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Bone SPECT/CT of the Foot and Ankle: Potential Clinical Application for Chronic Foot Pain

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Abstract

Diseases of the foot and ankle are common but relatively difficult to diagnose because of the complexity of the anatomy and the frequent occurrence of multiple diseases at the same time. For these reasons, management of chronic foot pain is often clinically challenging. MRI is the imaging modality of choice in many types of diseases causing chronic foot pain, due to high resolution and excellent soft tissue contrast. However, in the postoperative state, the use of MRI can be limited by artifact from metallic devices, and it may be difficult to confirm whether the pathology detected on the MRI is the actual cause of the pain. As bone scintigraphy provides metabolic information, it can help to find the origin of pain, and SPECT/CT can further improve the specificity by adding anatomical information. In daily clinical practice for management of foot and ankle pathologies, the use of bone SPECT/CT is gradually increasing. However, there has been limited evidence of usefulness of SPECT/CT in evaluating chronic foot pain. In this review article, the potential application of bone SPECT/CT for chronic foot pain is illustrated, and the role of SPECT/CT in the management of the foot and ankle diseases in clinical practice is described.

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References

  1. 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;39:431–42.

    Article  Google Scholar 

  2. Horger M, Eschmann SM, Pfannenberg C, Vonthein R, Besenfelder H, Claussen CD, et al. Evaluation of combined transmission and emission tomography for classification of skeletal lesions. AJR Am J Roentgenol. 2004;183:655–61.

    Article  Google Scholar 

  3. Mohan HK, Gnanasegaran G, Vijayanathan S, Fogelman I. SPECT/CT in imaging foot and ankle pathology—the demise of other coregistration techniques. Semin Nucl Med. 2010;40:41–51.

    Article  Google Scholar 

  4. Papathanassiou D, Bruna-Muraille C, Jouannaud C, Gagneux-Lemoussu L, Eschard JP, Liehn JC. Single-photon emission computed tomography combined with computed tomography (SPECT/CT) in bone diseases. Joint Bone Spine. 2009;76:474–80.

    Article  Google Scholar 

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

    Article  Google Scholar 

  6. Even-Sapir E, Flusser G, Lerman H, Lievshitz G, Metser U. SPECT/multislice low-dose CT: a clinically relevant constituent in the imaging algorithm of nononcologic patients referred for bone scintigraphy. J Nucl Med. 2007;48:319–24.

    PubMed  Google Scholar 

  7. Huellner MW, Strobel K. Clinical applications of SPECT/CT in imaging the extremities. Eur J Nucl Med Mol Imaging. 2014;41(Suppl 1):S50–8.

    Article  Google Scholar 

  8. Bailey DL, Willowson KP. An evidence-based review of quantitative SPECT imaging and potential clinical applications. J Nucl Med. 2013;54:83–9.

    Article  Google Scholar 

  9. Bailey DL, Willowson KP. Quantitative SPECT/CT: SPECT joins PET as a quantitative imaging modality. Eur J Nucl Med Mol Imaging. 2014;41(Suppl 1):S17–25.

    Article  Google Scholar 

  10. Arvola S, Jambor I, Kuisma A, Kemppainen J, Kajander S, Seppanen M, et al. Comparison of standardized uptake values between (99m)Tc-HDP SPECT/CT and (18)F-NaF PET/CT in bone metastases of breast and prostate cancer. EJNMMI Res. 2019;9:6.

    Article  CAS  Google Scholar 

  11. Lee WW, Group KS. Clinical applications of technetium-99m quantitative single-photon emission computed tomography/computed tomography. Nucl Med Mol Imaging. 2019;53:172–81.

    Article  CAS  Google Scholar 

  12. 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;49:529–36.

    Article  Google Scholar 

  13. Claassen L, Uden T, Ettinger M, Daniilidis K, Stukenborg-Colsman C, Plaass C. Influence on therapeutic decision making of SPECT-CT for different regions of the foot and ankle. Biomed Res Int. 2014;2014:927576.

    Article  Google Scholar 

  14. Nathan M, Mohan H, Vijayanathan S, Fogelman I, Gnanasegaran G. The role of 99mTc-diphosphonate bone SPECT/CT in the ankle and foot. Nucl Med Commun. 2012;33:799–807.

    Article  Google Scholar 

  15. Ha S, Hong SH, Paeng JC, Lee DY, Cheon GJ, Arya A, 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:e0117583.

    Article  CAS  Google Scholar 

  16. 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;91:1191–6.

    Article  CAS  Google Scholar 

  17. Kretzschmar M, Wiewiorski M, Rasch H, Jacob AL, Bilecen D, Walter MA, et al. 99mTc-DPD-SPECT/CT predicts the outcome of imaging-guided diagnostic anaesthetic injections: a prospective cohort study. Eur J Radiol. 2011;80:e410–5.

    Article  Google Scholar 

  18. 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;19:80–3.

    Article  Google Scholar 

  19. Balint GP, Korda J, Hangody L, Balint PV. Regional musculoskeletal conditions: foot and ankle disorders. Best Pract Res Clin Rheumatol. 2003;17:87–111.

    Article  Google Scholar 

  20. Garcia Jimenez R, Garcia-Gomez FJ, Noriega Alvarez E, Calvo Moron C, Martin-Marcuartu JJ. Hybrid imaging in foot and ankle disorders. Rev Esp Med Nucl Imagen Mol. 2018;37:191–202.

    PubMed  CAS  Google Scholar 

  21. Leumann A, Valderrabano V, Plaass C, Rasch H, Studler U, Hintermann B, et al. A novel imaging method for osteochondral lesions of the talus—comparison of SPECT-CT with MRI. Am J Sports Med. 2011;39:1095–101.

    Article  Google Scholar 

  22. Wiewiorski M, Pagenstert G, Rasch H, Jacob AL, Valderrabano V. Pain in osteochondral lesions. Foot Ankle Spec. 2011;4:92–9.

    Article  Google Scholar 

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

    Article  Google Scholar 

  24. Meftah M, Katchis SD, Scharf SC, Mintz DN, Klein DA, Weiner LS. SPECT/CT in the management of osteochondral lesions of the talus. Foot Ankle Int. 2011;32:233–8.

    Article  Google Scholar 

  25. Kampen WU, Westphal F, Van den Wyngaert T, Strobel K, Kuwert T, Van der Bruggen W, et al. SPECT/CT in postoperative foot and ankle pain. Semin Nucl Med. 2018;48:454–68.

    Article  Google Scholar 

  26. Keles-Celik N, Kose O, Sekerci R, Aytac G, Turan A, Guler F. Accessory ossicles of the foot and ankle: disorders and a review of the literature. Cureus. 2017;9:e1881.

    PubMed  PubMed Central  Google Scholar 

  27. Chong A, Ha JM, Lee JY. Clinical meaning of hot uptake on bone scan in symptomatic accessory navicular bones. Nucl Med Mol Imaging. 2016;50:322–8.

    Article  Google Scholar 

  28. Al-Jafar H, Al-Shemmeri E, Al-Shemmeri J, Aytglu L, Afzal U, Al-Enizi S. Precision of SPECT/CT allows the diagnosis of a hidden Brodie’s abscess of the talus in a patient with sickle cell disease. Nucl Med Mol Imaging. 2015;49:153–6.

    Article  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  30. Kim C, Lee SJ, Kim JY, Hwang KT, Choi YY. Comparative analysis of (99m)Tc-MDP three-phase bone scan with SPECT/CT and (99m)Tc-HMPAO-labeled WBC SPECT/CT in the differential diagnosis of clinically suspicious post-traumatic osteomyelitis. Nucl Med Mol Imaging. 2017;51:40–8.

    Article  CAS  Google Scholar 

  31. 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;34:130–9.

    Article  Google Scholar 

  32. Premkumar A, Perry MB, Dwyer AJ, Gerber LH, Johnson D, Venzon D, et al. Sonography and MR imaging of posterior tibial tendinopathy. AJR Am J Roentgenol. 2002;178:223–32.

    Article  Google Scholar 

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Correspondence to Ie Ryung Yoo.

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Yoo, I.R. Bone SPECT/CT of the Foot and Ankle: Potential Clinical Application for Chronic Foot Pain. Nucl Med Mol Imaging 54, 1–8 (2020). https://doi.org/10.1007/s13139-019-00627-5

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