Skip to main content
SpringerLink
Log in

4D-SPECT/CT in orthopaedics: a new method of combined quantitative volumetric 3D analysis of SPECT/CT tracer uptake and component position measurements in patients after total knee arthroplasty

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

The purpose was to evaluate the intra- and inter-observer reliability of combined quantitative 3D-volumetric single-photon emission computed tomography (SPECT)/CT analysis including size, intensity and localisation of tracer uptake regions and total knee arthroplasty (TKA) position.

Materials and methods

Tc-99m-HDP-SPECT/CT of 100 knees after TKA were prospectively analysed. The anatomical areas represented by a previously validated localisation scheme were 3D-volumetrically analysed. The maximum intensity was recorded for each anatomical area. Ratios between the respective value and the mid-shaft of the femur as the reference were calculated. Femoral and tibial TKA position (varus–valgus, flexion–extension, internal rotation– external rotation) were determined on 3D-CT. Two consultant radiologists/nuclear medicine physicians interpreted the SPECT/CTs twice with a 2-week interval. The inter- and intra-observer reliability was determined (ICCs). Kappa values were calculated for the area with the highest tracer uptake between the observers.

Results

The measurements of tracer uptake intensity showed excellent inter- and intra-observer reliabilities for all regions (tibia, femur and patella). Only the tibial shaft area showed ICCs <0.89. The kappa values were almost perfect (0.856, p < 0.001; 95 % CI 0.778, 0.922). For measurements of the TKA position, there was strong agreement within and between the readings of the two observers; the ICCs for the orientation of TKA components for inter- and intra-observer reliability were nearly perfect (ICCs >0.84).

Conclusion

This combined 3D-volumetric standardised method of analysing the location, size and the intensity of SPECT/CT tracer uptake regions (“hotspots”) and the determination of the TKA position was highly reliable and represents a novel promising approach to biomechanics.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bybel B, Brunken RC, DiFilippo FP, Neumann DR, Wu G, Cerqueira MD. SPECT/CT imaging: clinical utility of an emerging technology. Radiographics. 2008;28(4):1097–113.

    Article  PubMed  Google Scholar 

  2. Delbeke D, Schöder H, Martin WH, Wahl RL. Hybrid imaging (SPECT/CT and PET/CT): Improving therapeutic decisions. Semin Nucl Med. 2009;39(5):308–40.

    Article  PubMed  Google Scholar 

  3. Gnanasegaran G, Barwick T, Adamson K, Mohan H, Sharp D, Fogelman I. Multislice SPECT/CT in benign and malignant bone disease: when the ordinary turns into the extraordinary. Semin Nucl Med. 2009;39(6):431–42.

    Article  PubMed  Google Scholar 

  4. Hirschmann MT, Konala P, Iranpour F, Kerner A, Rasch H, Friederich NF. Clinical value of SPECT/CT for evaluation of patients with painful knees after total knee arthroplasty–a new dimension of diagnostics? BMC Musculoskelet Disord. 2011;12:36.

    Article  PubMed  Google Scholar 

  5. Hirschmann MT, Schmid R, Dhawan R, et al. Combined single photon emission computerized tomography and conventional computerized tomography: clinical value for the shoulder surgeons? Int J Shoulder Surg. 2011;5(3):72–6.

    Article  PubMed  Google Scholar 

  6. Konala P, Iranpour F, Kerner A, Rasch H, Friederich NF, Hirschmann MT. Clinical benefit of SPECT/CT for follow-up of surgical treatment of osteochondritis dissecans. Ann Nucl Med. 2010;24(8):621–4.

    Article  PubMed  Google Scholar 

  7. Scharf S. SPECT/CT imaging in general orthopedic practice. Semin Nucl Med. 2009;39(5):293–307.

    Article  PubMed  Google Scholar 

  8. Hirschmann MT, Iranpour F, Konala P, et al. 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. 2010;18(7):939.

    Article  PubMed  Google Scholar 

  9. Graute V, Feist M, Lehner S, et al. Detection of low-grade prosthetic joint infections using 99mTc-antigranulocyte SPECT/CT: initial clinical results. Eur J Nucl Med Mol Imaging. 2010;37(9):1751–9.

    Article  PubMed  Google Scholar 

  10. Hirschmann MT, Davda K, Iranpour F, Rasch H, Friederich NF. Combined single photon emission computerised tomography and conventional computerised tomography (SPECT/CT) in patellofemoral disorders: a clinical review. Int Orthop. 2011;35(5):675–80.

    Article  PubMed  Google Scholar 

  11. Hirschmann MT, Iranpour F, Davda K, Rasch H, Hugli R, Friederich NF. Combined single-photon emission computerized tomography and conventional computerized tomography (SPECT/CT): clinical value for the knee surgeons? Knee Surg Sports Traumatol Arthrosc. 2010;18(3):341–5.

    Article  PubMed  Google Scholar 

  12. Ahmad R, Kumar GS, Katam K, Dunlop D, Pozo JL. Significance of a "hot patella" in total knee replacement without primary patellar resurfacing. Knee. 2009;16(5):337–40.

    Article  PubMed  CAS  Google Scholar 

  13. Pagenstert GI, Barg A, Leumann AG, et al. SPECT-CT imaging in degenerative joint disease of the foot and ankle. J Bone Joint Surg Br. 2009;91(9):1191–6.

    PubMed  CAS  Google Scholar 

  14. Hirschmann MT, Wagner CR, Rasch H, Henckel J. Standardized volumetric 3D-analysis of SPECT/CT imaging in orthopaedics: overcoming the limitations of qualitative 2D analysis. BMC Med Imaging. 2012;12(1):5.

    Article  PubMed  Google Scholar 

  15. Hirschmann MT, Konala P, Amsler F, Iranpour F, Friederich NF, Cobb JP. The position and orientation of total knee replacement components: a comparison of conventional radiographs, transverse 2D-CT slices and 3D-CT reconstruction. J Bone Joint Surg Br Vol. 2011;93(5):629–33.

    Article  CAS  Google Scholar 

  16. Henckel J, Richards R, Lozhkin K, et al. Very low-dose computed tomography for planning and outcome measurement in knee replacement. The imperial knee protocol. JBJS (Br). 2006;88(11):1513–8.

    CAS  Google Scholar 

  17. Walter SD, Eliasziw M, Donner A. Sample size and optimal designs for reliability studies. Stat Med. 1998;17(1):101–10.

    Article  PubMed  CAS  Google Scholar 

  18. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

We greatly thank the Gottfried und Julia Bangerter-Rhyner-Stiftung, Berne, Switzerland as well as the Deutsche Arthrose Hilfe e.V, Saarlouis, Germany for supporting our research.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, 4101, Bruderholz, Switzerland

    Michael T. Hirschmann

  2. Institute for Radiology and Nuclear Medicine, Kantonsspital Baselland, 4101, Bruderholz, Switzerland

    Helmut Rasch, Anna L. Falkowski & Flavio Forrer

  3. Imperial College London, London, UK

    Johann Henckel

Authors
  1. Helmut Rasch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anna L. Falkowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Flavio Forrer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Johann Henckel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael T. Hirschmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael T. Hirschmann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rasch, H., Falkowski, A.L., Forrer, F. et al. 4D-SPECT/CT in orthopaedics: a new method of combined quantitative volumetric 3D analysis of SPECT/CT tracer uptake and component position measurements in patients after total knee arthroplasty. Skeletal Radiol 42, 1215–1223 (2013). https://doi.org/10.1007/s00256-013-1643-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-013-1643-2

Keywords

Search

Navigation