title: Assessment of the loading history of patients after high tibial osteotomy using SPECT/CT--a new diagnostic tool and algorithm.
abstract: BACKGROUND
  Single photon emission computerized tomography and conventional computerized tomography (SPECT/CT) tracer uptake has been shown to reflect the loading history of the tibiofemoral knee joint and correlate with the mechanical and anatomical alignment. It was our primary purpose to develop a novel standardized SPECT/CT algorithm for patients undergoing high tibial osteotomy, evaluate the inter- and intra-observer reliability (OR), and assess the clinical applicability for follow-up of patients before and after high tibial osteotomy.
  
  
  METHODS
  The localization scheme defines 9 femoral, 8 patellar, and 13 tibial zones to accurately map the examined tracer uptake volume in each anatomical area of interest. Maximum values for each area (mean ± standard deviation, median, and range) of the localization scheme were recorded as well as normalized values for the intensity of SPECT/CT tracer uptake calculated. The inter- and intra-OR was assessed for SPECT/CT localization and tracer activity. Pre- and postoperative mechanical alignment was assessed in SPECT/CT using a custom-made specialized software. The median inter- and intra-observer differences of the measured mechanical alignment were calculated along with the inter- and intra-OR.
  
  
  RESULTS
  The localization scheme showed near-perfect inter- and intra-OR (intra-class correlation coefficient (ICC) > 0.9) for the measurement of tracer activity and localization in all anatomical regions. For measurements of mechanical alignment, there was a strong agreement between the two observers (an inter-OR of ICC = 0.99 and an intra-OR of ICC = 0.98).
  
  
  CONCLUSIONS
  The presented SPECT/CT algorithm is highly reliable and clinically feasible. Combined with mechanical alignment analysis, it provides the surgeon with helpful information about realignment effects of high tibial osteotomies (HTOs) and might help identify the optimal personalized degree of correction in HTO surgery.
authors: Armin
authors: A
authors: Mucha
authors: Milos
authors: M
authors: Dordevic
authors: Enrique A
authors: EA
authors: Testa
authors: Helmut
authors: H
authors: Rasch
authors: Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland-Bruderholz, Bruderholz 4101, Switzerland. Michael.Hirschmann@unibas.ch.
authors: Michael T
authors: MT
authors: Hirschmann
mesh_terms: D000328:Adult; D000465:Algorithms; D017760:Bone Malalignment / Q000000981:diagnostic imaging; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D015588:Observer Variation; D010027:Osteotomy / Q000379:methods*; D019990:Perioperative Care / Q000379:methods; D011446:Prospective Studies; D015203:Reproducibility of Results; D013977:Tibia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods; D016474:Weight-Bearing / Q000502:physiology