The value of SPET/CT in chronic osteomyelitis

Abstract

The purpose of this study was to evaluate the use of combined transmission and emission tomography (TET) for correct localisation of heterotopic splenic tissue and differentiation of splenosis from other masses. The TET technique comprises the fusion of SPET and CT data obtained using the same imaging device to allow perfect overlap of anatomical and functional images. TET was performed in seven patients who either had haematological disorders and relapsing anaemia or thrombocytopenia after splenectomy or were under immunosuppression for different reasons. These patients presented 20 equivocal lesions on CT or MRI. Presence of splenic tissue was investigated using technetium-99m labelled colloids or heat-damaged red blood cells. Findings of spleen scintigraphy, TET and CT or MRI were compared with respect to localisation of splenosis and correct classification of lesions by CT or MRI. Histological validation was achieved by surgery or biopsy in all cases. All 20 lesions demonstrated by CT or MRI were correctly classified by TET as splenosis. Three additional lesions initially overlooked by CT or MRI could be detected. Diagnostic relevance was highest for intrahepatic, intrapulmonary or pleural splenic implants. It is concluded that TET allows exact localisation of heterotopic splenic tissue in patients with suspected splenosis.

Diabetic Foot Infection: Usefulness of SPECT/CT for 99mTc-HMPAO-Labeled Leukocyte Imaging

“…As suggested by a previously published paper (14), SPECT/CT was particularly useful in increasing the accuracy of nuclear imaging and interobserver agreement.…”

Osteomyelitis and Arthritis

“…The development of integrated computed tomography (SPECT)-computed tomography (CT) cameras has overcome partly the lack of spatial resolution in conventional nuclear medicine by using image coregistration (8).…”

“…However, the need to use multiple radionuclide tracers and to perform imaging at multiple times adds complexity, delays start of treatment and causes inconvenience to the patients. SPECT and SPECT/(CT) are useful supplementations of planar scintigraphy especially in equivocal cases and in the differentiation of soft tissue and bone infection as demonstrated in a patient with osteomyelitis (8,45). SPECT/(CT) should also be considered in patients with arthritis in complex body regions like the spine (46,47).…”

Radionuclide Infection Imaging: Conventional to Hybrid

“…SPECT/CT defined the precise anatomical localization of 44% of infectious sites that were erroneous or equivocal on scintigraphy in this study. In another preliminary report, (Horger et al, 2003) found that SPECT/CT improved the diagnostic performance of three-phase bone scan for osteomyelitis avoiding false-positive or equivocal results. In our own experience SPECT/CT has always had an incremental value to routine planar imaging and in many clinical situations in particular further characterizing the abnormalities to reach definitive imaging diagnosis ( Figure 5).…”

“…Tc-99m Sulesomab imaging show increased tracer uptake at distal right femur corresponding to the site seen on bone scan, confirming osteomyelitis. (Horger et al, 2003) showed that SPECT/CT changed the interpretation of radioimmunoscintigraphy with Tc-99m labelled anti-granulocyte antibodies in 28% of suggestive foci evaluated in 27 patients in whom relapsing post-traumatic osteomyelitis was suspected. In another recent study (Graute V et al, 2010) concluded that SPECT/CT substantially improves the utility of imaging with Tc-99m labelled anti-granulocyte antibodies for diagnosis and localization of suspected joint infections and provide information on the extent of the infection.…”