Evaluation of patients with painful total hip arthroplasty using combined single photon emission tomography and conventional computerized tomography (SPECT/CT) – a comparison of semi-quantitative versus 3D volumetric quantitative measurements

Abstract

BackgroundIt was the primary purpose of our study to evaluate the inter- and intra-observer reliability of a standardized SPECT/CT algorithm for evaluating patients with painful primary total hip arthroplasty (THA). The secondary purpose was a comparison of semi-quantitative and 3D volumetric quantification method for assessment of bone tracer uptake (BTU) in those patients.MethodsA novel SPECT/CT localization scheme consisting of 14 femoral and 4 acetabular regions on standardized axial and coronal slices was introduced and evaluated in terms of inter- and intra-observer reliability in 37 consecutive patients with hip pain after THA. BTU for each anatomical region was assessed semi-quantitatively using a color-coded Likert type scale (0-10) and volumetrically quantified using a validated software. Two observers interpreted the SPECT/CT findings in all patients two times with six weeks interval between interpretations in random order. Semi-quantitative and quantitative measurements were compared in terms of reliability. In addition, the values were correlated using Pearson`s correlation. A factorial cluster analysis of BTU was performed to identify clinically relevant regions, which should be grouped and analysed together.ResultsThe localization scheme showed high inter- and intra-observer reliabilities for all femoral and acetabular regions independent of the measurement method used (semiquantitative versus 3D volumetric quantitative measurements). A high to moderate correlation between both measurement methods was shown for the distal femur, the proximal femur and the acetabular cup. The factorial cluster analysis showed that the anatomical regions might be summarized into three distinct anatomical regions. These were the proximal femur, the distal femur and the acetabular cup region.ConclusionsThe SPECT/CT algorithm for assessment of patients with pain after THA is highly reliable independent from the measurement method used. Three clinically relevant anatomical regions (proximal femoral, distal femoral, acetabular) were identified.

Standardized Uptake Value Using Thyroid Quantitative SPECT/CT for the Diagnosis and Evaluation of Graves’ Disease: A Prospective Multicenter Study

“…Generally, in traditional nuclear medicine imaging, single photon emission computed tomography (SPECT) modality has been used for qualitative diagnosis by visual evaluation of radioactive distribution. For quantitative analysis, the target/nontarget (T/NT) ratio calculated from counts of their regions of interest (ROI) was widely used in SPECT modality, which was known as the semiquantitative analysis [1, 2]. Positron emission tomography (PET) was regarded as the only modality capable of absolute quantitative analysis in the past [3–5].…”

Systematic Review on Reproducibility of Nuclear Imaging in the Assessment of Painful Hip and Knee Replacements

“…A previous study showed that when SPECT/CT was added, inter-observer agreement regarding the location of infectious foci increased from κ = 0.68 to κ = 1.0 in in the assessment of osteomyelitis [11]. In agreement with the first clinical studies, 4 studies demonstrated "excellent" intra-and inter-observer agreement when SPECT/CT was added in the interpretation of symptomatic hip and knee arthroplasties [30][31][32][33]. However, these studies did not correlate the nuclear imaging results with surgical findings or clinical follow-up whether the prosthesis was loose or not.…”

Accuracy comparison of various quantitative [99mTc]Tc-DPD SPECT/CT reconstruction techniques in patients with symptomatic hip and knee joint prostheses

“…Only few studies investigated the relative intensity of periprosthetic bone metabolism with bone scintigraphy and bone SPECT/CT referencing the periprosthetic activity with ROIs of the femur [ 15 – 17 ] and found a good interreader agreement for such a standardized protocol [ 16 , 17 ]. To our knowledge, there is only one available study applying quantification of periprosthetic uptake for the diagnosis of aseptic loosening published 2008 by Klett et al [ 15 ].…”

“…The main focus of the diagnostic criteria of prosthetic loosening in SPECT/CT lies in the distribution of elevated bone metabolism around the prosthetic implant. Only few studies investigated the diagnostic value of uptake intensity of periprosthetic bone [ 15 – 17 ] with promising results although only relative semiquantitative uptake measures were used. Recently, a new generation of SPECT/CT scanners and reconstruction algorithms of SPECT data was introduced that allows the absolute quantification of tracer uptake [ 18 ] in clinical routine.…”