SPECT/CT in Postoperative Foot and Ankle Pain

Kampen, Willm Uwe; Westphal, Florian; Wyngaert, Tim Van den; Strobel, Klaus; Kuwert, Torsten; Bruggen, Wouter van der; Gnanasegaran, Gopinath; Jens, Jan-Hauke; Paycha, F.

doi:10.1053/j.semnuclmed.2018.03.003

Cited by 30 publications

(18 citation statements)

References 46 publications

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“…Planar scintigraphy and single-photon emission computed tomography/computed tomography (SPECT/CT) are increasingly used and are indeed cost-effective advanced imaging techniques for the evaluation of bone and joint diseases (Gnanasegaran et al, 2009 ; Scharf, 2009 ; Van den Wyngaert et al, 2018a ; Van den Wyngaert et al, 2016 ). SPECT/CT has been shown to be useful in the postoperative setting to evaluate healing or complications like infection, loosening or non-union after implantation of various metallic implants for arthrodesis, fracture stabilization or joint replacement with arthroplasties (Gnanasegaran et al, 2018 ; Kampen et al, 2018 ; Van den Wyngaert et al, 2018b ; van der Bruggen et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Impact of metal implants on xSPECT/CT Bone reconstruction: the “shining metal artefact”

Lima

Lago

Thali

et al. 2020

European J Hybrid Imaging

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Background Novel reconstruction algorithms, such as xSPECT Bone, are gaining more and more importance in Nuclear Medicine. With xSPECT Bone, the reconstructed emission image is enhanced by the information obtained in the corresponding CT image. The CT defines tissue classes according to the Hounsfield units. In the iterative reconstruction, each tissue class is handled separately in the forward projection step, and all together in the back projection step. As a consequence, xSPECT Bone reconstruction generates images with improved boundary delineation and better anatomic representation of tracer activity. Applying this technique, however, showed that artefacts may occur, when no uptake regions, like metal implants, exhibit fictitious uniform tracer uptake. Due to limitations in spatial resolution in gamma cameras, the xSPECT Bone reconstructed image resulted in spill-out activity from surrounding high uptake region being uniformly distributed over the metal implants. This new technology of xSPECT Bone reconstruction in general enhances the image quality of SPECT/CT; however, the potential introduction of specific artefacts which inadvertently come along with this new technology and their frequency have not yet been addressed in the literature. Therefore, the purpose of this work was to identify and characterize these specific metal artefacts (the so-called shining metal artefact) in order to reduce false positives and avoid potentially misdiagnosing loosened or infected implants. Case presentation In this work, we report five cases imaged with bone SPECT/CT of 5 anatomical regions (foot, elbow, spine, shoulder, ribs and knee). All cases demonstrated “shining metal artefacts” in xSPECT Bone reconstruction. Conclusion While xSPECT Bone reconstruction algorithm significantly improves image quality for the diagnosis of bone and joint disorders with SPECT/CT, specific “shining metal artefacts” caused by the xSPECT Bone have to be recognized in order to avoid image misinterpretation suggesting metallic implant loosening or possible infection. The simultaneous analysis of conventionally reconstructed SPECT images (for Siemens the Flash3D reconstruction) helps to avoid misinterpretation of potential artefacts introduced by xSPECT Bone reconstruction.

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Section: Introductionmentioning

confidence: 99%

Impact of metal implants on xSPECT/CT Bone reconstruction: the “shining metal artefact”

Lima

Lago

Thali

et al. 2020

European J Hybrid Imaging

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Section: Discussionmentioning

confidence: 99%

“…4 Currently, there is a lack of clinical studies assessing SPECT/CT and its role in pain evaluation preoperatively and postoperatively after arthrodesis surgery of the ankle. 5 Thus, the goal of our study was to evaluate the use of SPECT/CT imaging in patients who underwent ankle arthrodesis for end-stage arthritis and evaluate if there was any relationship with functional outcome scores. Comparable to a prior study by Pagenstert et al, 11 we found almost perfect interobserver reliabilities for SPECT/ CT for the ankle joint and substantial interobserver reliability for the subtalar and talonavicular joint interpretation.…”

Section: Discussionmentioning

confidence: 99%

“…6 While there are studies looking at the use of SPECT/CT to diagnostically assess patients with foot and ankle pain, there are limited studies looking at SPECT/CT activity and progression in conjunction with pain and functional outcome scores in patients with ankle arthritis. 5 Gross et al, 4 in a study of 85 patients with ankle arthritis undergoing supramalleolar osteotomy, showed a relationship between clinical and functional scores and radiotracer uptake. We found no study that has specifically looked at the use of SPECT/ CT in conjunction with clinical and functional scores in patients with end-stage ankle arthritis undergoing ankle arthrodesis.…”

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confidence: 98%

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Preliminary Experience With SPECT/CT to Evaluate Periarticular Arthritis Progression and the Relationship With Clinical Outcome Following Ankle Arthrodesis

et al. 2020

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Background: Single photon emission computed tomography combined with computed tomography (SPECT/CT) could potentially aid in diagnosing periarticular arthritis/activity and progression, facilitate effective treatment options, and evaluate the effect surgery has on the clinical outcome of patients with ankle arthritis. The goal of our study was to assess SPECT/CT activity in the ankle and periarticular joints before and after ankle fusion surgery and determine whether it was associated with clinical pain and function scores. Methods: Thirty-four patients recruited into this study underwent either arthroscopic or open ankle fusion. X-ray (XR) and SPECT/CT imaging was obtained as well as completion of patient Ankle Osteoarthritis Scale (AOS) and 36-item Short Form Survey (SF-36) questionnaires preoperatively and at 6 months postoperatively. Ankle, subtalar, and talonavicular joint arthritis grading on XR and CT, along with SPECT/CT activity, was evaluated by 2 nuclear medicine radiologists. Data were assessed for normality and analyzed with the appropriate comparative test. P value was set at <.05. Thirty patients (31 ankles) completed follow-up and were analyzed. Results: SPECT/CT activity showed no significant difference in the ankle joint at 6 months postoperatively while periarticular joint activity significantly increased ( P < .05). Six months postoperatively, patients had significant improvements in their AOS and SF-36 scores ( P < .05). SPECT/CT grading of all joints analyzed, however, was not associated with AOS or SF-36 scores preoperatively or at 6 months postoperatively. Conclusion: In this study, intensity of activity as evaluated by SPECT/CT in periarticular hindfoot joints in patients who had ankle arthrodesis was not associated with clinical/functional scores at 6 months postoperatively. Level of Evidence: Level IV, diagnostic study.

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“…A consistent and relevant impact on patient management has been demonstrated, with the potential for health-care cost savings, making SPECT/CT part of the routine diagnostic algorithm for patients with pain after primary total-knee arthroplasty according to some leading groups (25,26). Exciting results are emerging in other postoperative skeletal settings, including the spine, the hip, and hand or foot pain as well (27)(28)(29). Further progress will require novel radiopharmaceuticals offering improved pharmacokinetics (e.g., next-generation radiobisphosphonates) or visualizing specific causes such as infection (e.g., 99m Tc-UBI-29-4), as further discussed below.…”

Section: Leveraging the Full Diagnostic Power Of Spect/ctmentioning

confidence: 99%

SPECT/CT: Standing on the Shoulders of Giants, It Is Time to Reach for the Sky!

et al. 2020

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Twenty years ago, SPECT/CT became commercially available, combining the strengths of both techniques: the diagnostic sensitivity of SPECT and the anatomic detail of CT. Other benefits initially included attenuation correction of SPECT reconstructions, ultimately evolving to correction techniques that would enable absolute tracer uptake quantification. Recent developments in SPECT hardware include solid-state digital systems with higher sensitivity and resolution, using novel collimator designs based on tungsten. Similar advances in CT technology have been introduced in hybrid SPECT/ CT systems, replacing low-end x-ray tubes with high-end multislice CT scanners equipped with iterative reconstruction, metal artifact reduction algorithms, and dual-energy capabilities. More recently, the design of whole-body SPECT/CT systems has taken another major leap with the introduction of a ring-shaped gantry equipped with multiple movable detectors surrounding the patient. These exciting developments have fueled efforts to develop novel SPECT radiopharmaceuticals, creating new chelators and prosthetic groups for radiolabeling. Innovative SPECT radionuclide pairs have now become available for radiolabeling with the potential for use as theranostic agents. The growth of precision medicine and the associated need for accurate radionuclide treatment dosimetry will likely drive the use of SPECT/CT in the near future. In addition, expanding clinical applications of SPECT/CT in other areas such as orthopedics offer exciting opportunities. Although it is true that the SPECT/CT ecosystem has seen several challenges during its development over the past 2 decades, it is now a feature-rich and mature tool ready for clinical prime time.

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SPECT/CT in Postoperative Foot and Ankle Pain

Cited by 30 publications

References 46 publications

Impact of metal implants on xSPECT/CT Bone reconstruction: the “shining metal artefact”

Impact of metal implants on xSPECT/CT Bone reconstruction: the “shining metal artefact”

Preliminary Experience With SPECT/CT to Evaluate Periarticular Arthritis Progression and the Relationship With Clinical Outcome Following Ankle Arthrodesis

SPECT/CT: Standing on the Shoulders of Giants, It Is Time to Reach for the Sky!

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