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Richter A, Stukenborg-Colsman C, Plaass C. SPECT/CT of Total Ankle Arthroplasty. Foot Ankle Clin 2023; 28:493-507. [PMID: 37536815 DOI: 10.1016/j.fcl.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Use of SPECT/CT (Single Photon Emission Computed Tomography/Computed Tomography) is increasing providing additional information in patients with inconclusive clinical examination and unremarkable imaging findings presenting with chronic pain after total ankle arthroplasty. To differentiate the cause of pain after total ankle arthroplasty can be challenging. SPECT/CT combines structural and metabolic imaging as a hybrid tool leading to higher specificity and overall diagnostic accuracy presumably in cases of gutter impingement, prosthetic loosening, and osteoarthritis of adjacent joints. Moreover, SPECT/CT can complement diagnostic work up in periprosthetic joint infections. Basal tracer enhancement has to be considered for the interpretation of imaging findings.
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Affiliation(s)
- Alena Richter
- Department for Foot and Ankle surgery, DIAKOVERE Annastift, Orthopedic Clinic of the Hannover Medical School, Anna-von-Borries Strasse 1-7, Hannover 30625, Germany
| | - Christina Stukenborg-Colsman
- Department for Foot and Ankle surgery, DIAKOVERE Annastift, Orthopedic Clinic of the Hannover Medical School, Anna-von-Borries Strasse 1-7, Hannover 30625, Germany
| | - Christian Plaass
- Department for Foot and Ankle surgery, DIAKOVERE Annastift, Orthopedic Clinic of the Hannover Medical School, Anna-von-Borries Strasse 1-7, Hannover 30625, Germany.
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2
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Singh P, Agrawal K, Tripathy SK, Patro SS, Velagada S. Emerging role of bone scintigraphy single-photon emission computed tomography/computed tomography in foot pain management. Nucl Med Commun 2023; 44:571-584. [PMID: 37114428 DOI: 10.1097/mnm.0000000000001698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Foot and ankle joints being weight-bearing joints are commonly subjected to wear and tear and are prone to traumatic and other pathologies. Most of these foot and ankle pathologies present with pain. The diagnosis of pathology and localization of pain generators is difficult owing to the complex anatomy of the foot and similar clinical presentation. This makes the management of foot pain clinically challenging. Conventional anatomical imaging modalities are commonly employed for evaluation of any anatomical defect; however, these modalities often fail to describe the functional significance of the anatomical lesions, especially in presence of multiple lesions which is common in ankle and foot; however, hybrid single-photon emission computed tomography/computed tomography (SPECT/CT) by virtue of its dual modalities, that is, highly sensitive functional imaging and highly specific anatomical imaging can serve as a problem-solving tool in patient management. This review attempts to describe the role of hybrid SPECT/CT in overcoming the limitation of conventional imaging and describes its potential application in the management of foot and ankle pain.
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Affiliation(s)
- Parneet Singh
- Nuclear Medicine, All India Institute of Medical Sciences, AIIMS, Bhubaneswar
| | - Kanhaiyalal Agrawal
- Nuclear Medicine, All India Institute of Medical Sciences, AIIMS, Bhubaneswar
| | - Sujit Kumar Tripathy
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha
| | - Sai Sradha Patro
- Nuclear Medicine, All India Institute of Medical Sciences, AIIMS, Bhubaneswar
| | - Sandeep Velagada
- Department of Orthopedics, S.L.N Medical College and Hospital, Koraput, India
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3
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Single photon emission computed tomography/computed tomography imaging of gouty arthritis: A new voice. J Transl Int Med 2023. [DOI: 10.2478/jtim-2022-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
Abstract
Gouty arthritis, often referred to simply as gout, is a disorder of purine metabolism characterized by the deposition of monosodium urate monohydrate (MSU) crystals in multiple systems and organs, especially in joints and their surrounding soft tissue. Gout is a treatable chronic disease, and the main strategy for effective management is to reverse the deposition of MSU crystals by uric acid reduction, and to prevent gout attacks, tophi deposition and complications, and thereby improve the quality of life. However, the frequent association of gout with other conditions such as hypertension, obesity, cardiovascular disease, diabetes, dyslipidemia, chronic kidney disease (CKD) and kidney stones can complicate the treatment of gout and lead to premature death. Here, we review the use of medical imaging techniques for studying gouty arthritis with special interest in the potential role of single photon emission computed tomography (SPECT)/computed tomography (CT) in the clinical management of gout and complications (e.g., chronic kidney disease and cardiovascular disease).
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Review of the role of bone-SPECT/CT in tarsal coalitions. Nucl Med Commun 2023; 44:115-130. [PMID: 36630216 DOI: 10.1097/mnm.0000000000001643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Tarsal coalition (TC) is a congenital abnormal connection (fibrous, cartilaginous, or osseous) between two or more bones in the hind and midfoot, mostly consisting of calcaneonavicular or talocalcaneal coalition, and is often asymptomatic. However, TCs may result in foot motion limitation and pain with or without flatfoot (pes planus), arising in adolescents and young adults. Appropriate imaging is needed to pinpoint foot pain in the (suspected) TC, starting with plain radiographs. Still, normal radiographs do not exclude TCs. Computed tomography (CT) and MRI are frequently used advanced imaging techniques. CT alone has known limited sensitivity in cartilaginous and fibrous TCs and correlation between CT abnormalities and pain may be challenging, as solely anatomical changes in TCs are often asymptomatic. MRI can depict soft tissue abnormalities in TC with high accuracy. Nonetheless, after the implantation of metallic osteosynthesis material, MRI is often limited due to image distortion, signal loss, and misregistration. Bone scintigraphy with [99mTc]Tc-diphosphonate single photon emission computed tomography/CT (bone-SPECT/CT) is a known sensitive tool to detect osteoblastic bone pathology. However, the literature concerning bone-SPECT/CT in TC patients is limited. This article reviews bone-SPECT/CT patterns in TCs, how it complements other imaging techniques and their relation to clinical complaints. Bone-SPECT/CT excels in accurate bone pathology characterization in TC, confidently excluding synchronous lesions elsewhere, and offering optimal insight into osseous structures and 3D-localization of bone metabolism for surgery planning. Furthermore, even with implanted osteosynthesis material, bone-SPECT/CT can pinpoint the culprit pain generator, where MRI is either contra-indicated or considerably hampered.
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Uçkay İ, Hüllner MW, Achermann Y, Plate A, Schöni M, Rosskopf A, Berli MC. The Role of 99mTc-antigranulocyte SPECT/CT In Community-Acquired Diabetic Foot Osteomyelitis: A Clinical Experience. Curr Diabetes Rev 2022; 18:e030521193111. [PMID: 33949934 DOI: 10.2174/1573399817666210503140303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/12/2021] [Accepted: 02/18/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is the actual gold standard for the radiological diagnosis of diabetic foot osteomyelitis (DFO). MATERIALS AND METHODS MRI is not always available and many patients have contraindications. We evaluated the clinical value of 99mTc-antigranulocyte SPECT/CT (AGS) in eight DFO patients who underwent MRI before. RESULTS The goal was to have a better clinical view on the extent of bone infection and to ameliorate the surgical approach for DFO. However, this additional scintigraphy did not change anything in the clinical approach. CONCLUSION We shared our experience with AGS for clinical management of complex DFO cases.
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Affiliation(s)
- İlker Uçkay
- Department of Infectiology, Balgrist University Hospital, University of Zürich, 380, Forchstrasse, Switzerland
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zürich, 380, Forchstrasse, Switzerland
| | - Martin W Hüllner
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Swaziland
| | - Yvonne Achermann
- Department of Infectiology, Balgrist University Hospital, University of Zürich, 380, Forchstrasse, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andreas Plate
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Madlaina Schöni
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zürich, 380, Forchstrasse, Switzerland
| | - Andrea Rosskopf
- Department of Radiology, Balgrist University Hospital, Zurich, Switzerland
| | - Martin C Berli
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zürich, 380, Forchstrasse, Switzerland
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Gamma camera imaging (bone scan) in orthopedics: Foot, ankle, knees, and hip. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00214-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Képes Z, Mikó M, Kukuts K, Esze R, Barna S, Somodi S, Káplár M, Varga J, Garai I. Imaging with [ 99mTc]HMPAO - a novel perspective: investigation of [ 99mTc]HMPAO leg muscle uptake in metabolic diseases. Acta Radiol 2021; 64:187-194. [PMID: 34894745 DOI: 10.1177/02841851211063601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sensitive imaging modalities in the diagnosis of microcircular complications of the lower extremities induced by metabolic diseases are becoming a focus of interest. PURPOSE To investigate the [99mTc]HMPAO uptake of the legs in type 2 diabetes mellitus (T2DM) and obesity, and to search for associations with clinical parameters and nerve conducting studies. MATERIAL AND METHODS A total of 57 patients with controlled T2DM and 46 obese participants without DM were enrolled in the study. [99mTc]HMPAO SPECT/CT examinations were performed to evaluate the radiopharmaceutical accumulation of the legs. For the quantitative assessment of tracer uptake, standardized uptake value (SUVpeak) was measured in fixed spheric volumes of interest placed on both sural muscles on the attenuation-corrected images. Measurement of current perception threshold applying Neurometer (NM-01/CPT) was used to evaluate peripheral nerve dysfunction. Laboratory parameters assessing the glucose homeostasis of the study participants were also measured. RESULTS In the diabetic group, significantly lower leg SUV values were detected compared to the non-DM obese group (median: 0.517 vs. 0.607; P < 0.001). Body mass index (BMI) (P < 0.0001), age (P = 0.0283), HbA1c (P = 0.0068), and glucose level (P = 0.0044) proved to be significant predictors of muscle tracer uptake. Neurometer studies showed positive correlation with HbA1c levels in the T2DM group (P = 0.0002). CONCLUSION We assume that [99mTc]HMPAO uptake of leg muscles is associated with microcirculation, so quantitative [99mTc]HMPAO SPECT/CT might be a sensitive method for evaluating lower limb microvascular alterations. BMI, age, HbA1c, and glucose level may be significant predictors of peripheral vascular abnormalities triggered by metabolic disturbances.
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Affiliation(s)
- Zita Képes
- Department of Medical Imaging, Division of Nuclear Medicine and Translational Imaging, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Márton Mikó
- Department of Medical Imaging, Division of Nuclear Medicine and Translational Imaging, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Kornél Kukuts
- Scanomed Ltd Nuclear Medicine Centres Debrecen, Debrecen, Hungary
| | - Regina Esze
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Sándor Barna
- Scanomed Ltd Nuclear Medicine Centres Debrecen, Debrecen, Hungary
| | - Sándor Somodi
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Miklós Káplár
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - József Varga
- Department of Medical Imaging, Division of Nuclear Medicine and Translational Imaging, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ildikó Garai
- Department of Medical Imaging, Division of Nuclear Medicine and Translational Imaging, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Scanomed Ltd Nuclear Medicine Centres Debrecen, Debrecen, Hungary
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Yeats JC, Rahbek O, Griffith N, Easty M, Biassoni L, Eastwood DM. Bone scan with SPECT/CT in children with complex foot and ankle pain: Initial experience of a paediatric tertiary referral centre. J Child Orthop 2020; 14:433-439. [PMID: 33204351 PMCID: PMC7666803 DOI: 10.1302/1863-2548.14.200062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE This study was designed to review the diagnostic yield of single photon emission computed tomography-computed tomography (SPECT/CT) in children with complex foot/ankle pain. METHODS We reviewed the records of 33 patients with complex foot and ankle pain referred for SPECT/CT (36 scans) performed between 1st September 2009 to 30th September 2019. All patients had foot and ankle radiographs and 18 out of 33 patients had undergone magnetic resonance imaging (MRI) prior to SPECT/CT. The diagnostic contribution of SPECT/CT was established at the time of the scan during a multi-disciplinary team meeting. RESULTS The patients' mean age was 13.4 years (range six to 16.5 years) and 58% were female. In total, 18 patients had undergone previous surgical treatment. SPECT/CT was found to have decisive clinical value compared with radiographs and CT/MRI in 28 out of 36 cases. In ten patients it prompted surgical management (coalition excision, arthrodesis), in seven patients it redirected conservative management, in six patients it excluded other pathology and in five patients it showed additional/unexpected focal areas of mechanical stress, thus avoiding surgery. When compared with MRI, SPECT/CT added further clinical information in 13 out of 18 cases. SPECT/CT added decisive clinical value in five out of five patients with accessory ossicles, eight out of nine patients with tarsal coalition, five out of seven patients with surgically treated Congenital Talipes Equinovarus (CTEV) and four out of five patients with neuromuscular feet. In eight out of 36 cases SPECT/CT confirmed the diagnosis without adding significant information. CONCLUSIONS SPECT/CT can identify foci of active mechanical stress at cortical bone level in children with unexplained complex foot and ankle pain, particularly in the multiply operated foot, accessory ossicles and tarsal coalitions. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- James C. Yeats
- Departments of Orthopaedics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK,Correspondence should be sent to James Yeats, Department of Orthopaedics, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK. E-mail:
| | - Ole Rahbek
- Departments of Orthopaedics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Nigel Griffith
- Department of Ophthalmology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Marina Easty
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lorenzo Biassoni
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Deborah M. Eastwood
- Departments of Orthopaedics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Lima TVM, Bhure U, Pérez Lago MDS, Thali Y, Matijasevic S, Roos J, Strobel K. Impact of metal implants on xSPECT/CT Bone reconstruction: the "shining metal artefact". Eur J Hybrid Imaging 2020; 4:18. [PMID: 34191170 PMCID: PMC8218054 DOI: 10.1186/s41824-020-00087-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/17/2020] [Indexed: 11/29/2022] Open
Abstract
Background Novel reconstruction algorithms, such as xSPECT Bone, are gaining more and more importance in Nuclear Medicine. With xSPECT Bone, the reconstructed emission image is enhanced by the information obtained in the corresponding CT image. The CT defines tissue classes according to the Hounsfield units. In the iterative reconstruction, each tissue class is handled separately in the forward projection step, and all together in the back projection step. As a consequence, xSPECT Bone reconstruction generates images with improved boundary delineation and better anatomic representation of tracer activity. Applying this technique, however, showed that artefacts may occur, when no uptake regions, like metal implants, exhibit fictitious uniform tracer uptake. Due to limitations in spatial resolution in gamma cameras, the xSPECT Bone reconstructed image resulted in spill-out activity from surrounding high uptake region being uniformly distributed over the metal implants. This new technology of xSPECT Bone reconstruction in general enhances the image quality of SPECT/CT; however, the potential introduction of specific artefacts which inadvertently come along with this new technology and their frequency have not yet been addressed in the literature. Therefore, the purpose of this work was to identify and characterize these specific metal artefacts (the so-called shining metal artefact) in order to reduce false positives and avoid potentially misdiagnosing loosened or infected implants. Case presentation In this work, we report five cases imaged with bone SPECT/CT of 5 anatomical regions (foot, elbow, spine, shoulder, ribs and knee). All cases demonstrated “shining metal artefacts” in xSPECT Bone reconstruction. Conclusion While xSPECT Bone reconstruction algorithm significantly improves image quality for the diagnosis of bone and joint disorders with SPECT/CT, specific “shining metal artefacts” caused by the xSPECT Bone have to be recognized in order to avoid image misinterpretation suggesting metallic implant loosening or possible infection. The simultaneous analysis of conventionally reconstructed SPECT images (for Siemens the Flash3D reconstruction) helps to avoid misinterpretation of potential artefacts introduced by xSPECT Bone reconstruction.
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Affiliation(s)
- Thiago V M Lima
- Radiologie und Nuklearmedizin, Luzerner Kantonsspital, Lucerne, Switzerland. .,Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Ujwal Bhure
- Radiologie und Nuklearmedizin, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Yannick Thali
- Radiologie und Nuklearmedizin, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Savo Matijasevic
- Radiologie und Nuklearmedizin, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Justus Roos
- Radiologie und Nuklearmedizin, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Klaus Strobel
- Radiologie und Nuklearmedizin, Luzerner Kantonsspital, Lucerne, Switzerland
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Van den Wyngaert T, Elvas F, De Schepper S, Kennedy JA, Israel O. SPECT/CT: Standing on the Shoulders of Giants, It Is Time to Reach for the Sky! J Nucl Med 2020; 61:1284-1291. [PMID: 32620702 DOI: 10.2967/jnumed.119.236943] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/28/2020] [Indexed: 12/11/2022] Open
Abstract
Twenty years ago, SPECT/CT became commercially available, combining the strengths of both techniques: the diagnostic sensitivity of SPECT and the anatomic detail of CT. Other benefits initially included attenuation correction of SPECT reconstructions, ultimately evolving to correction techniques that would enable absolute tracer uptake quantification. Recent developments in SPECT hardware include solid-state digital systems with higher sensitivity and resolution, using novel collimator designs based on tungsten. Similar advances in CT technology have been introduced in hybrid SPECT/CT systems, replacing low-end x-ray tubes with high-end multislice CT scanners equipped with iterative reconstruction, metal artifact reduction algorithms, and dual-energy capabilities. More recently, the design of whole-body SPECT/CT systems has taken another major leap with the introduction of a ring-shaped gantry equipped with multiple movable detectors surrounding the patient. These exciting developments have fueled efforts to develop novel SPECT radiopharmaceuticals, creating new chelators and prosthetic groups for radiolabeling. Innovative SPECT radionuclide pairs have now become available for radiolabeling with the potential for use as theranostic agents. The growth of precision medicine and the associated need for accurate radionuclide treatment dosimetry will likely drive the use of SPECT/CT in the near future. In addition, expanding clinical applications of SPECT/CT in other areas such as orthopedics offer exciting opportunities. Although it is true that the SPECT/CT ecosystem has seen several challenges during its development over the past 2 decades, it is now a feature-rich and mature tool ready for clinical prime time.
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Affiliation(s)
- Tim Van den Wyngaert
- Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium .,Integrated Personalized and Precision Oncology Network, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Filipe Elvas
- Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Integrated Personalized and Precision Oncology Network, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Stijn De Schepper
- Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Integrated Personalized and Precision Oncology Network, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - John A Kennedy
- Department of Nuclear Medicine, Rambam Healthcare Campus, Haifa, Israel; and.,Rappaport School of Medicine, Israel Institute of Technology, Haifa, Israel
| | - Ora Israel
- Rappaport School of Medicine, Israel Institute of Technology, Haifa, Israel
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Computed Tomography (CT) Protocols Associated with Cardiac and Bone Single-Photon Emission Computed Tomography/CT (SPECT/CT) in Korea. Nucl Med Mol Imaging 2020; 54:139-146. [PMID: 32582397 DOI: 10.1007/s13139-020-00644-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Single-photon emission computed tomography/computed tomography (SPECT/CT) is an advanced hybrid nuclear medicine technology that generates both functional and anatomical images in a single study. As utilization of SPECT/CT in Korea has been increasing, the purpose of this study was to survey its application of cardiac and skeletal SPECT/CT imaging for protocol optimization. METHODS We surveyed CT protocols established for cardiac and skeletal SPECT/CT. We searched the guidelines for the CT protocols for SPECT/CT and reviewed the literature recently published. RESULTS Among 36 hybrid SPECT scanners equipped with four or more multi-channel detector CTs (MDCTs), 18 scanners were used to perform cardiac studies at both very low current CT (30-80 mA; 11.1%) and ultra-low current CT (13-30 mA; 88.9%). Among the 33 canners, very low current (≤ 80 mA) CT or low current CT (80-130 mA) was used in 23.5%, and 41.8% for spine disorders, and in 36.4% or 30.3% for foot/ankle disorders, respectively. In the CT reconstructions, slice thickness of 5 mm for cardiac studies was most commonly used (94.4%); thinner slices (0.6-1.0 mm) for spine and foot/ankle studies were used in 24.2% and 45.5%, respectively. We also reviewed the international guidelines. CONCLUSIONS The results and current recommendations will be helpful for optimizing CT protocols for SPECT/CT. Optimization of SPECT/CT protocols will be required for generating the proper strategy for the specific lesions and clinical purpose.
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12
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DeSutter C, Dube V, Ross A, Boyd G, Morash J, Glazebrook M. Preliminary Experience With SPECT/CT to Evaluate Periarticular Arthritis Progression and the Relationship With Clinical Outcome Following Ankle Arthrodesis. Foot Ankle Int 2020; 41:392-397. [PMID: 31904265 DOI: 10.1177/1071100719898279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Single photon emission computed tomography combined with computed tomography (SPECT/CT) could potentially aid in diagnosing periarticular arthritis/activity and progression, facilitate effective treatment options, and evaluate the effect surgery has on the clinical outcome of patients with ankle arthritis. The goal of our study was to assess SPECT/CT activity in the ankle and periarticular joints before and after ankle fusion surgery and determine whether it was associated with clinical pain and function scores. METHODS Thirty-four patients recruited into this study underwent either arthroscopic or open ankle fusion. X-ray (XR) and SPECT/CT imaging was obtained as well as completion of patient Ankle Osteoarthritis Scale (AOS) and 36-item Short Form Survey (SF-36) questionnaires preoperatively and at 6 months postoperatively. Ankle, subtalar, and talonavicular joint arthritis grading on XR and CT, along with SPECT/CT activity, was evaluated by 2 nuclear medicine radiologists. Data were assessed for normality and analyzed with the appropriate comparative test. P value was set at <.05. Thirty patients (31 ankles) completed follow-up and were analyzed. RESULTS SPECT/CT activity showed no significant difference in the ankle joint at 6 months postoperatively while periarticular joint activity significantly increased (P < .05). Six months postoperatively, patients had significant improvements in their AOS and SF-36 scores (P < .05). SPECT/CT grading of all joints analyzed, however, was not associated with AOS or SF-36 scores preoperatively or at 6 months postoperatively. CONCLUSION In this study, intensity of activity as evaluated by SPECT/CT in periarticular hindfoot joints in patients who had ankle arthrodesis was not associated with clinical/functional scores at 6 months postoperatively. LEVEL OF EVIDENCE Level IV, diagnostic study.
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Affiliation(s)
- Christopher DeSutter
- Department of Orthopedic Surgery, College of Medicine, University of Arizona, Phoenix, AZ, USA
| | - Vincent Dube
- Division of Orthopedic Surgery, Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
| | - Andrew Ross
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - Gordon Boyd
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
| | - Joel Morash
- Division of Orthopedic Surgery, Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
| | - Mark Glazebrook
- Division of Orthopedic Surgery, Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
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Nuclear Medicine Imaging Techniques of the Musculoskeletal System. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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Bone SPECT/CT of the Foot and Ankle: Potential Clinical Application for Chronic Foot Pain. Nucl Med Mol Imaging 2019; 54:1-8. [PMID: 32206126 DOI: 10.1007/s13139-019-00627-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/15/2019] [Accepted: 11/26/2019] [Indexed: 12/15/2022] Open
Abstract
Diseases of the foot and ankle are common but relatively difficult to diagnose because of the complexity of the anatomy and the frequent occurrence of multiple diseases at the same time. For these reasons, management of chronic foot pain is often clinically challenging. MRI is the imaging modality of choice in many types of diseases causing chronic foot pain, due to high resolution and excellent soft tissue contrast. However, in the postoperative state, the use of MRI can be limited by artifact from metallic devices, and it may be difficult to confirm whether the pathology detected on the MRI is the actual cause of the pain. As bone scintigraphy provides metabolic information, it can help to find the origin of pain, and SPECT/CT can further improve the specificity by adding anatomical information. In daily clinical practice for management of foot and ankle pathologies, the use of bone SPECT/CT is gradually increasing. However, there has been limited evidence of usefulness of SPECT/CT in evaluating chronic foot pain. In this review article, the potential application of bone SPECT/CT for chronic foot pain is illustrated, and the role of SPECT/CT in the management of the foot and ankle diseases in clinical practice is described.
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15
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Mandegaran R, Dhillon S, Jen H. Beyond the bones and joints: a review of ligamentous injuries of the foot and ankle on 99mTc-MDP-SPECT/CT. Br J Radiol 2019; 92:20190506. [PMID: 31365277 DOI: 10.1259/bjr.20190506] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
99mTc-MDP-single photon emission computed tomography (SPECT)/CT has established itself as a useful modality in the assessment of the painful foot and ankle, owing to its ability to depict anatomical and functional information simultaneously. Despite its growing popularity, much of the literature describing the utility of 99mTc-MDP-SPECT/CT of the foot and ankle is limited to osseous and articular pathology, with descriptions of ligamentous pathology limited to just a handful of cases. Though assessment of soft tissues using a combination of bone tracer and CT is limited, with a sound understanding of the regional anatomy, it is certainly within the scope of 99mTc-MDP-SPECT/CT to accurately identify ligamentous injuries based on focal tracer uptake patterns and suspected ligamentous injuries should be reported as such. This article provides a case-based pictorial review of the 99mTc-MDP-SPECT/CT appearances of the various ligamentous injuries of the foot and ankle with case examples and MRI correlation where available, most of which have yet to be described. The typical patterns of bone tracer uptake and associated CT abnormalities that may be observed are discussed.
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Affiliation(s)
- Ramin Mandegaran
- Department of Radiology and Diagnostic Imaging Faculty of Medicine, Dentistry University of Alberta 8440 112 St. NW Edmonton, Alberta, Canada.,Medical Imaging Consultants, Edmonton, Alberta, Canada
| | - Sukhvinder Dhillon
- Department of Radiology and Diagnostic Imaging Faculty of Medicine, Dentistry University of Alberta 8440 112 St. NW Edmonton, Alberta, Canada.,Medical Imaging Consultants, Edmonton, Alberta, Canada
| | - Ho Jen
- Department of Radiology and Diagnostic Imaging Faculty of Medicine, Dentistry University of Alberta 8440 112 St. NW Edmonton, Alberta, Canada.,Medical Imaging Consultants, Edmonton, Alberta, Canada
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