SPECT/CT in Postoperative Shoulder Pain

ACR Appropriateness Criteria® Imaging After Shoulder Arthroplasty: 2021 Update

“…Scan With SPECT or SPECT/CT Shoulder. The use of nuclear imaging for the evaluation of periprosthetic infection has been limited to the evaluation of hip and knee arthroplasties, but various clinical studies anecdotally suggest utilizing this modality in shoulder arthroplasties [30].…”

“…Tc-99m 3-phase bone scan is a highly sensitive modality for the detection of acute osteomyelitis in the setting of normal radiographs but remains low in specificity because the imaging findings can overlap with other abnormalities such as mechanical loosening and osteolysis [30]. In addition, increased bone uptake can be seen at the site of arthroplasty, related to postoperative bone remodeling, for up to 1 year following surgery [30]. A bone scan is also limited in its ability to assess the periprosthetic soft tissues for the presence of an abscess.…”

“…A blood pool SPECT/CT over the targeted clinical area can be obtained immediately after the static blood pool images and further localizes foci of hyperemia [31][32][33]. At 2 to 3 hours after radiopharmaceutical administration and the standard bone scan images, a second SPECT/CT over the area(s) of interest can localize new bone formation [30] but remains nonspecific. A positive 3-phase bone scan can be seen in periprosthetic infection, periprosthetic fracture, and in the early postoperative state.…”

“…An isolated In-111 WBC study is a sensitive but nonspecific technique for the evaluation of acute neutrophilic dominant periprosthetic infection [11]. Its specificity can be increased when interpreted in conjunction with a Tc-99m sulfur colloid study or, less optimally, a bone scan, which may not be indicated if both In-111 WBC and sulfur colloid studies have been performed [11,30]. However, a positive 3-phase bone scan can be used as a "road map" to identify abnormal bone, which can then be specifically addressed on the subsequent labeled WBC and marrow studies.…”

Novel Musculoskeletal and Orthopedic Applications of 18F-Sodium Fluoride PET

“…93 Scintigraphy with gallium-67 (Ga67) and indium-111 ( 111 In)-labeled white blood cells represent other methods of increasing the specificity of 3-phase BS. [94][95][96] Several studies have indicated that NaF-PET has utility in assessing complications related to hip arthroplasty. Increased NaF activity can indicate stem loosening in patients experiencing pain but with equivocal radiograph findings.…”