Combined single-photon emission computerized tomography and conventional computerized tomography (SPECT/CT): clinical value for the knee surgeons?

Hirschmann, Michael T.; Iranpour, Farhad; Davda, Kinner; Rasch, Helmut; Hügli, Rolf; Friederich, Niklaus F.

doi:10.1007/s00167-009-0879-9

Cited by 66 publications

(71 citation statements)

References 13 publications

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“…SPECT/CT combines structural and metabolic data into one image [6,7], and thus, offers the possibility of evaluating the most important pathological parts of OCD, namely osteonecrosis of the subchondral bone and subsequent separation of the osteochondral fragment from the femoral host bone. To our knowledge, there is no published case yet which deals with the application of SPECT/CT in a patient with OCD.…”

Section: Discussionmentioning

confidence: 99%

“…The SPECT/CT is increasingly recognized by orthopaedic surgeons [6][7][8][9]. With the case presented, we endeavour to highlight the clinical value of SPECT/CT in patients who have previously undergone treatment for osteochondral lesions, e.g.…”

Section: Introductionmentioning

confidence: 96%

“…Frequently the question whether the zone of bone oedema represents a clinically relevant finding remains unanswered [3]. In contrast to MRI, which provides only anatomical data, combined single photon emission computerized tomography and conventional CT (SPECT/CT) additionally provides information about the metabolic state regarding bone healing and integration of the osteochondral fragment [6,7].…”

Section: Introductionmentioning

confidence: 99%

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Clinical benefit of SPECT/CT for follow-up of surgical treatment of osteochondritis dissecans

et al. 2010

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We present the case of a 17-year-old ice-hockey player, who complained about persistent left medial knee pain having undergone a refixation of a grade III osteochondritis dissecans with biodegradable pins, a reconstruction of the anterior cruciate ligament (ACL) and a medial meniscal repair 1 year previously. Sequential MRIs performed 8 and 12 months after surgery were inconclusive, and failed to show the insufficient integration of the osteochondral fragment. Combined single photon emission and conventional computerized tomography (SPECT/CT) clearly revealed the cause of the patient's persistent knee problems-the osteochondral fragment had not integrated. SPECT/CT may hold great clinical value for symptomatic patients who have previously undergone treatment for osteochondral lesions, and it should be considered as alternative diagnostic imaging modality.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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Clinical benefit of SPECT/CT for follow-up of surgical treatment of osteochondritis dissecans

et al. 2010

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“…SPECT/CT is a hybrid imaging modality, which combines a 3D scintigraphy (SPECT) and a conventional computerised tomography (CT) [13]. SPECT/CT allows accurate anatomical localisation of metabolic tracer activity [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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The Painful Total Knee Arthroplasty

Werle

Johnston

Desy

et al. 2021

Evidence‐Based Orthopedics

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Combined single-photon emission computerized tomography and conventional computerized tomography (SPECT/CT): clinical value for the knee surgeons?

Cited by 66 publications

References 13 publications

Clinical benefit of SPECT/CT for follow-up of surgical treatment of osteochondritis dissecans

Clinical benefit of SPECT/CT for follow-up of surgical treatment of osteochondritis dissecans

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

The Painful Total Knee Arthroplasty

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