SPECT/CT versus MRI in patients with nonspecific pain of the hand and wrist – a pilot study

Huellner, Martin W.; Bürkert, Alexander; Schleich, F.; Schürch, Maja; Hug, Urs; Wartburg, U. von; Strobel, Klaus; Veit-Haibach, Patrick

doi:10.1007/s00259-011-2034-3

Cited by 47 publications

(31 citation statements)

References 35 publications

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Section: Applications Of Single Photon Emission Ct-ct In the Upper Limbmentioning

confidence: 99%

“…Huellner et al [57] recently reported a pilot retrospective study of 21 patients with non-specific hand and wrist pain, comparing SPECT-CT with MRI. MRI yielded a higher sensitivity of 86% vs 71% for SPECT-CT but a lower specificity of 20% vs 100% [57]. This pilot study supports the use of SPECT-CT as a problemsolving tool in patients with non-specific hand and wrist pain and reflects our own experience with SPECT-CT in the hand and wrist.…”

Section: Applications Of Single Photon Emission Ct-ct In the Upper Limbmentioning

confidence: 99%

“…Defined criteria was used for cartilage, subchondral bone plate and subchondral bone, including bone marrow signal change on MRI and activity on SPECT-CT. For MRI alone, SPECT-CT alone and the combined correlation, the treatment decision had to be defined Level IV Wiewioski et al [45] Correlation between pain from osteochondral lesions and pathological uptake seen on SPECT-CT in 15 patients and response to diagnostic local anaesthetic infiltration into the ankle joint Level IV Knupp et al [46] 27 patients with varus or valgus hindfoot were assessed using radiography, plain CT, bone scan and SPECT-CT. The degree of deformity, stage of osteoarthritis and level of bone scan and SPECT-CT activity were measured Levels IV/V Mohan et al [47] Assessed the additional value of SPECT-CT in 16 patients referred from a specialist orthopaedic clinic and role in changing management of bony foot and ankle pathology Levels IV/V Breunung et al [50] Single case describing additional benefit of SPECT-CT in the investigation of heel pain Levels IV/V Knee pain Fernando et al [55] Case review of selected single cases of SPECT-CT findings in painful knees Levels IV/V Upper limb Huellner et al [57] Retrospective study of 21 patients investigating non-specific pain of the hand or wrist. All patients underwent planar early-phase imaging and late-phase SPECT-CT in addition to MRI.…”

Section: Level IImentioning

confidence: 99%

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SPECT-CT: applications in musculoskeletal radiology

Saha

Burke²,

Desai³

et al. 2013

BJR

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This article reviews the technique, basic science principles and applications of integrated single photon emission CT (SPECT)-CT in musculoskeletal radiology. A review of the current evidence on the topic was undertaken, and selected clinical cases from the authors' institution have been used for illustration. SPECT-CT is a technology with emerging applications that offers technical advantages to image fusion of separately acquired SPECT and CT studies. The prevailing evidence indicates that there may be benefit in adding SPECT-CT to conventional imaging algorithms during the evaluation of some malignant and benign musculoskeletal conditions. SPECT-CT can improve both sensitivity and specificity by reducing equivocal interpretation in comparison to planar scintigraphy or SPECT alone. The evidence base for SPECT-CT in musculoskeletal radiology is still evolving. There is a lack of evidence comparing SPECT-CT with MRI in many key indications, and further research is required in these areas.A wide range of pathological conditions may affect the musculoskeletal system, including infection, trauma and malignant disease. Advances in MRI, multidetector CT (MDCT) and high-frequency ultrasound have provided considerable improvements in imaging musculoskeletal disease over the past decade. There are, however, limitations associated with each of these techniques. MRI image acquisition remains relatively time consuming and, particularly in musculoskeletal radiology, image quality can be degraded significantly by metal artefact from internal fixation and prostheses. MDCT offers exquisite characterisation of bone and can rapidly generate highquality three-dimensional reconstructions; however, the contrast resolution for soft tissues is limited and the modality can also suffer metal-related artefact, although like MRI, imaging parameters can be adjusted to reduce this artefact. High-frequency ultrasound, although operator dependent, provides excellent spatial and contrast resolution for superficial structures but is suboptimal for deeper structures and is unable to penetrate cortical bone.Bone scintigraphy remains an important and highly sensitive tool to the musculoskeletal radiologist but this is frequently criticized for its lack of specificity. Radionuclide imaging, however, may be the only modality to demonstrate pathology before it becomes evident on anatomical imaging. Developments in gamma camera technology now allow high-resolution imaging with shortened scan times, and single photon emission CT (SPECT) imaging has become commonplace in the UK. SPECT is able to increase sensitivity further and improves lesion localisation, but the paucity of anatomical markers on radionuclide imaging remains a constant challenge. Thus, the importance of correlating anatomical and functional imaging has become increasingly recognised [1].Use of a combined SPECT/CT system allows for sequential acquisition of both anatomical and functional information with a high degree of image fusion accuracy.

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Section: Applications Of Single Photon Emission Ct-ct In the Upper Limbmentioning

confidence: 99%

Section: Applications Of Single Photon Emission Ct-ct In the Upper Limbmentioning

confidence: 99%

Section: Level IImentioning

confidence: 99%

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SPECT-CT: applications in musculoskeletal radiology

Saha

Burke²,

Desai³

et al. 2013

BJR

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“…A multitude of further publications has addressed a range of more specific issues, such as SPECT/CT imaging of the feet and hands. SPECT/CT has been found to show good diagnostic accuracy in patients with obscure pain of the wrist or hand, being able to differentiate between osteoarthritic lesions, occult fractures and osteonecrosis [55][56][57][58]. A particularly elegant approach is that of combining SPECT/CT with arthrography, the latter yielding information on the intactness of articular cartilage and other soft-tissue structures such as the scapholunate and lunotriquetral ligaments [59].…”

Section: Differential Diagnosis Of Pain Associated With the Musculoskmentioning

confidence: 99%

Skeletal SPECT/CT: a review

Kuwert

2014

Clin Transl Imaging

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Skeletal scintigraphy is one of the most frequent in vivo procedures in the field of nuclear medicine. Visualizing bone metabolism, it exhibits a fairly high sensitivity to detect skeletal lesions, but has limitations in terms of specificity and spatial resolution, even when single-photon emission computed tomography (SPECT) is used. Combining SPECT with X-ray computed tomography helps overcome these limitations. This has, in particular, been shown when diagnosing bone involvement in malignant tumors. Emerging evidence indicates the benefit of hybrid imaging for bone scintigraphy during the workup of painful conditions affecting the back and the extremities. Methodological advances holding considerable promise for further improving its value are the quantitation of skeletal tracer uptake in absolute units, as well as multimodal image reconstruction techniques that have recently become available for use in clinical routine.

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“…Mit den aktuell verfügbaren SPECT-Geräten mit integrierter hochauflösender CT-Komponente, welche die oft unzureichende Ortsauflösung in der alleinigen SPECT kompensiert, wurden diese Probleme gelöst. Daher konnte die SPECT/CT bereits bei mehreren Indikationen ihren Nutzen im klinischen Alltag unter Beweis stellen [5,6,7,8].…”

Section: Hintergrundunclassified