission computed tomography/computed tomography (SPECT/CT) could predict the treatment outcome. Eleven patients with MMPRT who underwent preoperative SPECT/CT were retrospectively enrolled. Clinical symptoms were evaluated based on the knee injury and osteoarthritis outcome score (KOOS) and visual analogue scale (VAS) for pain. The uptake pattern of the medial tibial plateau (MTP) on SPECT/CT was visually assessed. Additionally, the maximum lesion-to-cortical counts ratio (LCR max ) for the anterior and posterior aspects of MTP and anterior-posterior MTP ratio (APR) were quantitatively assessed. Spearman correlation analyses were performed between the change in clinical symptom scores and preoperative SPECT/CT patterns. All patients showed increased radiotracer uptake in MTP. Among them, 8 (73%) showed dominant uptake in the anterior aspect of MTP. The rest 3 (27%) showed posterior-dominant uptake. Patients with anterior-dominant patterns tended to show better outcomes in terms of the postoperative KOOS score ( P = .07). Anterior MTP LCR max showed a negative correlation with the change in VAS (ρ = −0.664, P < .03). APR showed a correlation with the change in the KOOS score (ρ = 0.655, P < .03). Patients with MMPRT with relatively higher uptake in the anterior aspect of MTP could have better clinical outcomes after the repair. The preoperative SPECT/CT pattern may have a predictive value in selecting patients with good postoperative outcomes.

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“…A significant amount of work is required by the scientific community to generate evidence for the former. Unlike the case for PET, demonstrable clinical benefit has not been observed in longitudinal or cross-sectional form for quantitative SPECT yet (Al-Riyami et al 2018 ; De Laroche et al 2018 ). Assessments of correlations between quantitative results and certain clinical outcomes would provide results that throw the most weight behind quantitative SPECT’s cause (e.g.…”

Section: Obstaclesmentioning

confidence: 99%

Does quantification have a role to play in the future of bone SPECT?

Ross

Vilić

Sanderson

et al. 2019

European J Hybrid Imaging

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Routinely, there is a visual basis to nuclear medicine reporting: a reporter subjectively places a patient's condition into one of multiple discrete classes based on what they see. The addition of a quantitative result, such as a standardised uptake value (SUV), would provide a numerical insight into the nature of uptake, delivering greater objectivity, and perhaps improved patient management. For bone scintigraphy in particular quantification could increase the accuracy of diagnosis by helping to differentiate normal from abnormal uptake. Access to quantitative data might also enhance our ability to characterise lesions, stratify and monitor patients' conditions, and perform reliable dosimetry for radionuclide therapies. But is there enough evidence to suggest that we, as a community, should be making more effort to implement quantitative bone SPECT in routine clinical practice? We carried out multiple queries through the PubMed search engine to facilitate a crosssectional review of the current status of bone SPECT quantification. Highly cited papers were assessed in more focus to scrutinise their conclusions. An increasing number of authors are reporting findings in terms of metrics such as SUV max. Although interest in the field in general remains high, the rate of clinical implementation of quantitative bone SPECT remains slow and there is a significant amount of validation required before we get carried away.

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Clinical interest of quantitative bone SPECT-CT in the preoperative assessment of knee osteoarthritis

Cited by 28 publications

References 22 publications

Feasibility of dual-phase 99mTc-MDP SPECT/CT imaging in rheumatoid arthritis evaluation

Feasibility of dual-phase 99mTc-MDP SPECT/CT imaging in rheumatoid arthritis evaluation

Predicting outcome of repair of medial meniscus posterior root tear with early osteoarthritis using bone single-photon emission computed tomography/computed tomography

Does quantification have a role to play in the future of bone SPECT?

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