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Increased bone tracer uptake in symptomatic patients with ACL graft insufficiency: a correlation of MRI and SPECT/CT findings

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Magnetic resonance imaging (MRI) and single-photon emission computerised tomography/computerised tomography (SPECT/CT) are used as diagnostic tools in symptomatic patients after reconstruction of the anterior cruciate ligament (ACL). The benefit of SPECT/CT in comparison with MRI is under debate. The purpose of this study was to investigate whether and how bone tracer uptake (BTU) intensity and distribution in SPECT/CT correlate with MRI findings in symptomatic patients after ACL reconstruction.

Methods

Twenty-nine patients (male:female = 22:7, mean age ± SD 26 ± 10 years) with symptoms of pain and instability after ACL reconstruction were retrospectively investigated using prospectively acquired SPECT/CT and MRI. On MRI graft tear, graft signal intensity, bone marrow oedema, tunnel cyst formation, roof impingement, roof osteophytes, local arthrofibrosis, joint effusion and synovial thickness were analysed by two readers blinded to the BTU results. BTU was anatomically localised and volumetrically quantified. Spearman’s rho test was used for correlation of BTU in SPECT/CT and MRI findings (p < 0.05).

Results

SPECT/CT showed increased femoral and tibial BTU in patients with MRI-confirmed graft tear, signal hyperintensity of the intraarticular graft section, joint effusion, synovial thickening, roof osteophytes and bone marrow oedema. Cyst formation in the femoral tunnel results in significantly reduced BTU in femur and tibia. No correlation of increased BTU was found for graft impingement and graft arthrofibrosis.

Conclusions

Bone tracer uptake in SPECT/CT and defined MRI findings in symptomatic patients after ACL reconstruction were correlated. Both imaging modalities have a definite role in post-operative diagnostic and have established their value in those patients. This study provides a better understanding of the clinical value of SPECT/CT versus MRI in the clinical decision-making process. SPECT/CT provides a window into the in vivo loading of the joint as well as bone remodelling and graft incorporation process. In addition, ACL graft insufficiency can be detected by increased BTU.

Level of evidence

Retrospective cohort study, Level III.

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Acknowledgments

The authors would like to thank Mr. Patrick Jaeger for the graphical formatting.

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Authors and Affiliations

Authors

Contributions

DTM carried out all the SPECT/CT measurements, participated in the design of the study and coordination and drafted the manuscript, AH and AF carried out the MRI measurements, TK participated in the design of the study and provided scientific background, HR was responsible for the nuclear medicine imaging and MTH conceived the study and participated in its design and coordination and helped to draft the manuscript. FA helped with the statistical analysis. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Michael T. Hirschmann.

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The authors declare that they have no conflict of interest.

Funding

There is no funding source.

Ethical approval

The study was approved by the local ethical committee of the University of Basel, Switzerland, under the ID EK 2015-051.

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All patients gave their informed consent.

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Mathis, D.T., Hirschmann, A., Falkowski, A.L. et al. Increased bone tracer uptake in symptomatic patients with ACL graft insufficiency: a correlation of MRI and SPECT/CT findings. Knee Surg Sports Traumatol Arthrosc 26, 563–573 (2018). https://doi.org/10.1007/s00167-017-4588-5

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