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Nuclear Medicine Imaging of Knee Injuries

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Nuclear Medicine and Radiologic Imaging in Sports Injuries

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Abstract

This chapter deals with the clinical value of nuclear medicine, in particular SPECT/CT, in patients with knee injuries. A thorough overview of nuclear medicine imaging protocols, diagnostic algorithms and the clinical value for different knee pathologies is given. These knee pathologies or variants include patients with anterior knee pain; jumper’s knee; runner’s knee; patellar dislocation; patellar maltracking; patellar fractures; meniscal lesions; ligament tears such as anterior cruciate ligament, posterior cruciate ligament or collaterals; Stieda-Pellegrini lesion; cartilage lesions; osteochondral lesions; overloading of a knee compartment; osteoarthritis and fractures. The clinical value is further illustrated by images and typical instructional case descriptions.

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Abbreviations

CT:

Computerized tomography

SPECT:

Single-photon emission computerized tomography

MRI:

Magnetic resonance imaging

PPV:

Positive predictive value

References

  • Adams WB (2004) Treatment options in overuse injuries of the knee: patellofemoral syndrome, iliotibial band syndrome, and degenerative meniscal tears. Curr Sports Med Rep 3:256–260

    Article  PubMed  Google Scholar 

  • Amarasekera HW, Costa ML, Parsons N et al (2011) SPECT/CT bone imaging after hip resurfacing arthroplasty: is it feasible to use CT attenuation correction in the presence of metal implants? Nucl Med Commun 32:289–297

    Article  PubMed  Google Scholar 

  • Basdekis G, Christel P, Anne F (2009) Validation of the position of the femoral tunnels in anatomic double-bundle ACL reconstruction with 3-D CT scan. Knee Surg Sports Traumatol Arthrosc 17:1089–1094

    Article  PubMed  Google Scholar 

  • Biersack HJ, Wingenfeld C, Hinterthaner B et al (2012) SPECT-CT of the foot. Nuklearmedizin 51:26–31

    Article  PubMed  Google Scholar 

  • Breunung N, Barwick T, Fernando R et al (2008) Additional benefit of SPECT-CT in investigating heel pain. Clin Nucl Med 33:705–706

    Article  PubMed  Google Scholar 

  • Buck FM, Hoffmann A, Hofer B et al (2009) Chronic medial knee pain without history of prior trauma: correlation of pain at rest and during exercise using bone scintigraphy and MR imaging. Skeletal Radiol 38:339–347

    Article  PubMed  Google Scholar 

  • Bybel B, Brunken RC, DiFilippo FP et al (2008) SPECT/CT imaging: clinical utility of an emerging technology. Radiographics 28:1097–1113

    Article  PubMed  Google Scholar 

  • Collier BD, Johnson RP, Carrera GF et al (1985) Chronic knee pain assessed by SPECT: comparison with other modalities. Radiology 157:795–802

    Article  CAS  PubMed  Google Scholar 

  • Cook GJ, Fogelman I (1996) Lateral collateral ligament tear of the knee: appearances on bone scintigraphy with single-photon emission tomography. Eur J Nucl Med 23:720–722

    Article  CAS  PubMed  Google Scholar 

  • De Geeter F, De Neve J, Van Steelandt H (1995) Bone scan in iliotibial band syndrome. Clin Nucl Med 20:550–551

    Article  PubMed  Google Scholar 

  • Delbeke D, Schoder H, Martin WH et al (2009) Hybrid imaging (SPECT/CT and PET/CT): improving therapeutic decisions. Semin Nucl Med 39:308–340

    Article  PubMed  Google Scholar 

  • Dorchak JD, Barrack RL, Alexander AH et al (1993) Radionuclide imaging of the knee with chronic anterior cruciate ligament tear. Orthop Rev 22:1233–1241

    CAS  PubMed  Google Scholar 

  • Dye SF, Boll DA (1986) Radionuclide imaging of the patellofemoral joint in young adults with anterior knee pain. Orthop Clin North Am 17:249–262

    CAS  PubMed  Google Scholar 

  • Dye S, Chew MH (1993) The use of scintigraphy to detect increased osseous metabolic activity about the knee. J Bone Joint Surg 75:1388–1406

    Google Scholar 

  • Etchebehere EC, Etchebehere M, Gamba R et al (1998) Orthopedic pathology of the lower extremities: scintigraphic evaluation in the thigh, knee, and leg. Semin Nucl Med 28:41–61

    Article  CAS  PubMed  Google Scholar 

  • Even-Sapir E, Arbel R, Lerman H et al (2002) Bone injury associated with anterior cruciate ligament and meniscal tears: assessment with bone single photon emission computed tomography. Invest Radiol 37:521–527

    Article  PubMed  Google Scholar 

  • Franc BL, Myers R, Pounds TR et al (2012) Clinical utility of SPECT-(low-dose)CT versus SPECT alone in patients presenting for bone scintigraphy. Clin Nucl Med 37:26–34

    Article  PubMed  Google Scholar 

  • Gnanasegaran G, Barwick T, Adamson K et al (2009) Multislice SPECT/CT in benign and malignant bone disease: when the ordinary turns into the extraordinary. Semin Nucl Med 39:431–442

    Article  PubMed  Google Scholar 

  • Graute V, Feist M, Lehner S et al (2010) Detection of low-grade prosthetic joint infections using 99mTc-antigranulocyte SPECT/CT: initial clinical results. Eur J Nucl Med Mol Imaging 37:1751–1759

    Article  PubMed  Google Scholar 

  • Gregory PL, Batt ME, Kerslake RW et al (2004) The value of combining single photon emission computerised tomography and computerised tomography in the investigation of spondylolysis. Eur Spine J 13:503–509

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Grevitt MP, Taylor M, Churchill M et al (1993) SPECT imaging in the diagnosis of meniscal tears. J R Soc Med 86:639–641

    PubMed Central  CAS  PubMed  Google Scholar 

  • Hart R, Konvicka M, Filan P et al (2008) SPECT scan is a reliable tool for selection of patients undergoing unicompartmental knee arthroplasty. Arch Orthop Trauma Surg 128:679–682

    Article  PubMed  Google Scholar 

  • Hayashi D, Roemer FW, Guermazi A (2012) Osteoarthritis year 2011 in review: imaging in OA–a radiologists’ perspective. Osteoarthritis Cartilage 20:207–214

    Article  CAS  PubMed  Google Scholar 

  • Hirschmann MT, Adler T, Rasch H et al (2010a) Painful knee joint after ACL reconstruction using biodegradable interference screws- SPECT/CT a valuable diagnostic tool? A case report. Sports Med Arthrosc Rehabil Ther Technol 2:24

    Article  PubMed Central  PubMed  Google Scholar 

  • Hirschmann MT, Iranpour F, Konala P et al (2010b) A novel standardized algorithm for evaluating patients with painful total knee arthroplasty using combined single photon emission tomography and conventional computerized tomography. Knee Surg Sports Traumatol Arthrosc 18:939

    Article  PubMed  Google Scholar 

  • Hirschmann MT, Davda K, Iranpour F et al (2011a) Combined single photon emission computerised tomography and conventional computerised tomography (SPECT/CT) in patellofemoral disorders: a clinical review. Int Orthop 35:675–680

    Article  PubMed Central  PubMed  Google Scholar 

  • Hirschmann MT, Davda K, Rasch H et al (2011b) Clinical value of combined single photon emission computerized tomography and conventional computer tomography (SPECT/CT) in sports medicine. Sports Med Arthrosc 19:174–181

    Article  PubMed  Google Scholar 

  • Hirschmann MT, Konala P, Iranpour F et al (2011c) Clinical value of SPECT/CT for evaluation of patients with painful knees after total knee arthroplasty–a new dimension of diagnostics? BMC Musculoskelet Disord 12:36

    Article  PubMed Central  PubMed  Google Scholar 

  • Hirschmann MT, Schmid R, Dhawan R et al (2011d) Combined single photon emission computerized tomography and conventional computerized tomography: clinical value for the shoulder surgeons? Int J Shoulder Surg 5:72–76

    Article  PubMed Central  PubMed  Google Scholar 

  • Hirschmann MT, Mathis D, Afifi FK et al (2012a) Single photon emission computerized tomography and conventional computerized tomography (SPECT/CT) for evaluation of patients after anterior cruciate ligament reconstruction: a novel standardized algorithm combining mechanical and metabolic information. Knee Surg Sports Traumatol Arthrosc 21(4):965–974

    Article  PubMed  Google Scholar 

  • Hirschmann MT, Schon S, Afifi FK et al (2012b) Assessment of loading history of compartments in the knee using bone SPECT/CT: a study combining alignment and 99mTc-HDP tracer uptake/distribution patterns. J Orthop Res 31:268–274

    Article  PubMed  Google Scholar 

  • Hirschmann MT, Wagner CR, Rasch H et al (2012c) Standardized volumetric 3D-analysis of SPECT/CT imaging in orthopaedics: overcoming the limitations of qualitative 2D analysis. BMC Med Imaging 12:5

    Article  PubMed Central  PubMed  Google Scholar 

  • Hogervorst T, Pels Rijcken TH, van der Hart CP et al (2000a) Abnormal bone scans in anterior cruciate ligament deficiency indicate structural and functional abnormalities. Knee Surg Sports Traumatol Arthrosc 8:137–142

    Article  CAS  PubMed  Google Scholar 

  • Hogervorst T, van der Hart CP, Pels Rijcken TH et al (2000b) Abnormal bone scans of the tibial tunnel 2 years after patella ligament anterior cruciate ligament reconstruction: correlation with tunnel enlargement and tibial graft length. Knee Surg Sports Traumatol Arthrosc 8:322–328

    Article  CAS  PubMed  Google Scholar 

  • Hogervorst T, Pels Rijcken TH, Rucker D et al (2002) Changes in bone scans after anterior cruciate ligament reconstruction: a prospective study. Am J Sports Med 30:823–833

    PubMed  Google Scholar 

  • Horger M, Eschmann SM, Pfannenberg C et al (2007) Added value of SPECT/CT in patients suspected of having bone infection: preliminary results. Arch Orthop Trauma Surg 127:211–221

    Article  PubMed  Google Scholar 

  • Jeer PJ, Mahr CC, Keene GC et al (2006) Single photon emission computed tomography in planning unicompartmental knee arthroplasty. A prospective study examining the association between scan findings and intraoperative assessment of osteoarthritis. Knee 13:19–25

    Article  PubMed  Google Scholar 

  • Kim HR, So Y, Moon SG et al (2008) Clinical value of (99m)Tc-methylene diphosphonate (MDP) bone single photon emission computed tomography (SPECT) in patients with knee osteoarthritis. Osteoarthritis Cartilage 16:212–218

    Article  PubMed  Google Scholar 

  • Konala P, Iranpour F, Kerner A et al (2010) Clinical benefit of SPECT/CT for follow-up of surgical treatment of osteochondritis dissecans. Ann Nucl Med 24:621–624

    Article  PubMed  Google Scholar 

  • Lee A, Emmett L, Van der Wall H et al (2008) SPECT/CT of femeroacetabular impingement. Clin Nucl Med 33:757–762

    Article  PubMed  Google Scholar 

  • Lorberboym M, Ami DB, Zin D et al (2003) Incremental diagnostic value of 99mTc methylene diphosphonate bone SPECT in patients with patellofemoral pain disorders. Nucl Med Commun 24:403–410

    Article  CAS  PubMed  Google Scholar 

  • Madsen MT (2007) Recent advances in SPECT imaging. J Nucl Med 48:661–673

    Article  PubMed  Google Scholar 

  • Madsen JL (2008) Bone SPECT/CT detection of a sequestrum in chronic-infected nonunion of the tibia. Clin Nucl Med 33:700–701

    Article  PubMed  Google Scholar 

  • Marks PH, Goldenberg JA, Vezina WC et al (1992) Subchondral bone infractions in acute ligamentous knee injuries demonstrated on bone scintigraphy and magnetic resonance imaging. J Nucl Med 33:516–520

    CAS  PubMed  Google Scholar 

  • Mohan HK, Gnanasegaran G, Vijayanathan S et al (2010) SPECT/CT in imaging foot and ankle pathology-the demise of other coregistration techniques. Semin Nucl Med 40:41–51

    Article  PubMed  Google Scholar 

  • Molnar TJ, Fox JM (1993) Overuse injuries of the knee in basketball. Clin Sports Med 12:349–362

    CAS  PubMed  Google Scholar 

  • Murray IP, Dixon J, Kohan L (1990) SPECT for acute knee pain. Clin Nucl Med 15:828–840

    Article  CAS  PubMed  Google Scholar 

  • Naslund JE, Odenbring S, Naslund UB et al (2005) Diffusely increased bone scintigraphic uptake in patellofemoral pain syndrome. Br J Sports Med 39:162–165

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • O’Connor MK, Kemp BJ (2006) Single-photon emission computed tomography/computed tomography: basic instrumentation and innovations. Semin Nucl Med 36:258–266

    Article  PubMed  Google Scholar 

  • Pagenstert GI, Barg A, Leumann AG et al (2009) SPECT-CT imaging in degenerative joint disease of the foot and ankle. J Bone Joint Surg Br 91:1191–1196

    Article  CAS  PubMed  Google Scholar 

  • Petersson IF, Boegard T, Dahlstrom J et al (1998) Bone scan and serum markers of bone and cartilage in patients with knee pain and osteoarthritis. Osteoarthritis Cartilage 6:33–39

    Article  CAS  PubMed  Google Scholar 

  • Purnell ML, Larson AI, Clancy W (2008) Anterior cruciate ligament insertions on the tibia and femur and their relationships to critical bony landmarks using high-resolution volume-rendering computed tomography. Am J Sports Med 36:2083–2090

    Article  PubMed  Google Scholar 

  • Ryan PJ, Fogelman I (1994) The role of nuclear medicine in orthopaedics. Nucl Med Commun 15:341–360

    Article  CAS  PubMed  Google Scholar 

  • Scharf S (2009) SPECT/CT imaging in general orthopedic practice. Semin Nucl Med 39:293–307

    Article  PubMed  Google Scholar 

  • So Y, Chung JK, Seong SC et al (2000) Usefulness of 99Tcm-MDP knee SPET for pre-arthroscopic evaluation of patients with internal derangements of the knee. Nucl Med Commun 21:103–109

    Article  CAS  PubMed  Google Scholar 

  • Strobel K, Steurer-Dober I, Huellner MW et al (2012) Importance of SPECT/CT for knee and hip joint prostheses. Radiologe 52:629–637

    Article  CAS  PubMed  Google Scholar 

  • Taunton JE, Clement DB, Smart GW et al (1987) Non-surgical management of overuse knee injuries in runners. Can J Sport Sci 12:11–18

    CAS  PubMed  Google Scholar 

  • Van Den Eeckhaut A, Walgraeve N, De Geeter F (2003) Bone SPECT findings in runner’s knee. Clin Nucl Med 28:492–493

    Google Scholar 

  • Vellala RP, Manjure S, Ryan PJ (2004) Single photon emission computed tomography scanning in the diagnosis of knee pathology. J Orthop Surg (Hong Kong) 12:87–90

    CAS  Google Scholar 

  • Yildirim M, Gursoy R, Varoglu E et al (2004) 99mTc-MDP bone SPECT in evaluation of the knee in asymptomatic soccer players. Br J Sports Med 38:15–18

    Article  PubMed Central  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, CH-4101, Switzerland

    Michael T. Hirschmann MD

  2. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland Bruderholz, Bruderholz, CH-4101, Switzerland

    Enrique Testa MD

  3. Institute for Radiology and Nuclear Medicine, Kantonsspital Baselland Bruderholz, Bruderholz, CH-4101, Switzerland

    Flavio Forrer MD & Helmut Rasch MD

Authors
  1. Michael T. Hirschmann MD
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  2. Flavio Forrer MD
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  3. Enrique Testa MD
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  4. Helmut Rasch MD
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Corresponding author

Correspondence to Michael T. Hirschmann MD .

Editor information

Editors and Affiliations

  1. Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Andor W.J.M. Glaudemans

  2. Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Rudi A.J.O. Dierckx

  3. Department of Radiology, Antwerp University Hospital, Edegem, Belgium

    Jan L.M.A. Gielen

  4. Exercise and Health, Center for Sports Medicine, University Center for Sport, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Johannes (Hans) Zwerver

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Hirschmann, M.T., Forrer, F., Testa, E., Rasch, H. (2015). Nuclear Medicine Imaging of Knee Injuries. In: Glaudemans, A., Dierckx, R., Gielen, J., Zwerver, J. (eds) Nuclear Medicine and Radiologic Imaging in Sports Injuries. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-46491-5_30

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  • DOI: https://doi.org/10.1007/978-3-662-46491-5_30

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-46490-8

  • Online ISBN: 978-3-662-46491-5

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