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.

Skelettszintigrafie - SPECT/CT - Orthopädie - Sportmedizin

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

Literatur

• 1 Arendt E, Agel J, Heikes C. et al . Stress injuries to bone in college athletes: a retrospective review of experience at a single institution.  Am J Sports Med. 2003;  31 959-968
• 2 Balius R, Pedret C, Estruch A. et al . Stress fractures of the metacarpal bones in adolescent tennis players: a case series.  Am J Sports Med. 2010;  38 1215-1220
• 3 Bryant LR, Song WS, Banks KP. et al . Comparison of planar scintigraphy alone and with SPECT for the initial evaluation of femoral neck stress fracture.  AJR Am J Roentgenol. 2008;  191 1010-1015
• 4 Buck FM, Hoffmann A, Hofer B. et al . Chronic medial knee pain without history of prior trauma: correlation of pain at rest and during exercise using bone scintigraphy and MR imaging.  Skeletal Radiol. 2009;  38 339-347
• 5 Cassas KJ, Cassettari-Wayhs A. Childhood and adolescent sports-related overuse injuries.  Am Fam Physician. 2006;  73 1014-1022
• 6 Cooper RAS, Anderson J. Atlas of Nuclear Imaging in Sports Medicine.. 1st ed: McGraw-Hill; 2003
• 7 Even-Sapir E, Flusser G, Lerman H. et al . SPECT/multislice low-dose CT: a clinically relevant constituent in the imaging algorithm of nononcologic patients referred for bone scintigraphy.  J Nucl Med. 2007;  48 319-324
• 8 Gaeta M, Minutoli F, Scribano E. et al . CT and MR imaging findings in athletes with early tibial stress injuries: comparison with bone scintigraphy findings and emphasis on cortical abnormalities.  Radiology. 2005;  235 553-561
• 9 Hamers S, Freyschmidt J. „Leave me alone lesions” des Knochens – Teil 1.  Radiologie up2date. 2002;  2 189-218
• 10 Heiba SI, Kolker D, Mocherla B. et al . The Optimized Evaluation of Diabetic Foot Infection by Dual Isotope SPECT/CT Imaging Protocol.  J Foot Ankle Surg. 2010; 
• 11 Hirschmann MT, Davda K, Iranpour F. et al . Combined single photon emission computerised tomography and conventional computerised tomography (SPECT/CT) in patellofemoral disorders: a clinical review.  Int Orthop. 2010; 
• 12 Hirschmann MT, Iranpour F, Konala P. et al . A novel standardized algorithm for evaluating patients with painful total knee arthroplasty using combined single photon emission tomography and conventional computerized tomography.  Knee Surg Sports Traumatol Arthrosc. 2010;  18 939-944
• 13 Holder LE, Cole LA, Myerson MS. Reflex sympathetic dystrophy in the foot: clinical and scintigraphic criteria.  Radiology. 1992;  184 531-535
• 14 Holder LE, Schwarz C, Wernicke PG. et al . Radionuclide bone imaging in the early detection of fractures of the proximal femur (hip): multifactorial analysis.  Radiology. 1990;  174 509-515
• 15 Klaeser B, Spanjol PM, Wartenberg J. et al . TM. Bone scan: Impact of education and professional experience on the assessment of planar bone scans, SPECT and SPECT-CT.  Nuklearmedizin. 2008;  03 A134
• 16 Kretzschmar M, Wiewiorski M, Rasch H. et al . (99m)Tc-DPD-SPECT/CT predicts the outcome of imaging-guided diagnostic anaesthetic injections: A prospective cohort study.  Eur J Radiol. 2010; 
• 17 Luk WH, Au-Yeung AW, Yang MK. Diagnostic value of SPECT versus SPECT/CT in femoral avascular necrosis: preliminary results.  Nucl Med Commun. 2010;  31 958-961
• 18 Matheson GO, Clement DB, McKenzie DC. et al . Stress fractures in athletes. A study of 320 cases.  Am J Sports Med. 1987;  15 46-58
• 19 Moran DS, Evans RK, Hadad E. Imaging of lower extremity stress fracture injuries.  Sports Med. 2008;  38 345-356
• 20 Mulconrey DS, Knight RQ, Bramble JD. et al . Interobserver reliability in the interpretation of diagnostic lumbar MRI and nuclear imaging.  Spine J. 2006;  6 177-184
• 21 Pagenstert GI, Barg A, Leumann AG. et al . SPECT-CT imaging in degenerative joint disease of the foot and ankle.  J Bone Joint Surg Br. 2009;  91 1191-1196
• 22 Romer W, Nomayr A, Uder M. et al . SPECT-guided CT for evaluating foci of increased bone metabolism classified as indeterminate on SPECT in cancer patients.  J Nucl Med. 2006;  47 1102-1106
• 23 Ryu JS, Kim JS, Moon DH. et al . Bone SPECT is more sensitive than MRI in the detection of early osteonecrosis of the femoral head after renal transplantation.  J Nucl Med. 2002;  43 1006-1011
• 24 Shin AY, Morin WD, Gorman JD. et al . The superiority of magnetic resonance imaging in differentiating the cause of hip pain in endurance athletes.  Am J Sports Med. 1996;  24 168-176
• 25 Spitz J, Lauer I, Tittel K. et al . Scintimetric evaluation of remodeling after bone fractures in man.  J Nucl Med. 1993;  34 1403-1409
• 26 Spitz J. Nuklearmedizin in der Traumatologie.  Nuklearmediziner. 2002;  25 250-255
• 27 Strobel K, Burger C, Seifert B. et al . Characterization of focal bone lesions in the axial skeleton: performance of planar bone scintigraphy compared with SPECT and SPECT fused with CT.  AJR Am J Roentgenol. 2007;  188 W467-W474
• 28 Tahmasebi MN, Saghari M, Moslehi M. et al . Comparison of SPECT bone scintigraphy with MRI for diagnosis of meniscal tears.  BMC Nucl Med. 2005;  5 2
• 29 Wuppenhorst N, Maier C, Frettloh J. et al . Sensitivity and specificity of 3-phase bone scintigraphy in the diagnosis of complex regional pain syndrome of the upper extremity.  Clin J Pain. 2010;  26 182-189
• 30 Zukotynski K, Curtis C, Grant FD. et al . The value of SPECT in the detection of stress injury to the pars interarticularis in patients with low back pain.  J Orthop Surg Res. 2010;  5 13
• 31 Zyluk A. The usefulness of quantitative evaluation of three-phase scintigraphy in the diagnosis of post-traumatic reflex sympathetic dystrophy.  J Hand Surg Br. 1999;  24 16-21

Korrespondenzadresse