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The value of bone SPECT/CT in evaluation of foot and ankle arthrodesis and adjacent joint secondary osteoarthritis

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Objective

To evaluate the value of SPECT/CT (single photon emission computed tomography/computed tomography) in foot and ankle arthrodesis and development of secondary osteoarthritis in the adjacent joints.

Materials and methods

SPECT/CT of 140 joints in the foot and ankle (34 upper ankle (UA), 28 lower ankle (LA), 27 talonavicular (TN), 12 calcaneo-cuboidal (CC), and 39 other smaller joints after arthrodesis in 72 patients were evaluated retrospectively regarding fusion grade in CT (0 = no fusion, 1 =  < 50% fusion, 2 =  > 50% fusion, 3 = complete fusion) and radiotracer uptake (0 = no uptake, 1 = mild uptake, 2 = moderate uptake, 3 = high uptake) on SPECT/CT. Severity of osteoarthritis (1 = mild, 2 = moderate, 3 = severe) and radiotracer uptake grade in adjacent joints was also assessed. In 54 patients, clinical information about interventions in the follow-up was available.

Results

According to the SPECT/CT, arthrodesis was successful (grade 2 or 3 CT fusion and grade 0 or 1 uptake) in 73% (25/34) of UA joints, 71% (20/28) of LA joints, 67% (18/27) TN, 100% (12/12) CC joints, and 62% (24/39) of other smaller joints. In 12 joints, there were discrepant findings in SPECT/CT (fusion grade 2 and uptake grade 2 or 3 (n = 9); or, fusion grade 0 or 1 and uptake grade 1 (n = 3)). The fusion rate 6–12 months after arthrodesis was 42% (14/33), 59% (20/34) after 13–24 months, and 89% (65/73) after more than 24 months, respectively. Average radiotracer uptake in arthrodesis decreased with age: 6–12 months: 1.60, 12–24 months: 1.32,  > 24 months: 0.38. There was a significant negative correlation between radiotracer uptake grade and CT fusion grade. Osteoarthritis was observed in 131 adjacent joints. During the post scan follow-up, additional arthrodeses were performed in 33 joints, of which 11 joints were re-arthrodesis and 22 were new arthrodeses in osteoarthritic adjacent joints. All these 11 joints with failed arthrodesis had grade 0 of CT fusion and grade 2 or 3 of radiotracer uptake. All 22 adjacent joints with osteoarthritis, which subsequently underwent arthrodesis, had grade 2 or 3 radiotracer uptake, and the primary arthrodesis joints were healed and fused in all these cases.

Conclusion

Bone SPECT/CT is a valuable hybrid imaging tool in the evaluation of foot and ankle arthrodesis and gives additional useful information about the development of secondary osteoarthritis in the adjacent joints with higher value for the assessment of secondary osteoarthritis. A practical four-type classification (‘Lucerne Criteria’) combining metabolic and morphologic SPECT/CT information for evaluation of arthrodesis joints has been proposed.

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Data Availability

The datasets can be made available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Nuclear Medicine and Radiology, Cantonal Hospital Lucerne, 6000, Lucerne 16, Switzerland

    Ujwal Bhure, Hannes Grünig, Maria del Sol Pérez Lago, Thiago Lima & Klaus Strobel

  2. Faculty of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002, Lucerne, Switzerland

    Dirk Lehnick

  3. Department of Orthopedics, Cantonal Hospital Lucerne, 6000, Lucerne 16, Switzerland

    Martin Wonerow

  4. Division of Nuclear Medicine, MRI, Zürich, Switzerland

    Thomas F. Hany

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  1. Ujwal Bhure
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All authors contributed in a significant way to the content and revision of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Ujwal Bhure.

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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. Ethics committee approval was obtained for the study. Informed consent was waived by the ethics committee due to the retrospective design.

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Bhure, U., Grünig, H., del Sol Pérez Lago, M. et al. The value of bone SPECT/CT in evaluation of foot and ankle arthrodesis and adjacent joint secondary osteoarthritis. Eur J Nucl Med Mol Imaging 51, 68–80 (2023). https://doi.org/10.1007/s00259-023-06421-y

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