The Value of SPECT-CT in Diagnosing Complex Non-Arthritic and Non-Neoplastic Conditions of the Foot and Ankle

Abstract

Introduction

There is little information on the value of using single photon emission computerized tomography–computed tomography (SPECT-CT) in non-arthritic and non-neoplastic conditions of the foot and ankle (F&A). The vast majority of studies have investigated the role of SPECT-CT in degenerative conditions, bony pathology, and neoplastic conditions. The diagnostic value of SPECT-CT in purely non-arthritic and non-neoplastic conditions, in the absence of other conclusive radiological findings, is yet to be clarified. The aim of this study was to evaluate the value of SPECT-CT in a cohort of patients with complex F&A pathology, in whom diagnostic uncertainty existed after conventional imaging techniques, and to assess its added value in routine clinical practice.

Methodology

A retrospective analysis of 297 SPECT-CTs from 2010 to 2017 found 18 SPECT-CTs (age = 16-56 years) performed for non-arthritic F&A pathology. Changes in diagnosis, management, and clinical outcome scores were recorded before and after SPECT-CT imaging.

Results

The results demonstrated that the provisional diagnosis was different from the SPECT-CT diagnosis in 10 (56%) out of the 18 patients and led to a modified treatment plan, which was successful in 8 (80%) out of the 10 patients. The post-intervention Manchester Oxford Foot Questionnaire (MOX-FQ) and Visual Analogue Scale (VAS) score improved from 76 ± 18 to 58 ± 24 (P = .02), and from 72 ± 17 to 49 ± 32 (P = .01), respectively. The SPECT-CT scan was useful in confirming the provisional diagnosis in the remaining 8 patients where a diagnostic uncertainty existed after conventional imaging techniques. Overall, a total of 15 out of 18 patients (83%) showed an improvement in their symptoms after management led by SPECT-CT diagnosis.

Conclusion

Our study highlights the added value of SPECT-CT in patients presenting with non-arthritic and non-neoplastic F&A conditions in which there is diagnostic uncertainty after conventional imaging. In 80% of cases, a change in management driven by the SPECT-CT findings led to a successful outcome. We have found SPECT-CT to be a useful investigative modality in assessing these complex F&A cases.

Levels of Evidence

Level IV

Keywords

SPECT-CT bone scintigraphy foot ankle non-arthritic foot pain diagnostic imaging

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References

Maurice

Newman

Watt

Bone scanning of the foot for unexplained pain. J Bone Joint Surg Br. 1987;69:448-452.

Ferkel

Karzel

Del Pizzo

Friedman

Fischer

SP.

Arthroscopic treatment of anterolateral impingement of the ankle. Am J Sports Med. 1991;19:440-446.

Ogilvie-Harris

Gilbart

Chorney

Chronic pain following ankle sprains in athletes: the role of arthroscopic surgery. Arthroscopy. 1997;13:564-574.

Bunyaviroch

Aggarwal

Oates

ME.

Optimized scintigraphic evaluation of infection and inflammation: role of single-photon emission computed tomography/computed tomography fusion imaging. Semin Nucl Med. 2006;36(4):295-311.

Horger

Bares

The role of single-photon emission computed tomography/computed tomography in benign and malignant bone disease. Semin Nucl Med. 2006;36(4):286-294.

O’Connor

Kemp

BJ.

Single-photon emission computed tomography/computed tomography: basic instrumentation and innovations. Semin Nucl Med. 2006;36(4):258-266.

Mohan

Gnanasegaran

Vijayanathan

Fogelman

SPECT/CT in imaging foot and ankle pathology—the demise of other coregistration techniques. Semin Nucl Med. 2010;40(1):41-51.

Kretzschmar

Wiewiorski

Rasch

, et al. 99mTc-DPD-SPECT/CT predicts the outcome of imaging-guided diagnostic anaesthetic injections: a prospective cohort study. Eur J Radiol. 2011;80(3):e410-e415.

Pagenstert

Barg

Leumann

, et al. SPECT-CT imaging in degenerative joint disease of the foot and ankle. J Bone Joint Surg Br. 2009;91(9):1191-1196.

10.

Meftah

Katchis

Scharf

Mintz

Klein

Weiner

LS.

SPECT/CT in the management of osteochondral lesions of the talus. Foot Ankle Int. 2011;32(3):233-238.

11.

Knupp

Pagenstert

Barg

Bolliger

Easley

Hintermann

SPECT-CT compared with conventional imaging modalities for the assessment of the varus and valgus malaligned hindfoot. J Orthop Res. 2009;27(11):1461-1466.

12.

Breunung

Barwick

Fernando

, et al. Additional benefit of SPECT-CT in investigating heel pain. Clin Nucl Med. 2008;33(10):705-706.

13.

Heiba

Kolker

Mocherla

, et al. The optimized evaluation of diabetic foot infection by dual isotope SPECT/CT imaging protocol. J Foot Ankle Surg. 2010;49(6):529-536.

14.

Claassen

Yao

Ettinger

, et al. Relevance of SPECT-CT in complex cases of foot and ankle surgery: a comparison with MRI. Foot Ankle Spec. 2019;13(6):451-462. doi:10.1177/1938640019890987.

15.

Wiewiorski

Pagenstert

Rasch

Jacob

Valderrabano

Pain in osteochondral lesions. Foot Ankle Spec. 2011;4:92-99.

16.

Mandegaran

Dhillon

Jen

Beyond the bones and joints: a review of ligamentous injuries of the foot and ankle on (99m)Tc-MDP-SPECT/CT. Br J Radiol. 2019;92(1104):20190506. doi:10.1259/bjr.20190506.

17.

Chicklore

Gnanasegaran

Vijayanathan

Fogelman

Potential role of multislice SPECT/CT in impingement syndrome and soft-tissue pathology of the ankle and foot. Nucl Med Commun. 2013;34(2):130-139. doi:10.1097/MNM.0b013e32835c0964.

18.

Gnanasegaran

Mohan

Sharp

, et al. Single photon emission computed tomography-computed tomography in the management of foot pathology. Nucl Med Commun. 2008;29:482.

19.

Singh

Javed

Parthipun

Sott

AH.

The diagnostic value of single photon-emission computed tomography bone scans combined with CT (SPECT-CT) in diseases of the foot and ankle. Foot Ankle Surg. 2013;19:80-83.

20.

Mohan

Holker

Gnanasegaran

, et al. The applicability of SPECT-CT in directing the management of bony ankle and foot pathology. Eur J Nucl Med Mol Imaging. 2007;34:S166.

21.

Newman

Newberg

AH.

Congenital tarsal coalition: multimodality evaluation with emphasis on CT and MR imaging. Radiographics. 2000;20:321-332.

22.

Upadhyay

Beadsmoore

Marshall

Toms

Buscombe

Technetium-99m methylene diphosphonate single-photon emission computed tomography/computed tomography of the foot and ankle. World J Nucl Med. 2017;16(2):88-100. doi:10.4103/1450-1147.203077.

23.

Leumann

Valderrabano

Plaass

, et al. A novel imaging method for osteochondral lesions of the talus—comparison of SPECT-CT with MRI. Am J Sports Med. 2011;39(5):1095-1101.

24.

Mandegaran

Dhillon

Jen

Beyond the bones and joints: a review of ligamentous injuries of the foot and ankle on (99m)Tc-MDP-SPECT/CT. Br J Radiol. 2019;92(1104):20190506. doi:10.1259/bjr.20190506.

25.

Hong

Paeng

, et al. Comparison of SPECT/CT and MRI in diagnosing symptomatic lesions in ankle and foot pain patients: diagnostic performance and relation to lesion type. PLoS One. 2015;10(2):e0117583.

26.

Hirschmann

Davda

Rasch

Arnold

Friederich

NF.

Clinical value of combined single photon emission computerized tomography and conventional computer tomography (SPECT/CT) in sports medicine. Sports Med Arthrosc Rev. 2011;19(2):174-181.

27.

Gupta

Trethewey

Brooker

, et al. Radionuclide bone scan SPECT-CT: lowering the dose of CT significantly reduces radiation dose without impacting CT image quality. Am J Nucl Med Mol Imaging. 2017;7(2):63-73.