title: SPECT/CT versus MRI in patients with nonspecific pain of the hand and wrist - a pilot study.
abstract: BACKGROUND
  Hand and wrist pain is a diagnostic challenge for hand surgeons and radiologists due to the complex anatomy of the involved small structures. The American College of Radiology recommends MRI as the study of choice in patients with chronic wrist pain if radiographs are negative. Lately, state-of-the-art SPECT/CT systems have been introduced and may help in the diagnosis of this selected indication.
  
  
  METHODS
  This retrospective study included 21 patients with nonspecific pain of the hand/wrist. The diagnosis of nonspecific wrist pain was made by the referring hand surgeon based on patient history, clinical examination, plain radiography and clinical guidelines. All patients received planar early-phase imaging and late-phase SPECT/CT imaging as well as MRI. Lesions were divided into major (causative) and minor (not causative) pathologies according to clinical follow-up. Furthermore, oedema-like bone marrow changes seen on MRI were compared with focally increased tracer uptake seen on SPECT/CT images.
  
  
  RESULTS
  MRI yielded a quite high sensitivity (0.86), but a low specificity (0.20). In contrast, SPECT/CT yielded a high specificity (1.00) and a low sensitivity (0.71). Oedema-like bone marrow changes were detected in 15 lesions in 11 patients. In ten lesions with bone marrow oedema on MRI, foci of elevated tracer uptake were detected on SPECT/CT. Overall, MRI was more sensitive, but SPECT/CT was more specific in the evaluation of causative pathologies.
  
  
  CONCLUSIONS
  In this initial comparison, SPECT/CT showed higher specificity than MRI in the evaluation of causative pathologies in patients with nonspecific wrist pain. However, MRI was more sensitive. Thus, SPECT/CT was shown to be a useful problem-solving tool in the diagnostic work-up of these patients.
authors.affiliation: Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, CH-6004 Lucerne, Switzerland. martin.huellner@LUKS.ch
authors.forename: Martin W
authors.initials: MW
authors.lastname: Huellner
authors.forename: Alexander
authors.initials: A
authors.lastname: Bürkert
authors.forename: Florian S
authors.initials: FS
authors.lastname: Schleich
authors.forename: Maja
authors.initials: M
authors.lastname: Schürch
authors.forename: Urs
authors.initials: U
authors.lastname: Hug
authors.forename: Urs
authors.initials: U
authors.lastname: von Wartburg
authors.forename: Klaus
authors.initials: K
authors.lastname: Strobel
authors.forename: Patrick
authors.initials: P
authors.lastname: Veit-Haibach
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001692:Biological Transport; D001855:Bone Marrow Diseases / Q000000981:diagnostic imaging / Q000378:metabolism; D004487:Edema / Q000000981:diagnostic imaging / Q000378:metabolism; D005260:Female; D006225:Hand / Q000000981:diagnostic imaging*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D010146:Pain / Q000000981:diagnostic imaging*; D010865:Pilot Projects; D049268:Positron-Emission Tomography; D011849:Radioactive Tracers; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014953:Wrist / Q000000981:diagnostic imaging*; D055815:Young Adult
chemical_list: D011849:Radioactive Tracers