Initial experience of SPECT/CT in the diagnosis of occult scaphoid fracture

Abstract

Background *Equal contributors.Planar bone scintigraphy (PBS) is often advocated for diagnosing occult scaphoid fractures. PBS is a sensitive diagnostic modality, but lacks specificity, which may result in over-diagnosis.PurposeTo examine, in a pilot study, the potential additional value of single photon emission computed tomography (SPECT) combined with low dose computed tomography (CT) for the diagnosis of an occult scaphoid fracture.Material and MethodsTen patients that underwent combined PBS and SPECT/CT for a clinically suspected scaphoid fracture, where radiographs could not detect a fracture, were included in this pilot study. The PBS and SPECT/CT results were independently and separately evaluated by a nuclear physician for scaphoid fractures and other injuries.ResultsPBS was positive for a scaphoid fracture in four patients and diagnosed three other fractures. SPECT/CT showed five scaphoid fractures and one other fracture. SPECT/CT – PBS had discrepant results in three patients. In two patients PBS diagnosed a trapezoid fracture where SPECT/CT showed a scaphoid fracture. The other patient was diagnosed with a scaphoid fracture on PBS, whereas SPECT/CT showed bone bruise of other carpal bones.ConclusionSPECT/CT has the potential to be more accurate than PBS as it uses anatomical information of the CT to discriminate between the scaphoid, other carpal bones, and bone bruises. Larger studies with an independent reference standard are needed for confirmation of these preliminary data.

Occult capitate fracture through a bone island – SPECT/CT arthrography imaging

“…1% of all fractures) and often difficult to diagnose with conventional imaging. De Zwart et al compared SPECT/CT to planar bone scintigraphy in ten patients with carpal trauma and found more accurate anatomic description of fractures with SPECT/CT in three patients (de Zwart et al, 2015). Allainmat et al confirmed the superiority of SPECT/CT in the detection of posttraumatic bone lesions after carpal injury (Allainmat et al, 2013).…”

SPECT/CT: an update on technological developments and clinical applications

“…In their study, they demonstrated that the use of SPECT/CT-correlated images provided a definite diagnosis in 92% of skeleton lesions otherwise classified as indeterminate on using only SPECT. In a recent article, de Zwart et al 49 showed SPECT/CT to have a potential of being more accurate than planar scintigraphy imaging, as it uses anatomical information of the CT to discriminate among the scaphoid, other carpal bones and bone bruises. They concluded that SPECT/CT is superior to planar bone scintigraphy in the detection of occult fractures and presents additional information about the injury site and localization of the fracture, and the method could potentially serve as a future reference standard for studies concerning scaphoid fractures.…”