99mTc-DPD-SPECT/CT predicts the outcome of imaging-guided diagnostic anaesthetic injections: a prospective cohort study.
OBJECTIVE
We hypothesized that bone SPECT combined with multiplanar reconstructed CT can identify and target the pain-inducing focus in the foot and can be used to successfully guide anaesthetic infiltrations. Therefore we prospectively investigated feasibility and predictive value of bone SPECT/CT for image guided diagnostic infiltrations in patients with chronic foot pain.


METHODS
All patients received a standardized bone SPECT/CT of both feet. The scintigraphically most active structures were subsequently infiltrated with local anaesthetics under CT-guidance. The pre- and post-infiltration pain intensity was measured using the visual analogue scale (VAS). Then, we assessed (i) the agreement on pain originating structures determined by standard clinical assessment versus SPECT/CT and (ii) the predictive value of SPECT-CT in groups with and without agreement.


RESULTS
27 of 30 participants reported a pain reduction on VAS of 50% or more, resulting in a response rate of 90%. When assessing the agreement on pain initiating structures determined by standard clinical assessment versus SPECT/CT, we found a disagreement in 16 of 30 (53%) cases. Particularly, disagreement appeared in all 9 participants with symptoms located in the mid-foot (100%). In participants with hind-foot pathology, disagreement was found in 7 of 21 cases (33%).


CONCLUSIONS
The present study shows the feasibility of 99mTc-DPD-SPECT/CT guided infiltration of osseous structures of patients with chronic foot pain. 99mTc-DPD-SPECT/CT had a higher predictive value on the clinical outcome than the clinical assessment. In the clinical setting 99mTc-DPD-SPECT/CT might overrule the clinical assessment in case of disagreement on the target lesion.
Division of Interventional Radiology, University Hospital, Petersgraben 4, CH-4031 Basel, Switzerland. martinkretzschmar@me.com
Martin
M
Kretzschmar
Martin
M
Wiewiorski
Helmut
H
Rasch
Augustinus L
AL
Jacob
Deniz
D
Bilecen
Martin A
MA
Walter
Victor
V
Valderrabano
D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage; D000843:Ankle Joint / Q000000981:diagnostic imaging; D018771:Arthralgia / Q000175:diagnosis* / Q000188:drug therapy*; D002045:Bupivacaine / Q000008:administration & dosage*; D015331:Cohort Studies; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004164:Diphosphonates; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D011379:Prognosis; D011446:Prospective Studies; D015641:Radiography, Interventional / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013382:Subtraction Technique; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
D000779:Anesthetics, Local; D004164:Diphosphonates; D015609:Organotechnetium Compounds; C033905:technetium Tc 99m 1,1-diphosphonopropane-2,3-dicarboxylic acid; D002045:Bupivacaine