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Nuclear Medicine and Molecular Imaging

, Volume 50, Issue 4, pp 322–328 | Cite as

Clinical Meaning of Hot Uptake on Bone Scan in Symptomatic Accessory Navicular Bones

  • Ari Chong
  • Jung-Min HaEmail author
  • Jun-Young Lee
Original Article

Abstract

Introduction

We analyzed clinical factors related to uptake on a Tc-99 m HDP bone scan of the accessory navicular (AN).

Materials and Methods

We retrospectively reviewed patients who had been examined by an orthopedic surgeon and underwent bone scan due to suspected symptomatic AN. A three-point grading system was used to evaluate uptake on bone scan. Relationships between grade, symptoms, age, gender, symptom duration, and bone size were analyzed.

Results

In total, 73 ANs (30 asymptomatic, 43 symptomatic) were enrolled. The majority of asymptomatic ANs had no uptake but some had grade 1 (n = 8) or 2 (n = 2) uptake. All asymptomatic ANs with uptake remained asymptomatic during follow-up. For the asymptomatic ANs, larger bones showed a higher grade. With a cut-off value of size ≤6.8 mm, there is no chance of uptake. All symptomatic ANs showed uptake on bone scan. For symptomatic ANs, larger size and shorter pain duration were related to a higher grade. Age, gender, and left-/right-sideness were not related to grade. Multiple regressions revealed that only uptake grade, not size or symptom duration, was the significant risk factor for a symptomatic AN. With a cut-off value of grade <1, a symptomatic AN could be ruled out with a negative predictive value of 100 %.

Conclusion

Bone scanning is useful for symptomatic ANs with a high negative predictive value. Higher grade is related to larger size and shorter pain duration. For asymptomatic ANs, grade was related to size but did not predict symptom development.

Keywords

Accessory navicular bone Emission-computed Radionuclide imaging Tomography 

Notes

Acknowledgments

This study was supported by research fund from Chosun University, 2013

Compliance with Ethical Standards

Conflict of Interest

Ari Chong, Jung-Min Ha and Jun-Young Lee declare that they have no conflict of interests.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

The institutional review board of our institute approved this retrospective study, and the requirement to obtain informed consent was waived.

References

  1. 1.
    Kim JR, Park CI, Moon YJ, Wang SI, Kwon KS. Concomitant calcaneo-cuboid-cuneiform osteotomies and the modified Kidner procedure for severe flatfoot associated with symptomatic accessory navicular in children and adolescents. J Orthop Surg Res. 2014;9:131.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Fredrick LA, Beall DP, Ly JQ, Fish JR. The symptomatic accessory navicular bone: a report and discussion of the clinical presentation. Curr Probl Diagn Radiol. 2005;34:47–50.CrossRefPubMedGoogle Scholar
  3. 3.
    Mellado JM, Ramos A, Salvado E, Camins A, Danus M, Sauri A. Accessory ossicles and sesamoid bones of the ankle and foot: imaging findings, clinical significance and differential diagnosis. Eur Radiol. 2003;13 Suppl 4:L164–77.CrossRefGoogle Scholar
  4. 4.
    Miller TT. Painful accessory bones of the foot. Semin Musculoskelet Radiol. 2002;6:153–61.CrossRefPubMedGoogle Scholar
  5. 5.
    Sarrafian SK, Kelikian AS. Osteology. In: Sarrafian SK, editor. Anatomy of the foot and ankle. Philadelphia: Lippincott; 1993. p. 89–112.Google Scholar
  6. 6.
    Keats TE. The foot. In: Keats TE, editor. Atlas of normal roentgen variants that may simulate disease. St. Louis: Mosby-Year Book; 1992. p. 615–704.Google Scholar
  7. 7.
    Romanowski CA, Barrington NA. The accessory navicular—an important cause of medial foot pain. Clin Radiol. 1992;46:261–4.CrossRefPubMedGoogle Scholar
  8. 8.
    Jain S, Karunanithi S, Agarwal KK, Kumar G, Roy SG, Tripathi M. Incremental value of single photon emission tomography/computed tomography in 3-phase bone scintigraphy of an accessory navicular bone. Indian J Nucl Med. 2014;29:191–2.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Grogan DP, Gasser SI, Ogden JA. The painful accessory navicular: a clinical and histopathological study. Foot Ankle. 1989;10:164–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Tsuruta T, Shiokawa Y, Kato A, Matsumoto T, Yamazoe Y, Oike T, et al. Radiological study of the accessory skeletal elements in the foot and ankle (author’s transl). Nihon Seikeigeka Gakkai Zasshi. 1981;55:357–70.PubMedGoogle Scholar
  11. 11.
    Chiu NT, Jou IM, Lee BF, Yao WJ, Tu DG, Wu PS. Symptomatic and asymptomatic accessory navicular bones: findings of Tc-99m MDP bone scintigraphy. Clin Radiol. 2000;55:353–5.CrossRefPubMedGoogle Scholar
  12. 12.
    Lassmann M, Biassoni L, Monsieurs M, Franzius C, Jacobs F. The new EANM paediatric dosage card. Eur J Nucl Med Mol Imaging. 2007;34:796–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Chisin R, Peyser A, Milgrom C. Bone scintigraphy in the assessment of the hallucal sesamoids. Foot Ankle Int. 1995;16:291–4.CrossRefPubMedGoogle Scholar
  14. 14.
    Sudhakar P, Sharma AR, Narsimhulu G, Prabhakar V. Diagnostic utility and clinical significance of three phase bone scan in symptomatic accessory navicular bone. Indian J Nucl Med. 2006;21:18–22.Google Scholar
  15. 15.
    Kim RS, Kang JS, Kim YT, Kim BS. Diagnosing symptomatic accessory tarsal bones using SPECT/CT. J Korean Foot Ankle Soc. 2011;15:212–6.Google Scholar
  16. 16.
    Mohan H, Holker P, Gnanasegaran G, Vijayanathan S, Sharp D, Langroudi B, et al. The applicability of SPECT-CT in directing the management of bony foot and ankle pathology. Eur J Nucl Med Mol Imaging. 2007;34 suppl 2:S166.Google Scholar

Copyright information

© Korean Society of Nuclear Medicine 2016

Authors and Affiliations

  1. 1.Department of Nuclear MedicineChosun University HospitalGwangjuRepublic of Korea
  2. 2.Department of Orthopaedic Surgery, Foot and Ankle SurgeryChosun University HospitalGwangjuRepublic of Korea

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