Development of a Protocol for SPECT/CT in the Assessment of Wrist Disorders

Abstract

Background Single-photon emission computed tomography and computed tomography (SPECT/CT) is a hybrid diagnostic imaging modality that allows clinicians to integrate their diagnostic evaluations and deliver a definitive diagnosis in musculoskeletal disorders. Specifically, in identification of osseous pathology, the conventional bone scan delivers greater specificity compared with magnetic resonance imaging (MRI). However, use of SPECT/CT enhances the sensitivity and specificity. Use of this modality denotes the possibility to specify the lesion more accurately and precisely while grading the activity according to osseous structural changes.

Purpose This study aimed to evaluate the clinical utility of SPECT/CT in the diagnoses and management of osseous wrist disorders. The objectives were to examine the value of SPECT/CT in the diagnosis of osseous-related wrist pain and whether the findings altered management.

Patients and Methods A retrospective cohort study of 20 patients with such wrist pain was conducted. SPECT/CT was used in the diagnostic process for these patients.

Results Following SPECT/CT imaging, the common final diagnoses were osteoarthritis (10; 50%) and avascular necrosis (5; 25%). Less common diagnoses included ulnar carpal impact syndrome, infection, malunion, complex regional pain syndrome, and carpal boss. Some presented with multiple pathologies. SPECT/CT changed the final diagnosis in 11 cases, resulting in nonoperative treatment (7; 63%) or surgery (4; 37%).

Conclusion Findings from this study and the literature demonstrate the clinical utility of SPECT/CT in the assessment of osseous-related wrist disorders. We present an algorithm for the assessment of wrist pain with osseous pathology. This commences with clinical assessment and plane radiographs (first-line investigation). Some cases will require a second-line investigation (ultrasound, CT, and/or MRI). If the diagnosis remains unclear, SPECT/CT is recommended as a third-line investigation.

Keywords

SPECT/CT - wrist - osteoarthritis - avascular necrosis - ulnar impingement

• References

• 1 Dalinka MK, Alazraki N, Berquist TH , et al. Chronic wrist pain. American College of Radiology. ACR Appropriateness Criteria. Radiology 2000; 215 (Suppl): 333-338
• 2 Newberg A, Dalinka MK, Alazraki N , et al. Acute hand and wrist trauma. American College of Radiology. ACR Appropriateness Criteria. Radiology 2000; 215 (Suppl): 375-378
• 3 Buck AK, Nekolla S, Ziegler S , et al. SPECT/CT. J Nucl Med 2008; 49 (8) 1305-1319
• 4 Gnanasegaran G, Ballinger JR. Molecular imaging agents for SPECT (and SPECT/CT). Eur J Nucl Med Mol Imaging 2014; 41 (Suppl. 01) S26-S35
• 5 Griffith JF. Functional imaging of the musculoskeletal system. Quant Imaging Med Surg 2015; 5 (3) 323-331
• 6 Palestro CJ, Love C, Bhargava KK. Labeled leukocyte imaging: current status and future directions. Q J Nucl Med Mol Imaging 2009; 53 (1) 105-123
• 7 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 (9) 1191-1196
• 8 Querellou S, Arnaud L, Williams T , et al. Role of SPECT/CT compared with MRI in the diagnosis and management of patients with wrist trauma occult fractures. Clin Nucl Med 2014; 39 (1) 8-13
• 9 Allainmat L, Aubault M, Noël V, Baulieu F, Laulan J, Eder V. Use of hybrid SPECT/CT for diagnosis of radiographic occult fractures of the wrist. Clin Nucl Med 2013; 38 (6) e246-e251
• 10 Arora S, Singh Dhull V, Karunanithi S, Kumar Parida G, Sharma A, Shamim SA. (99m)Tc-MDP SPECT/CT as the one-stop imaging modality for the diagnosis of early setting of Kienbock's disease. Rev Esp Med Nucl Imagen Mol 2015; 34 (3) 185-187
• 11 Liodakis E, Liodaki E, Krettek C , et al. Can the viability of a nonunion be evaluated using SPECT/CT? A preliminary retrospective study. Technol Health Care 2011; 19 (2) 103-108
• 12 Huellner MW, Strobel K. Clinical applications of SPECT/CT in imaging the extremities. Eur J Nucl Med Mol Imaging 2014; 41 (Suppl. 01) S50-S58
• 13 Huellner MW, Bürkert A, Schleich FS , et al. SPECT/CT versus MRI in patients with nonspecific pain of the hand and wrist - a pilot study. Eur J Nucl Med Mol Imaging 2012; 39 (5) 750-759
• 14 Strobel K, Steurer-Dober I, Da Silva AJ , et al. Feasibility and preliminary results of SPECT/CT arthrography of the wrist in comparison with MR arthrography in patients with suspected ulnocarpal impaction. Eur J Nucl Med Mol Imaging 2014; 41 (3) 548-555
• 15 Sharma P, Mukherjee A, Karunanithi S , et al. 99mTc-Methylene diphosphonate SPECT/CT as the one-stop imaging modality for the diagnosis of osteoid osteoma. Nucl Med Commun 2014; 35 (8) 876-883
• 16 Gnanasegaran G, Jackson P, Povlsen B, Vijayanathan S, Fogelman I. Wrist registration: conventional radionuclide and SPECT/CT imaging. In: Fogelman I, Gnanasegaran G, van der Wall H, eds. Radionuclide and Hybrid Bone Imaging [Internet]. Berlin: Springer; 2012: 609-631 . Available online at: http://link.springer.com/chapter/10.1007/978-3-642-02400-9_24 (cited July 24, 2015)
• 17 Xie C, Gnanasegaran G, Mohan H, Livieratos L. Assessment of inter-modality spatial alignment accuracy in hybrid single photon emission computed tomography in patients with hand and wrist pain. World J Nucl Med 2013; 12 (3) 87-93
• 18 Saha S, Burke C, Desai A, Vijayanathan S, Gnanasegaran G. SPECT-CT: applications in musculoskeletal radiology. Br J Radiol 2013; 86 (1031) 20120519