SPECT/CT versus MRI in patients with nonspecific pain of the hand and wrist – a pilot study
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Hand and wrist pain is a diagnostic challenge for hand surgeons and radiologists due to the complex anatomy of the involved small structures. The American College of Radiology recommends MRI as the study of choice in patients with chronic wrist pain if radiographs are negative. Lately, state-of-the-art SPECT/CT systems have been introduced and may help in the diagnosis of this selected indication.
Materials and methods
This retrospective study included 21 patients with nonspecific pain of the hand/wrist. The diagnosis of nonspecific wrist pain was made by the referring hand surgeon based on patient history, clinical examination, plain radiography and clinical guidelines. All patients received planar early-phase imaging and late-phase SPECT/CT imaging as well as MRI. Lesions were divided into major (causative) and minor (not causative) pathologies according to clinical follow-up. Furthermore, oedema-like bone marrow changes seen on MRI were compared with focally increased tracer uptake seen on SPECT/CT images.
MRI yielded a quite high sensitivity (0.86), but a low specificity (0.20). In contrast, SPECT/CT yielded a high specificity (1.00) and a low sensitivity (0.71). Oedema-like bone marrow changes were detected in 15 lesions in 11 patients. In ten lesions with bone marrow oedema on MRI, foci of elevated tracer uptake were detected on SPECT/CT. Overall, MRI was more sensitive, but SPECT/CT was more specific in the evaluation of causative pathologies.
In this initial comparison, SPECT/CT showed higher specificity than MRI in the evaluation of causative pathologies in patients with nonspecific wrist pain. However, MRI was more sensitive. Thus, SPECT/CT was shown to be a useful problem-solving tool in the diagnostic work-up of these patients.
KeywordsWrist pain Hand pain Chronic pain SPECT/CT MRI
Chronic regional pain syndrome
Triangular fibrocartilage complex
Conflicts of interest
- 4.World Health Organization. The International Classification of Functioning, Disability and Health (ICF). Chapter 4: Mobility, d440: Fine hand use. Geneva: WHO; 2005.Google Scholar
- 13.Beasley RW. Beasley's surgery of the hand. New York: Thieme; 2003. p. 376–7Google Scholar
- 14.Angelides AC. Ganglions of the hand and wrist. In: Green DP, Hotchkiss RN, Pederson WC, editors. Operative hand surgery. 4th ed. New York: Churchill Livingstone; 1999. p. 2171–83.Google Scholar
- 15.Nahra ME, Bucchieri JS. Open and arthroscopic excision of ganglion cysts and related tumors. In: Hunt TR, Wiesel SW, editors. Operative techniques in hand, wrist, and forearm surgery. 1st ed. Philadelphia: Lippincott Williams & Wilkins; 2010. p. 918–29.Google Scholar
- 37.Koo KH, Ahn IO, Song HR, Kim SY, Jones Jr JP. Increased perfusion of the femoral head in transient bone marrow edema syndrome. Clin Orthop Relat Res. 2002;(402):171–5.Google Scholar