title: 99mTc-HDP SPECT-CT Aids Localization of Joint Injections in Degenerative Joint Disease of the Foot and Ankle.
abstract: BACKGROUND
  Pain relating to degenerative joint disease within the foot and ankle can be difficult to localize with clinical examination alone due to the complex anatomy of the joints. The aim of this study was to determine whether single-photon emission computed tomography combined with conventional computed tomography (SPECT-CT) could be used to localize the site of degenerative joint disease for intra-articular injection and thereby improve the clinical success of the procedure.
  
  
  METHODS
  A prospective study was performed involving 203 patients who had undergone triple-phase (99m)Tc-hydroxymethylene diphosphonate bone scans with SPECT-CT of the foot and ankle for degenerative joint disease. Fifty-two patients went on to have joint injections for degenerative joint disease, with clinical follow-up. Correlation with the clinical diagnosis and the outcome of intra-articular injections with 0.5% bupivacaine and 80 mg of Depo-Medrone was performed. A successful outcome was determined by an improvement in the visual analog pain score of at least 50%.
  
  
  RESULTS
  In 19 (37%) patients, the site of degenerative joint disease determined by SPECT-CT differed from the initial clinical assessment and resulted in a change in management. Overall, 46 (88%) patients showed an improvement in symptoms.
  
  
  CONCLUSIONS
  The study demonstrated a high clinical success rate for SPECT-CT-guided joint injections. The technique was useful in localizing degenerative joint disease of the ankle, hindfoot, and midfoot as an adjunct to clinical examination.
  
  
  METHODS
  Level IV, case series.
authors.affiliation: Epsom & St Helier University Hospitals NHS Trust, Carshalton, UK arum.parthipun@esth.nhs.uk.
authors.forename: Arum
authors.initials: A
authors.lastname: Parthipun
authors.affiliation: St George's University Hospitals NHS Foundation Trust, London, UK.
authors.forename: Joanna
authors.initials: J
authors.lastname: Moser
authors.affiliation: St George's University Hospitals NHS Foundation Trust, London, UK.
authors.forename: Wing
authors.initials: W
authors.lastname: Mok
authors.affiliation: St George's University Hospitals NHS Foundation Trust, London, UK.
authors.forename: Anton
authors.initials: A
authors.lastname: Paramithas
authors.affiliation: Epsom & St Helier University Hospitals NHS Trust, Carshalton, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Hamilton
authors.affiliation: Epsom & St Helier University Hospitals NHS Trust, Carshalton, UK.
authors.forename: Andrea Helene
authors.initials: AH
authors.lastname: Sott
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage; D000843:Ankle Joint / Q000000981:diagnostic imaging*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D005260:Female; D033023:Foot Joints / Q000000981:diagnostic imaging*; D006801:Humans; D007270:Injections, Intra-Articular / Q000379:methods*; D007592:Joint Diseases / Q000000981:diagnostic imaging* / Q000188:drug therapy; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077555:Methylprednisolone Acetate; D008875:Middle Aged; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D013669:Technetium Tc 99m Medronate / Q000031:analogs & derivatives; D015899:Tomography, Emission-Computed, Single-Photon; D064232:Visual Analog Scale; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D019275:Radiopharmaceuticals; D000077555:Methylprednisolone Acetate; C024226:technetium Tc 99m hydroxymethylene diphosphonate; D008775:Methylprednisolone; D013669:Technetium Tc 99m Medronate; D002045:Bupivacaine
keywords: SPECT-CT; ankle; bone scan; degenerative joint disease; hindfoot; midfoot