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SPECT/CT in der Handgelenkdiagnostik

SPECT/CT in diagnostics of the hand joint

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Zusammenfassung

Klinisches/methodisches Problem

Handgelenkschmerzen sind eine diagnostische Herausforderung für Handchirurgen und Radiologen. Insbesondere chronische Handgelenkschmerzen sind oft nur schwer einer genauen Lokalisation zuzuordnen, eine Schnittbildgebung ist deshalb oft unerlässlich.

Radiologische Standardverfahren

Der etablierte Standard zur nichtinvasiven Diagnostik chronischer Handgelenkschmerzen ist die Magnetresonanztomographie.

Methodische Innovationen

In den letzten Jahren ist mit der „single photon emission computed tomography“/CT (SPECT/CT) eine neue Modalität zum diagnostischen Spektrum muskuloskelettaler Veränderungen hinzugetreten, welche neben morphologischen Daten auch metabolische Informationen liefert.

Leistungsfähigkeit

Die SPECT/CT ermöglicht eine genaue Detektion und präzise anatomische Zuordnung unterschiedlicher Handgelenkpathologien. Dies ist oftmals entscheidend für eine korrekte Therapie.

Bewertung

Die SPECT/CT ist bei Patienten mit chronischen Handgelenkschmerzen spezifischer als die MRT. Sie bietet außerdem Vorteile bei Patienten mit posttraumatischen Veränderungen oder Metallimplantaten und kann als problemlösende Methode bei unklaren Fällen eingesetzt werden.

Empfehlung für die Praxis

Eine Anwendung der SPECT/CT erscheint aus unserer Sicht immer dann sinnvoll, wenn eine Abklärung mittels MRT unergiebig war bzw. das MRT mehrere Pathologien zeigt, bei denen nicht klar ist, welche die klinisch führende ist. Auch ein primärer Einsatz bei bestimmten ossären Pathologien, bei Patienten mit Metallimplantaten oder bei unklaren Handgelenkschmerzen erscheint gerechtfertigt.

Abstract

Clinical/methodical issue

Hand and wrist pain remains a diagnostic challenge, both for hand surgeons and for radiologists. Especially chronic wrist pain is often hard to localize clinically and further cross-sectional imaging is often indispensable.

Standard radiological methods

The well-established standard for non-invasive diagnostic imaging in chronic wrist pain is magnetic resonance imaging (MRI).

Methodical innovations

Recently, state-of-the-art single photon emission computed tomography/computed tomography (SPECT/CT) systems have been introduced into the diagnostic array for musculoskeletal conditions. Besides morphological data SPECT/CT also provides metabolic information.

Performance

SPECT/CT allows an exact detection and precise anatomical mapping of different pathologies of the wrist, which is often crucial for therapy.

Achievements

In patients with chronic wrist pain, SPECT/CT is more specific than MRI. It is also beneficial in patients with posttraumatic conditions and metal implants and may serve as a problem-solving tool in difficult cases.

Practical recommendations

It is considered that SPECT/CT imaging is useful if MRI results are equivocal or present no clearly leading pathology. A primary examination with SPECT/CT seems to be a reasonable option for patients with certain bone pathologies, metal implants and non-specific wrist pain.

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Abbreviations

ACR:

American College of Radiology

CMC:

Karpometakarpal

CRPS:

„Chronic regional pain syndrome“

CT:

Computertomographie

DRUG:

Distales Radioulnargelenk

FOV:

„Field of view“

GRE:

„Gradient-recalled echo“

LT:

Lunotriquetral

MBq:

Megabecquerel

MRT:

Magnetresonanztomographie

PDw:

„Proton density-weighted“

SPECT/CT:

„Single photon emission computed tomography/computed tomography“

SPIR:

„Spectral presaturation with inversion recovery“

T:

Tesla

99mTc-DPD:

99mTechnetium-3,3-diphosphono-1,2-propanedicarboxylic

TE:

„Time to echo“

TFCC:

„Triangular fibrocartilage complex“

TR:

„Time to repetition“

TSE:

„Turbo spin echo“

WATS:

„Water selective excitation“

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Authors and Affiliations

  1. Institut für Radiologie und Nuklearmedizin, Luzerner Kantonsspital, CH-6004, Luzern, Schweiz

    M.W. Huellner, K. Strobel & P. Veit-Haibach

  2. Abteilung für Hand- und Plastische Chirurgie, Luzerner Kantonsspital, Luzern, Schweiz

    U. Hug & U. von Wartburg

Authors
  1. M.W. Huellner
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  2. K. Strobel
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  3. U. Hug
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  4. U. von Wartburg
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  5. P. Veit-Haibach
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Corresponding author

Correspondence to M.W. Huellner.

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Huellner, M., Strobel, K., Hug, U. et al. SPECT/CT in der Handgelenkdiagnostik. Radiologe 52, 621–628 (2012). https://doi.org/10.1007/s00117-011-2269-9

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