Clinical Value of Combined Single Photon Emission Computerized Tomography and Conventional Computer Tomography (SPECT/CT) in Sports Medicine

Hirschmann, Michael T.; Davda, Kinner; Rasch, Helmut; Arnold, Markus; Friederich, Niklaus F.

doi:10.1097/jsa.0b013e3181ec8707

Cited by 61 publications

(51 citation statements)

References 19 publications

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“…In our own work, we have demonstrated that SPECT/CT is able to detect symptomatic bipartite patella in patients with knee problems (Hirschmann et al 2011b ). In the case presented here, the patient, who is a world-class downhill skier, suffered from osteoarthritis of the fabellar bone in his knee, which was unambiguously identifi ed.…”

Section: Accessory Bonesmentioning

confidence: 96%

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Nuclear Medicine Imaging of Knee Injuries

Hirschmann

Forrer

Testa

et al. 2015

Nuclear Medicine and Radiologic Imaging in Sports Injuries

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Section: Accessory Bonesmentioning

confidence: 96%

“…The most common accessory bones of the knee are the fabella and bi-or multipartite patella (Hirschmann et al 2011b ). In our own work, we have demonstrated that SPECT/CT is able to detect symptomatic bipartite patella in patients with knee problems (Hirschmann et al 2011b ).…”

Section: Accessory Bonesmentioning

confidence: 98%

Nuclear Medicine Imaging of Knee Injuries

Hirschmann

Forrer

Testa

et al. 2015

Nuclear Medicine and Radiologic Imaging in Sports Injuries

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“…With SPECT-CT, we are able to interpret subtle, vague abnormalities on bone scans as specifi c focal areas of pathology. SPECT-CT has provided new indications for bone scintigraphy and is increasingly recognized as a promising diagnostic tool in orthopedic conditions (Scharf 2009 ) and sports injuries (Hirschmann et al 2011 ), especially in complex bony structures as the foot and ankle. Recently, hybrid systems capable of acquiring high-resolution multislice CT images have been developed, which will further increase the diagnostic accuracy ( Fig.…”

Section: Introductionmentioning

confidence: 99%

Nuclear Medicine Imaging of Foot Injuries

Arias-Bouda

Smit

2015

Nuclear Medicine and Radiologic Imaging in Sports Injuries

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In sports medicine, foot disorders present a signifi cant clinical challenge due to the complex anatomy and function of the foot. Injuries are complex involving soft tissue as well as bony structures. Bone scintigraphy is a sensitive technique, which provides essential functional information which correlates better with clinical symptoms and treatment response than anatomical abnormalities. It is a useful tool to detect conditions affecting the bony structures of the foot in an early phase, but can also be helpful in the initial evaluation of soft tissue injuries. MRI though remains better in delineating most soft tissue injuries. The emergence of SPECT-CT has increased the accuracy of bone scintigraphy. This is particularly true for the recently developed hybrid systems, which are capable of

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“…SPECT/CT allows accurate anatomical localisation of metabolic tracer activity [9]. Recently, we have introduced a novel diagnostic SPECT/CT algorithm for the challenging group of patients with problems after ACL reconstruction [6,9,14,15]. This standardised algorithm including grading and anatomical localization of SPECT/CT tracer uptake promises the identification of specific pathological tracer uptake patterns and distributions [9].…”

Section: Introductionmentioning

confidence: 99%

“…The intensity and distribution of 99mTc-HDP-SPECT/ CT tracer, which as diphosphonate is targeted towards osteoblastic activity, is influenced by mechanical or anatomical alignment, vascular supply, infection, osteoblastic activity or currently unknown other factors [9,13,14,[16][17][18][19]. In patients after ACL reconstruction it could be hypothesized if the position and orientation of the bone tunnels and the stability and/or laxity of the knee joint are decisive factors.…”

Section: Introductionmentioning

confidence: 99%

SPECT/CT tracer uptake is influenced by tunnel orientation and position of the femoral and tibial ACL graft insertion site

Hirschmann

Mathis

Rasch

et al. 2012

International Orthopaedics (SICOT)

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Purpose SPECT/CT is a hybrid imaging modality, which combines a 3D scintigraphy (SPECT) and a conventional computerised tomography (CT). SPECT/CT allows accurate anatomical localisation of metabolic tracer activity. It allows the correlation of surgical factors such as tunnel position and orientation with mechanical alignment, clinical outcome and biological factors. The purpose of this study was to investigate whether the SPECT/CT tracer uptake (intensity and distribution) correlates with the stability and laxity of the knee joint and the position and orientation of the tibial and femoral tunnels in patients after anterior cruciate ligament (ACL) reconstruction. Methods A consecutive series of knees (n066), with symptoms of pain and/or instability after ACL reconstruction were prospectively evaluated using clinical examination and 99mTc-HDP-SPECT/CT. Clinical laxity testing was performed using the Rolimeter (Ormed, Freiburg, Germany) including Lachman testing (0-2 mm, 3-5 mm, 6-10 mm, >10 mm), anterior drawer test (0-2 mm, 3-5 mm, 6-10 mm, >10 mm), pivot shift test (positive versus negative) and patientbased subjective instability (yes versus no).For analysis of SPECT/CT tracer uptake a previously validated SPECT/CT localisation scheme consisting of 17 tibial, nine femoral and four patellar regions on standardised axial, coronal, and sagittal slices was used. The tracer activity on SPECT/CT was localised and recorded using a 3D volumetric and quantitative analysis software.Mean, standard deviation, minimum and maximum of grading for each area of the localisation scheme were recorded. The position and orientation of the tibial and femoral tunnel was assessed using a previously published method on 3D-CT. Results Correlation of instability, pivot shift as well as clinical laxity testing with 99mTc-HDP-SPECT/CT tracer uptake intensity and distribution showed no significant correlation. 99mTc-HDP-SPECT/CT tracer uptake correlated significantly with the position and orientation of the ACL graft. A more horizontal femoral graft position showed significantly increased tracer uptake within the superior and posterior femoral regions. A more posteriorly-placed femoral insertion site showed significantly more tracer uptake within the femoral and tibial tunnel regions. A more vertical or a less medial tibial tunnel orientation showed significant increased uptake within the tibial and femoral tunnel regions. A more anterior tibial tunnel position showed significantly more tracer uptake in the femoral and tibial tunnel regions as well as the entire tibiofemoral joint. Conclusions SPECT/CT tracer uptake intensity and distribution showed a significant correlation with the femoral and tibial tunnel position and orientation in patients with symptomatic knees after ACL reconstruction. No correlation was found with stability or clinical laxity.Michael T. Hirschmann and Dominic Mathis contributed equally to this paper.

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Clinical Value of Combined Single Photon Emission Computerized Tomography and Conventional Computer Tomography (SPECT/CT) in Sports Medicine

Cited by 61 publications

References 19 publications

Nuclear Medicine Imaging of Knee Injuries

Nuclear Medicine Imaging of Knee Injuries

Nuclear Medicine Imaging of Foot Injuries

SPECT/CT tracer uptake is influenced by tunnel orientation and position of the femoral and tibial ACL graft insertion site

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