Knochenszintigrafie und SPECT/CT bei orthopädischen Fragestellungen

Zusammenfassung

Die multimodale Bildgebung mittels SPECT/CT in der orthopädischen Diagnostik verbindet die exzellente Sensitivität der Skelettszintigrafie mit der morphologischen Information der Computertomografie als Schlüssel zu einer spezifischen Befundinterpretation. Es resultiert eine bildgebende Modalität, die auch in einem kompetitiven, durch etablierte Verfahren wie die MRI dominierten Umfeld bestehen und die orthopädische Knochendiagnostik bereichern kann. Die SPECT/CT leistet unter anderem einen wichtigen Beitrag in der Diagnostik nach komplexen ossären Traumata und eignet sich im Gegensatz zur MRT gleichermaßen bei Patienten mit Osteosynthesen oder metallischen Implantaten. Die Anwendung der SPECT/CT in der Sportmedizin ermöglicht den sehr empfindlichen und spezifischen Nachweis ossärer Stressreaktionen, noch bevor morphologische Veränderungen in der CT oder MRT fassbar werden. Auch aktive degenerative Knochenprozesse bei Patienten mit ossären Schmerzsyndromen können identifiziert und exakt lokalisiert werden. Weitere, vorzugsweise prospektive diagnostische Studien im Vergleich zu Konkurrenzverfahren sind erforderlich, um die Position der nuklearmedizinischen Diagnostik in Orthopädie und Sportmedizin zu stärken und die Implementierung der SPECT/CT in diagnostische Algorithmen zu fördern.

Abstract

Multi-modality imaging with SPECT-CT in orthopaedics combines the excellent sensitivity of scintigraphy with the morphological information of CT as a key for specific interpretation of findings in bone scans. The result is an imaging modality with the clear potential to prove of value even in a competitive setting dominated by MRI, and to significantly add to diagnostic imaging in orthopaedics. SPECT-CT is of great value in the diagnostic evaluation after fractures, and – in contrast to MRI – it is well suited for imaging in patients with osteosyntheses and metallic implants. In sports medicine, SPECT-CT allows for a sensitive and specific detection of osseous stress reactions before morphological changes become detectable by CT or MRI. In patients with osseous pain syndromes, actively evolving degenerative changes as a cause of pain can be identified and accurately localized. Further, particularly prospective diagnostic studies providing comparative data are needed to strengthen the position of nuclear imaging in orthopaedics and sports medicine and to help implementing SPECT/CT in diagnostic algorithms.

Schlüsselwörter

Skelettszintigrafie - SPECT/CT - Orthopädie - Sportmedizin

Key words

skeletal scintigraphy - bone scan - SPECT/CT - orthopedics - sports medicine

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