Imaging Non-Specific Wrist Pain: Interobserver Agreement and Diagnostic Accuracy of SPECT/CT, MRI, CT, Bone Scan and Plain Radiographs

Abstract

PurposeChronic hand and wrist pain is a common clinical issue for orthopaedic surgeons and rheumatologists. The purpose of this study was 1. To analyze the interobserver agreement of SPECT/CT, MRI, CT, bone scan and plain radiographs in patients with non-specific pain of the hand and wrist, and 2. to assess the diagnostic accuracy of these imaging methods in this selected patient population.Materials and MethodsThirty-two consecutive patients with non-specific pain of the hand or wrist were evaluated retrospectively. All patients had been imaged by plain radiographs, planar early-phase imaging (bone scan), late-phase imaging (SPECT/CT including bone scan and CT), and MRI. Two experienced and two inexperienced readers analyzed the images with a standardized read-out protocol. Reading criteria were lesion detection and localisation, type and etiology of the underlying pathology. Diagnostic accuracy and interobserver agreement were determined for all readers and imaging modalities. ResultsThe most accurate modality for experienced readers was SPECT/CT (accuracy 77%), followed by MRI (56%). The best performing, though little accurate modality for inexperienced readers was also SPECT/CT (44%), followed by MRI and bone scan (38% each). The interobserver agreement of experienced readers was generally high in SPECT/CT concerning lesion detection (kappa 0.93, MRI 0.72), localisation (kappa 0.91, MRI 0.75) and etiology (kappa 0.85, MRI 0.74), while MRI yielded better results on typification of lesions (kappa 0.75, SPECT/CT 0.69). There was poor agreement between experienced and inexperienced readers in SPECT/CT and MRI. ConclusionsSPECT/CT proved to be the most helpful imaging modality in patients with non-specific wrist pain. The method was found reliable, providing high interobserver agreement, being outperformed by MRI only concerning the typification of lesions. We believe it is beneficial to integrate SPECT/CT into the diagnostic imaging algorithm of chronic wrist pain.

The value of SPECT/CT in carpal boss

“…Nevertheless, there were still a considerable number of patients with discordant findings: absence of local pain despite scintigraphic uptake, or local pain without scintigraphic uptake. These findings reflect one of the known shortcomings of SPECT/CT of the wrist: increased uptake is occasionally found in the absence of any clinical symptoms [8]. Therefore, any uptake in the wrist found with scintigraphic methods demands careful interpretation in the light of clinical examination in order to avoid unnecessary CMC carpometacarpal joint, CRPS complex regional pain syndrome treatment related to an overestimation of imaging findings.…”

“…With SPECT/CT, anatomical detail as well as metabolic activity of bone in wrist diseases is visible in one single examination. Thus, SPECT/CT is increasingly used for the imaging of wrist pathologies [7][8][9][10]. The aim of this study was to assess the value of SPECT/CT in the evaluation of CB.…”

Two decades of SPECT/CT – the coming of age of a technology: An updated review of literature evidence

“…SPECT/CT arthrography has been used for assessment of the scapholunate and lunotriquetral ligament or the triangular fibrocartilage complex [108]. In patients with nonspecific regional pain, SPECT/CT has shown a higher lesion detection rate than X-ray and planar BS [109] and higher specificity than MRI [110].…”

MR Evaluation in non Traumatic Chronic Wrist Pain

“…The method was found reliable, providing high interobserver agreement, being outperformed by MRI only concerning the typification of lesions. It is beneficial to integrate SPECT/CT into the diagnostic imaging algorithm of chronic wrist pain 5…”