title: Feasibility and preliminary results of SPECT/CT arthrography of the wrist in comparison with MR arthrography in patients with suspected ulnocarpal impaction.
abstract: OBJECTIVE
  To evaluate the feasibility and performance of SPECT/CT arthrography of the wrist in comparison with MR arthrography in patients with suspected ulnocarpal impaction.
  
  
  METHODS
  This prospective study included 28 wrists of 27 patients evaluated with SPECT/CT arthrography and MR arthrography. Iodine contrast medium and gadolinium were injected into the distal radioulnar and midcarpal joints. Late-phase SPECT/CT was performed 3.5 h after intravenous injection of approximately 650 MBq (99m)Tc-DPD. MR and SPECT/CT images were separately reviewed in relation to bone marrow oedema, radionuclide uptake, and tears in the scapholunate (SL) and lunotriquetral (LT) ligaments and triangular fibrocartilage complex (TFCC), and an overall diagnosis of ulnar impaction. MR, CT and SPECT/CT imaging findings were compared with each other, with the surgical findings in 12 patients and with clinical follow-up.
  
  
  RESULTS
  The quality of MR arthrography and SPECT/CT arthrography images was fully diagnostic in 23 of 28 wrists (82%) and 25 of 28 wrists (89%), respectively. SPECT/CT arthrography was not diagnostic for ligament lesions due to insufficient intraarticular contrast in one wrist. MR and SPECT/CT images showed concordant findings regarding TFCC lesions in 22 of 27 wrists (81%), SL ligament in 22 of 27 wrists (81%) and LT ligament in 23 of 27 wrists (85%). Bone marrow oedema on MR images and scintigraphic uptake were concordant in 21 of 28 wrists (75%). MR images showed partial TFCC defects in four patients with normal SPECT/CT images. MR images showed bone marrow oedema in 4 of 28 wrists (14%) without scintigraphic uptake, and scintigraphic uptake was present without MR bone marrow oedema in three wrists (11%). Regarding diagnosis of ulnar impaction the concordance rate between CT and SPECT/CT was 100% and reached 96% (27 of 28) between MR and SPECT/CT arthrography. The sensitivity and specificity of MR, CT and SPECT/CT arthrography were 93%, 100% and 100%, and 93%, 93% and 93%, respectively.
  
  
  CONCLUSIONS
  SPECT/CT arthrography of the wrist is feasible. Regarding diagnosis of ulnar impaction we found a high concordance with MR arthrography. SPECT/CT arthrography of the wrist is an alternative to MR arthrography in patients with contraindications to MR imaging.
authors.affiliation: Department of Nuclear Medicine and Radiology, Lucerne Cantonal Hospital, Lucerne, Switzerland, klaus.strobel@ksl.ch.
authors.forename: Klaus
authors.initials: K
authors.lastname: Strobel
authors.forename: Isabelle
authors.initials: I
authors.lastname: Steurer-Dober
authors.forename: Angela J
authors.initials: AJ
authors.lastname: Da Silva
authors.forename: Martin W
authors.initials: MW
authors.lastname: Huellner
authors.forename: Maria
authors.initials: M
authors.lastname: del Sol Pérez Lago
authors.forename: Elvira
authors.initials: E
authors.lastname: Bodmer
authors.forename: Urs
authors.initials: U
authors.lastname: von Wartburg
authors.forename: Patrick
authors.initials: P
authors.lastname: Veit-Haibach
authors.forename: Katharina
authors.initials: K
authors.lastname: Tornquist
authors.forename: Urs
authors.initials: U
authors.lastname: Hug
mesh_terms: D000328:Adult; D000368:Aged; D001175:Arthrography / Q000379:methods*; D004164:Diphosphonates / Q000493:pharmacokinetics; D005260:Female; D005682:Gadolinium / Q000493:pharmacokinetics; D006801:Humans; D007457:Iodine Radioisotopes / Q000493:pharmacokinetics; D007592:Joint Diseases / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D015609:Organotechnetium Compounds / Q000493:pharmacokinetics; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D014457:Ulna / Q000000981:diagnostic imaging / Q000473:pathology; D014953:Wrist / Q000000981:diagnostic imaging* / Q000473:pathology
chemical_list: D004164:Diphosphonates; D007457:Iodine Radioisotopes; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C033905:technetium Tc 99m 1,1-diphosphonopropane-2,3-dicarboxylic acid; D005682:Gadolinium