title: Imaging non-specific wrist pain: interobserver agreement and diagnostic accuracy of SPECT/CT, MRI, CT, bone scan and plain radiographs.
abstract: OBJECTIVE
  Chronic hand and wrist pain is a common clinical issue for orthopaedic surgeons and rheumatologists. The purpose of this study was 1. To analyze the interobserver agreement of SPECT/CT, MRI, CT, bone scan and plain radiographs in patients with non-specific pain of the hand and wrist, and 2. to assess the diagnostic accuracy of these imaging methods in this selected patient population.
  
  
  METHODS
  Thirty-two consecutive patients with non-specific pain of the hand or wrist were evaluated retrospectively. All patients had been imaged by plain radiographs, planar early-phase imaging (bone scan), late-phase imaging (SPECT/CT including bone scan and CT), and MRI. Two experienced and two inexperienced readers analyzed the images with a standardized read-out protocol. Reading criteria were lesion detection and localisation, type and etiology of the underlying pathology. Diagnostic accuracy and interobserver agreement were determined for all readers and imaging modalities.
  
  
  RESULTS
  The most accurate modality for experienced readers was SPECT/CT (accuracy 77%), followed by MRI (56%). The best performing, though little accurate modality for inexperienced readers was also SPECT/CT (44%), followed by MRI and bone scan (38% each). The interobserver agreement of experienced readers was generally high in SPECT/CT concerning lesion detection (kappa 0.93, MRI 0.72), localisation (kappa 0.91, MRI 0.75) and etiology (kappa 0.85, MRI 0.74), while MRI yielded better results on typification of lesions (kappa 0.75, SPECT/CT 0.69). There was poor agreement between experienced and inexperienced readers in SPECT/CT and MRI.
  
  
  CONCLUSIONS
  SPECT/CT proved to be the most helpful imaging modality in patients with non-specific wrist pain. The method was found reliable, providing high interobserver agreement, being outperformed by MRI only concerning the typification of lesions. We believe it is beneficial to integrate SPECT/CT into the diagnostic imaging algorithm of chronic wrist pain.
authors.affiliation: Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.
authors.forename: Martin W
authors.initials: MW
authors.lastname: Huellner
authors.affiliation: Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.
authors.forename: Alexander
authors.initials: A
authors.lastname: Bürkert
authors.affiliation: Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.
authors.forename: Klaus
authors.initials: K
authors.lastname: Strobel
authors.affiliation: Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.
authors.forename: María del Sol
authors.initials: Mdel S
authors.lastname: Pérez Lago
authors.affiliation: Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.
authors.forename: Lennart
authors.initials: L
authors.lastname: Werner
authors.affiliation: Department of Hand and Plastic Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
authors.forename: Urs
authors.initials: U
authors.lastname: Hug
authors.affiliation: Department of Hand and Plastic Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
authors.forename: Urs
authors.initials: U
authors.lastname: von Wartburg
authors.affiliation: Division of Biostatistics, Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.affiliation: Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Veit-Haibach
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D059350:Chronic Pain / Q000000981:diagnostic imaging*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D014953:Wrist / Q000000981:diagnostic imaging*