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      The role of hybrid bone SPECT/CT imaging in the work-up of the limping patient: a symptom-based and joint-oriented review

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          Abstract

          A vast spectrum of lower limb bone and joint disorders (hip, knee, ankle, foot) present with a common clinical presentation: limping. Too often this symptom generates an inefficient cascade of imaging studies.

          This review attempts to optimise the diagnostic effectiveness of bone scintigraphy using the hybrid SPECT/CT technique in relation to the diagnostic clues provided by other imaging modalities, discusses the appropriate clinical indications, optimal scintigraphic procedures and illustrates updated image pattern-oriented reporting. Frequent lower limb bone and joint pathologies that can now be reliably diagnosed using hybrid bone SPECT/CT imaging will be reviewed.

          Bone SPECT/CT can be an effective problem-solving tool in patients with persistent limping when careful history taking, clinical examination, and first-line imaging modalities fail to identify the underlying cause.

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          Heterotopic ossification.

          A. Elgazzar, Bradley B. Collier, Dia Shehab (2002)
          Heterotopic ossification (HO) is the presence of bone in soft tissue where bone normally does not exist. The acquired form of HO most frequently is seen with either musculoskeletal trauma, spinal cord injury, or central nervous system injury. For example, patients who have recently undergone total hip arthroplasty or have paraplegia after spinal cord injury are at risk for HO. The fever, swelling, erythema, and occasional joint tenderness seen in early HO can be difficult to distinguish from cellulitis, osteomyelitis, or thrombophlebitis. Bone scanning and other imaging tests frequently are used to distinguish between these diagnostic possibilities. As treatment or prophylaxis for HO, either a nonsteroidal antiinflammatory drug (such as indomethacin), a diphosphonate (such as ethane-1-hydroxy-1,1-diphosphate), or local radiation therapy is recommended. Before therapy begins, bone scanning may be requested to confirm the diagnosis of HO. In addition, surgical resection of HO is used to preserve joint mobility; however, HO is likely to recur and possibly progress if resection is undertaken before the lesion has become mature. With a view toward avoiding recurrent HO and other operative complications, serial quantitative bone scans are used as an aid to time surgical intervention.
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            MRI after arthroplasty: comparison of MAVRIC and conventional fast spin-echo techniques.

            Sohrab Shah, H Potter, Lisa Koch … (2011)
            The goal of this study was to evaluate the quality of images obtained with a prototype imaging technique, multiacquisition variable-resonance image combination (MAVRIC), compared with fast spin-echo (FSE) images in the evaluation of patients who have undergone hip, shoulder, or knee arthroplasty. MRI with metal-artifact reduction FSE and MAVRIC sequences was performed in the care of 122 patients who had undergone 74 hip, 27 shoulder, and 21 knee arthroplasties. The FSE and MAVRIC images were subjectively graded for visualization of the synovium, prosthesis-bone interface, and hip abductors or supraspinatus tendon. The presence of synovitis, osteolysis, or supraspinatus tendon tear was recorded. Visualization of the synovium was significantly better on MAVRIC images than on FSE images of the hip (p < 0.0001), shoulder (p < 0.01), and knee (p < 0.01). Synovitis was detected only on the MAVRIC images of nine subjects (12%) who had undergone hip arthroplasty and five subjects (18%) who had undergone shoulder arthroplasty. Visualization of the periprosthetic bone was significantly better on MAVRIC images of the hip (p < 0.0001), shoulder (p < 0.0001), and knee (p < 0.01). Osteolysis was detected only on the MAVRIC images of 12 subjects (16%) who had undergone hip arthroplasty, six (22%) who had undergone shoulder arthroplasty, and five (24%) who had undergone knee arthroplasty. Visualization of the supraspinatus tendon was significantly better on MAVRIC images (p < 0.0001). Supraspinatus tendon tears in 12 subjects (44%) were detected only on MAVRIC images. MAVRIC complements the information on FSE images after arthroplasty and is a useful additional sequence, particularly when there is concern about synovitis, periprosthetic osteolysis, or the presence of a supraspinatus tendon tear.
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              PET and SPECT in osteomyelitis and prosthetic bone and joint infections: a systematic review.

              Otto C. Boerman, Wouter van der Star, Martin Gotthardt … (2009)
              To review the literature on diagnostic accuracy and clinical value of single-photon emission computed tomography (SPECT) and positron emission tomography (PET) for imaging of bone and joint infections. The PubMed/MEDLINE and Embase (OvidSP) literature databases were systematically searched for publications on SPECT and PET on osteomyelitis and prosthetic bone and joint infections using specific guidelines with MeSH-terms, truncations, and completion using cross-references. In 44 original articles (15 for SPECT and 29 for (18)F-fluorodeoxyglucose [FDG]-PET) on osteomyelitis and prosthetic bone and joint infection, 1634 patients were included (580 patients SPECT, 1054 patients FDG-PET). Level of evidence (Oxford criteria) was 2-3b. For SPECT, the highest diagnostic accuracy of 95% for diagnosis of bone and joint infections is achieved with combined (111)In-WBC and (99m)Tc-sulfur colloid. Acceptable diagnostic accuracy was also obtained with (99m)Tc-WBC or (111)In-WBC combined with (99m)Tc-methylene diphosphonate ((99m)Tc-MDP). FDG-PET is useful for diagnosis of osteomyelitis with a sensitivity and specificity generally over 95%. In patients with orthopedic implant infections, sensitivity varies widely from 28% to 91% and specificity from 9% to 97%. This variation in FDG-PET performance in orthopedic implant infections depends largely on the (use of different) criteria to diagnose infection. Determination of the best criteria is still a matter of debate. SPECT/computed tomography (CT) with (111)In-WBC combined with (99m)Tc-MDP or (99m)Tc-sulfur colloid seems to be the best imaging technique for diagnosis of bone and joint infections. FDG-PET is also useful for diagnosis of osteomyelitis with improved spatial resolution over SPECT imaging, allowing more accurate localization. Localization can be further improved by adding CT. Diagnosis of orthopedic implant infections with FDG-PET depends strongly on the localization of the implant and the criteria used to diagnose infection. Confirmation of well defined criteria to diagnose infection on FDG-PET in patients with metallic implants is thus of paramount importance for optimal diagnosis.
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                Author and article information

                Contributors
                T. Van den Wyngaert:
                ORCID: http://orcid.org/0000-0002-0320-9075
                +32 3 821 35 68 , tim.van.den.wyngaert@uza.be
                Journal
                Journal ID (nlm-ta): Eur J Hybrid Imaging
                Journal ID (iso-abbrev): Eur J Hybrid Imaging
                Title: European Journal of Hybrid Imaging
                Publisher: Springer International Publishing (Cham )
                ISSN (Electronic): 2510-3636
                Publication date (Electronic): 23 April 2018
                Publication date PMC-release: 23 April 2018
                Publication date (Print): 2018
                Volume: 2
                Issue: 1
                Electronic Location Identifier: 8
                Affiliations
                [1 ]Department of Nuclear Medicine, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, India
                [2 ]ISNI 0000 0000 8587 8621, GRID grid.413354.4, Department of Radiology and Nuclear Medicine, , Lucerne Cantonal Hospital, ; Lucerne, Switzerland
                [3 ]ISNI 0000 0004 0396 6978, GRID grid.416043.4, Department of Radiology and Nuclear Medicine, , Slingeland Hospital, ; Doetinchem, The Netherlands
                [4 ]ISNI 0000 0001 0439 3380, GRID grid.437485.9, Department of Nuclear Medicine, , Royal Free London NHS Foundation Trust, ; London, UK
                [5 ]Nuclear Medicine Spitalerhof, Hamburg, Germany
                [6 ]ISNI 0000 0000 9935 6525, GRID grid.411668.c, Clinic of Nuclear Medicine, , University Hospital Erlangen, ; Erlangen, Germany
                [7 ]ISNI 0000 0004 0626 3418, GRID grid.411414.5, Department of Nuclear Medicine, , Antwerp University Hospital, ; Wilrijkstraat 10, 2650 Edegem, Belgium
                [8 ]ISNI 0000 0001 0790 3681, GRID grid.5284.b, Faculty of Medicine and Health Sciences, , University of Antwerp, ; Wilrijk, Belgium
                [9 ]ISNI 0000 0001 2175 4109, GRID grid.50550.35, Department of Nuclear Medicine, Hôpital Lariboisière, , Assistance Publique-Hôpitaux de Paris, ; Paris, France
                Author information
                http://orcid.org/0000-0002-0320-9075
                Article
                Publisher ID: 26
                DOI: 10.1186/s41824-018-0026-2
                PMC ID: 5954706
                SO-VID: 50ed682a-b517-4e4c-a1c3-ee8437fbe499
                Copyright © © The Author(s) 2018
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 13 November 2017
                Date accepted : 17 January 2018
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © The Author(s) 2018

                Keywords: limping,hip,knee,foot,ankle,spect/ct,bone scintigraphy
                Data availability:
                Keywords: limping, hip, knee, foot, ankle, spect/ct, bone scintigraphy

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