The value of bone hybrid SPECT-CT in detection of stress injuries and evaluation of post-therapeutic complications

• Published in: The Journal of nuclear medicine (1978) Vol. 58; p. 304
• Main Authors: Gunalp, Bengul, Ince, Semra, Ayan, Asli, Okuyucu, Kursat, Alagoz, Engin
• Format: Journal Article
• Language: English
• Published: New York Society of Nuclear Medicine 01-05-2017
• Subjects: Abnormalities; Ankle; Avascular necrosis; Bone imaging; Bone surgery; Bones; Complications; Computed tomography; Data acquisition; Degeneration; Diagnosis; Diagnostic systems; Femur; Field of view; Fractures; Functional magnetic resonance imaging; Injuries; Intravenous administration; Lesions; Loosening; Magnetic resonance imaging; Medical imaging; Morphology; Necrosis; Nuclear medicine; Pain; Patients; Problem solving; Radiation; Radiation effects; Radiographs; Radiography; Radiology; Scintigraphy; Single photon emission computed tomography; Spine; Spondylolisthesis; Surgery; Surgical implants; Trauma; Wrist
• ISSN: 0161-5505; 1535-5667

Objectives: Planar bone scintigraphy is quite sensitive for the early detection of bone and joint traumatic injuries but its specificity is low due to lack of anatomical and morphological information. Referring clinician usually requests additional radiological examinations for the planning of patient's treatment. The aim of this study is to determine the role of SPECT-CT to establish sensitive and definitive diagnosis of acute and post-therapeutic trauma patients. Methods: Sixty eight acute (first two weeks after trauma) trauma patients and 34 post-therapeutic trauma patients who underwent orthopedic implant insertion or spinal fusion surgery and had recurrent pain after surgery included this study. All patients underwent bone SPECT-CT following planar BS for establishing more definitive diagnosis. Standard bone scintigraphy was performed 2-3 hours after intravenous injection of 555 to 740 MBq 99m Tc-methylene diphosphonate (MDP). SPECT-CT was performed just after planar bone scintigraphy using a dual head gamma camera SPECT spiral CT system (GE Discovery NM-CT 670). Spiral low dose CT (20-50 mAs and 120 KVp, slice thickness 2.5-5 mm, pitch 1.5) data were acquired with a field of view restricted to the scintigraphic abnormalities. In post-therapeutic patients with metallic implants CT was acquired with 180-200 mAs, 120 kVp and slice thickness 1.5-3 mm. Reconstructed data was displayed in transaxial, coronal and saggital planes. We compared the findings of BS with findings of SPECT-CT with regard to the precise location and characterization of lesions. Validation of the findings was achieved by clinical and radiological follow-up. Results: Bone SPECT-CT provided sufficient anatomic and metabolic information for the definitive diagnosis in 50 of 68 (73.5%) acute trauma patients and eliminates further radiologic examination for the management of the patients. SPECT-CT identified stress fracture of pars interarticularis in 6 patients, ankle and food bones in 25 patients, wrists bones in 17 patients, tendon avulsion injuries in 5 patients, tendinitis in 11 patients, and occult insufficiency fractures in 4 patients and femur avascular necrosis in two patients. In posttherapeutic group SPECT-CT identified screw and implant loosening in 5 patients, adjacent segment-facet joint degeneration in 6 patients, pedicle fracture and spondylolysis in 3 patients, spondylolisthesis in 2 patients, pseudoarthrosis in 3 patients and spondilodiscitis in 1 patients. These findings were confirmed by MRI or subsequent surgery. Functional information from SPECT component was found also very useful for interpretation of anatomic imaging findings of MRI and CT. Conclusion: Bone SPECT-CT can be used as a problem solving tool allowing sensitive and definitive diagnosis of acute traumatic injuries and later postoperative therapy complications especially in complex and small bonny structures such as spine, ankle and wrist. Combination of functional and anatomic information improves the diagnostic confidence and accuracy and reduced the need for other investigations such as repeated radiographs or MRI, thereby saving time, cost and subsequent radiation exposure. Research Support: None