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SPECT/CT versus MRI in patients with nonspecific pain of the hand and wrist – a pilot study

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

Abstract

Background

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.

Results

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.

Conclusion

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.

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Abbreviations

CRPS:

Chronic regional pain syndrome

TFCC:

Triangular fibrocartilage complex

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Authors and Affiliations

  1. Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, CH-6004, Lucerne, Switzerland

    Martin W. Huellner, Alexander Bürkert, Florian S. Schleich, Klaus Strobel & Patrick Veit-Haibach

  2. Department of Hand and Plastic Surgery, Lucerne Cantonal Hospital, CH-6004, Lucerne, Switzerland

    Maja Schürch, Urs Hug & Urs von Wartburg

Authors
  1. Martin W. Huellner
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  2. Alexander Bürkert
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Correspondence to Martin W. Huellner.

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Huellner, M.W., Bürkert, A., Schleich, F.S. et al. SPECT/CT versus MRI in patients with nonspecific pain of the hand and wrist – a pilot study. Eur J Nucl Med Mol Imaging 39, 750–759 (2012). https://doi.org/10.1007/s00259-011-2034-3

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  • DOI: https://doi.org/10.1007/s00259-011-2034-3

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