Skip to main content

Advertisement

SpringerLink
Log in

Clinical applications of SPECT/CT in imaging the extremities

  • Review Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Today, SPECT/CT is increasingly used and available in the majority of larger nuclear medicine departments. Several applications of SPECT/CT as a supplement to or replacement for traditional conventional bone scintigraphy have been established in recent years. SPECT/CT of the upper and lower extremities is valuable in many conditions with abnormal bone turnover due to trauma, inflammation, infection, degeneration or tumour. SPECT/CT is often used in patients if conventional radiographs are insufficient, if MR image quality is impaired due to metal implants or in patients with contraindications to MR. In complex joints such as those in the foot and wrist, SPECT/CT provides exact anatomical correlation of pathological uptake. In many cases SPECT increases the sensitivity and CT the specificity of the study, increasing confidence in the final diagnosis compared to planar images alone. The CT protocol should be adapted to the clinical question and may vary from very low-dose (e.g. attenuation correction only), to low-dose for anatomical correlation, to normal-dose protocols enabling precise anatomical resolution. The aim of this review is to give an overview of SPECT/CT imaging of the extremities with a focus on the hand and wrist, knee and foot, and for evaluation of patients after joint arthroplasty.

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
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Hegenscheid K, Puls R, Rosenberg C. Imaging strategies for knee injuries. Radiologe. 2012;52(11):980–6.

    Article  CAS  PubMed  Google Scholar 

  2. Kaur J, Chopra R. Three dimensional CT reconstruction for the evaluation and surgical planning of mid face fractures: a 100 case study. J Maxillofac Oral Surg. 2010;9(4):323–8.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Chen KN, Wang G, Cao LG, Zhang MC. Differences of percutaneous retrograde screw fixation of anterior column acetabular fractures between male and female: a study of 164 virtual three-dimensional models. Injury. 2009;40(10):1067–72.

    Article  PubMed  Google Scholar 

  4. Brown GA, Firoozbakhsh K, Gehlert RJ. Three-dimensional CT modeling versus traditional radiology techniques in treatment of acetabular fractures. Iowa Orthop J. 2001;21:20–4.

    CAS  PubMed Central  PubMed  Google Scholar 

  5. Heiba SI, Kolker D, Mocherla B, Kapoor K, Jiang M, Son H, et al. The optimized evaluation of diabetic foot infection by dual isotope SPECT/CT imaging protocol. J Foot Ankle Surg. 2010;49(6):529–36

    Article  PubMed  Google Scholar 

  6. Yang DC, Ratani RS, Mittal PK, Chua RS, Pate SM. Radionuclide three-phase whole-body bone imaging. Clin Nucl Med. 2002;27(6):419–26.

    Article  PubMed  Google Scholar 

  7. Pankaj A, Kotwal PP, Mittal R, Deepak KK, Bal CS. Diagnosis of post-traumatic complex regional pain syndrome of the hand: current role of sympathetic skin response and three-phase bone scintigraphy. J Orthop Surg (Hong Kong). 2006;14(3):284–90.

    CAS  Google Scholar 

  8. Huellner MW, Burkert A, Schleich FS, Schurch M, Hug U, von Wartburg U, et al. SPECT/CT versus MRI in patients with nonspecific pain of the hand and wrist – a pilot study. Eur J Nucl Med Mol Imaging. 2012;39(5):750–9.

    Article  PubMed  Google Scholar 

  9. Linke R, Kuwert T, Uder M, Forst R, Wuest W. Skeletal SPECT/CT of the peripheral extremities. AJR Am J Roentgenol. 2010;194(4):W329–35.

    Article  PubMed  Google Scholar 

  10. Ito S, Yamamoto Y, Tanii T, Aga F, Nishiyama Y. SPECT/CT imaging in ulnocarpal impaction syndrome. Clin Nucl Med. 2013. doi:10.1097/RLU.0b013e31828da39d

  11. Allainmat L, Aubault M, Noel V, Baulieu F, Laulan J, Eder V. Use of hybrid SPECT/CT for diagnosis of radiographic occult fractures of the wrist. Clin Nucl Med. 2013;38(6):e246–51.

    Article  PubMed  Google Scholar 

  12. Schleich FS, Schurch M, Huellner MW, Hug U, von Wartburg U, Strobel K, et al. Diagnostic and therapeutic impact of SPECT/CT in patients with unspecific pain of the hand and wrist. EJNMMI Res. 2012;2(1):53.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Tetsumura A, Honda E, Sasaki T, Kino K. Metallic residues as a source of artifacts in magnetic resonance imaging of the temporomandibular joint. Dentomaxillofac Radiol. 1999;28(3):186–90.

    Article  CAS  PubMed  Google Scholar 

  14. Bagheri MH, Ahmadloo N, Rezaian S. Artifacts in magnetic resonance imaging after surgical resection of brain tumors. Magn Reson Imaging. 2013;31(5):700–2.

    Article  PubMed  Google Scholar 

  15. Henderson RA, Lachiewicz PF. Groin pain after replacement of the hip: aetiology, evaluation and treatment. J Bone Joint Surg Br. 2012;94(2):145–51.

    Article  CAS  PubMed  Google Scholar 

  16. Classen T, Zaps D, Landgraeber S, Li X, Jager M. Assessment and management of chronic pain in patients with stable total hip arthroplasty. Int Orthop. 2013;37(1):1–7.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Chang EY, McAnally JL, Van Horne JR, Statum S, Wolfson T, Gamst A, et al. Metal-on-metal total hip arthroplasty: do symptoms correlate with MR imaging findings? Radiology. 2012;265(3):848–57.

    Article  PubMed  Google Scholar 

  18. Kruger T, Hug U, Hullner MW, Schleich F, Veit-Haibach P, von Wartburg U, et al. SPECT/CT arthrography of the wrist in ulnocarpal impaction syndrome. Eur J Nucl Med Mol Imaging. 2011;38(4):792.

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

  20. Degreef I, Verduyckt J, Debeer P, De Smet L. An unusual cause of shoulder pain: osteoid osteoma of the acromion – a case report. J Shoulder Elbow Surg. 2005;14(6):643–4.

    Article  CAS  PubMed  Google Scholar 

  21. Berquist TH. Imaging of joint replacement procedures. Radiol Clin North Am. 2006;44(3):419–37.

    Article  PubMed  Google Scholar 

  22. Temmerman OP, Raijmakers PG, Berkhof J, Hoekstra OS, Teule GJ, Heyligers IC. Accuracy of diagnostic imaging techniques in the diagnosis of aseptic loosening of the femoral component of a hip prosthesis: a meta-analysis. J Bone Joint Surg Br. 2005;87(6):781–5.

    Article  CAS  PubMed  Google Scholar 

  23. Temmerman OP, Raijmakers PG, David EF, Pijpers R, Molenaar MA, Hoekstra OS, et al. A comparison of radiographic and scintigraphic techniques to assess aseptic loosening of the acetabular component in a total hip replacement. J Bone Joint Surg Am. 2004;86-A(11):2456–63.

    PubMed  Google Scholar 

  24. Aliabadi P, Tumeh SS, Weissman BN, McNeil BJ. Cemented total hip prosthesis: radiographic and scintigraphic evaluation. Radiology. 1989;173(1):203–6.

    CAS  PubMed  Google Scholar 

  25. Callaghan JJ, Van Nostrand D, Dysart SH, Savory CG, Hopkins WJ. Prospective serial technetium diphosphonate and indium-111 white blood cell labeled imaging in primary uncemented total hip arthroplasty. Iowa Orthop J. 1996;16:104–12.

    CAS  PubMed Central  PubMed  Google Scholar 

  26. Venesmaa P, Vanninen E, Miettinen H, Kroger H. Periprosthetic bone turnover after primary total hip arthroplasty measured by single-photon emission computed tomography. Scand J Surg. 2012;101(4):241–8.

    Article  CAS  PubMed  Google Scholar 

  27. Strobel K, Steurer-Dober I, Huellner MW, Veit-Haibach P, Allgayer B. Importance of SPECT/CT for knee and hip joint prostheses. Radiologe. 2012;52(7):629–35.

    Article  CAS  PubMed  Google Scholar 

  28. Love C, Marwin SE, Palestro CJ. Nuclear medicine and the infected joint replacement. Semin Nucl Med. 2009;39(1):66–78.

    Article  PubMed  Google Scholar 

  29. Graute V, Feist M, Lehner S, Haug A, Muller PE, Bartenstein P, 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 

  30. Filippi L, Schillaci O. Usefulness of hybrid SPECT/CT in 99mTc-HMPAO-labeled leukocyte scintigraphy for bone and joint infections. J Nucl Med. 2006;47(12):1908–13.

    CAS  PubMed  Google Scholar 

  31. Luk WH, Au-Yeung AW, Yang MK. Diagnostic value of SPECT versus SPECT/CT in femoral avascular necrosis: preliminary results. Nucl Med Commun. 2010;31(11):958–61.

    Article  PubMed  Google Scholar 

  32. Sutter R, Ulbrich EJ, Jellus V, Nittka M, Pfirrmann CW. Reduction of metal artifacts in patients with total hip arthroplasty with slice-encoding metal artifact correction and view-angle tilting MR imaging. Radiology. 2012;265(1):204–14.

    Article  PubMed  Google Scholar 

  33. Bryant LR, Song WS, Banks KP, Bui-Mansfield LT, Bradley YC. Comparison of planar scintigraphy alone and with SPECT for the initial evaluation of femoral neck stress fracture. AJR Am J Roentgenol. 2008;191(4):1010–5.

    Article  PubMed  Google Scholar 

  34. Buck FM, Hoffmann A, Hofer B, Pfirrmann CW, Allgayer B. 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. 2009;38(4):339–47.

    Article  PubMed  Google Scholar 

  35. Strobel K, Wiesmann R, Tornquist K, Steurer-Dober I, Muller U. SPECT/CT arthrography of the knee. Eur J Nucl Med Mol Imaging. 2012;39(12):1975–6.

    Article  CAS  PubMed  Google Scholar 

  36. Sacchetti GM, Ghisellini F, Brambilla M, De Consoli A, Fornara P, Rizzo E, et al. Quantitative scintigraphic evaluation of total knee arthroplasties: a feasibility study. Clin Orthop Relat Res. 1996;325:181–9.

    Article  PubMed  Google Scholar 

  37. Smith SL, Wastie ML, Forster I. Radionuclide bone scintigraphy in the detection of significant complications after total knee joint replacement. Clin Radiol. 2001;56(3):221–4.

    Article  CAS  PubMed  Google Scholar 

  38. Hirschmann MT, Iranpour F, Konala P, Kerner A, Rasch H, Cobb JP, 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):939–44.

    Article  PubMed  Google Scholar 

  39. 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 Central  PubMed  Google Scholar 

  40. Hirschmann MT, Mathis D, Afifi FK, Rasch H, Henckel J, Amsler F, et al. 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. 2013;21(4):965–74.

    Article  PubMed  Google Scholar 

  41. Hirschmann MT, Mathis D, Rasch H, Amsler F, Friederich NF, Arnold MP. SPECT/CT tracer uptake is influenced by tunnel orientation and position of the femoral and tibial ACL graft insertion site. Int Orthop. 2013;37(2):301–9.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Rasch H, Falkowski AL, Forrer F, Henckel J, Hirschmann MT. 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. 2013;42(9):1215–23.

    Article  PubMed  Google Scholar 

  43. Testa EA, Rasch H, Forrer F, Hirschmann MT. Clinical value of 4D-SPECT/CT in patients with painful total knee arthroplasty. Br J Sports Med. 2013;47(10):e3.

    Google Scholar 

  44. Hirschmann MT, Henckel J, Rasch H. SPECT/CT in patients with painful knee arthroplasty – what is the evidence? Skeletal Radiol. 2013;42(9):1201–7.

    Article  PubMed  Google Scholar 

  45. Biersack HJ, Wingenfeld C, Hinterthaner B, Frank D, Sabet A. SPECT-CT of the foot. Nuklearmedizin. 2012;51(1):26–31.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  47. Singh VK, Javed S, Parthipun A, 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(2):80–3.

    Article  PubMed  Google Scholar 

  48. Chicklore S, Gnanasegaran G, Vijayanathan S, Fogelman I. Potential role of multislice SPECT/CT in impingement syndrome and soft-tissue pathology of the ankle and foot. Nucl Med Commun. 2013;34(2):130–9.

    Article  PubMed  Google Scholar 

  49. Davies M, Cassar-Pullicino VN, Davies AM, McCall IW, Tyrrell PN. The diagnostic accuracy of MR imaging in osteoid osteoma. Skeletal Radiol. 2002;31(10):559–69.

    Article  PubMed  Google Scholar 

  50. Newman JS, Newberg AH. Congenital tarsal coalition: multimodality evaluation with emphasis on CT and MR imaging. Radiographics. 2000;20(2):321–32; quiz 526–7, 532.

    Article  CAS  PubMed  Google Scholar 

  51. Filippi L, Uccioli L, Giurato L, Schillaci O. Diabetic foot infection: usefulness of SPECT/CT for 99mTc-HMPAO-labeled leukocyte imaging. J Nucl Med. 2009;50(7):1042–6.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We express our gratitude to Geoffrey Warnock, PhD, for his valuable help preparing the manuscript.

Conflicts interest

Klaus Strobel received an ISS grant from Philips Healthcare.

Author’s contributions

K.S. and M.H. participated in the design and coordination of the review and drafted the manuscript. All authors read and approved the final manuscript.

Author information

Authors and Affiliations

  1. Department of Medical Radiology, Division of Nuclear Medicine, University Hospital Zurich, 8091, Zurich, Switzerland

    Martin W. Huellner

  2. Department of Nuclear Medicine and Radiology, Lucerne Cantonal Hospital, 6004, Lucerne, Switzerland

    Klaus Strobel

Authors
  1. Martin W. Huellner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Klaus Strobel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martin W. Huellner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Huellner, M.W., Strobel, K. Clinical applications of SPECT/CT in imaging the extremities. Eur J Nucl Med Mol Imaging 41 (Suppl 1), 50–58 (2014). https://doi.org/10.1007/s00259-013-2533-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-013-2533-5

Keywords

Search

Navigation