The diagnostic utility of single-photon emission computed tomography combined with computed tomography (SPECT/CT) in hand and wrist disorders: a systematic review

Abstract

Introduction:

This systematic review aimed to investigate the use of single-photon emission computed tomography/computed tomography (SPECT/CT) in diagnosing and managing hand and wrist disorders, especially hand and wrist pain of unknown aetiology.

Methods:

A systematic review of the Embase, MEDLINE and Cochrane databases was performed in accordance with Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Author experiences with SPECT/CT and, where available, sensitivity and specificity data were analysed.

Results:

The search yielded 3546 records, of which 3477 were excluded, leaving 69 for full-text analysis. Fourteen studies were eligible for inclusion. Overall, SPECT/CT demonstrated sensitivities and specificities in the ranges 0.6–0.83 and 0.9–0.1 for non-specific hand and wrist pain (n = 6), 0.75–1.0 and 0.82–0.93 for osseous disorders (n = 5) and 0.72–1.0 and 0.65–0.82 for rheumatic disorders (n = 3). For hand and wrist disorders, SPECT/CT demonstrated comparable sensitivity and specificity to magnetic resonance imaging (MRI), but greater diagnostic accuracy than routine imaging modalities. In cases where the pathology was subtle or ambiguous, SPECT/CT could help confirm the diagnosis, estimate the severity of the condition and identify clinically relevant anatomy.

Conclusion:

Although SPECT/CT has comparable diagnostic accuracy to other cross-sectional imaging modalities, such as MRI, the additional information it provides influences surgical management in only a minority of cases. Its substantial radiation exposure may prevent SPECT/CT from being used routinely, but it can be an effective problem-solving tool in cases where the diagnosis remains unclear despite prior imaging.