title: Development of a Protocol for SPECT/CT in the Assessment of Wrist Disorders.
abstract: BackgroundSingle-photon emission computed tomography and computed tomography (SPECT/CT) is a hybrid diagnostic imaging modality that allows clinicians to integrate their diagnostic evaluations and deliver a definitive diagnosis in musculoskeletal disorders. Specifically, in identification of osseous pathology, the conventional bone scan delivers greater specificity compared with magnetic resonance imaging (MRI). However, use of SPECT/CT enhances the sensitivity and specificity. Use of this modality denotes the possibility to specify the lesion more accurately and precisely while grading the activity according to osseous structural changes.PurposeThis study aimed to evaluate the clinical utility of SPECT/CT in the diagnoses and management of osseous wrist disorders. The objectives were to examine the value of SPECT/CT in the diagnosis of osseous-related wrist pain and whether the findings altered management.Patients and MethodsA retrospective cohort study of 20 patients with such wrist pain was conducted. SPECT/CT was used in the diagnostic process for these patients.ResultsFollowing SPECT/CT imaging, the common final diagnoses were osteoarthritis (10; 50%) and avascular necrosis (5; 25%). Less common diagnoses included ulnar carpal impact syndrome, infection, malunion, complex regional pain syndrome, and carpal boss. Some presented with multiple pathologies. SPECT/CT changed the final diagnosis in 11 cases, resulting in nonoperative treatment (7; 63%) or surgery (4; 37%).ConclusionFindings from this study and the literature demonstrate the clinical utility of SPECT/CT in the assessment of osseous-related wrist disorders. We present an algorithm for the assessment of wrist pain with osseous pathology. This commences with clinical assessment and plane radiographs (first-line investigation). Some cases will require a second-line investigation (ultrasound, CT, and/or MRI). If the diagnosis remains unclear, SPECT/CT is recommended as a third-line investigation.
authors: Clinique Jeanne d'Arc, Institut de la Main, Nantes, France.
authors: Aude Le
authors: AL
authors: Corre
authors: School of Medicine, Flinders University, Adelaide, South Australia, Australia.
authors: Kym Phuong
authors: KP
authors: Huynh
authors: School of Medicine, Flinders University, Adelaide, South Australia, Australia.
authors: Rasmeet Singh
authors: RS
authors: Dhaliwal
authors: School of Medicine, Flinders University, Adelaide, South Australia, Australia.
authors: Gregory Ian
authors: GI
authors: Bain
keywords: SPECT/CT; avascular necrosis; osteoarthritis; ulnar impingement; wrist