Comparison of SPECT/CT and MRI in Diagnosing Symptomatic Lesions in Ankle and Foot Pain Patients: Diagnostic Performance and Relation to Lesion Type

Seunggyun Ha,Jin Chul Paeng,June-Key Chung,Sung Hwan Hong,Dong Yeon Lee,Dong Soo Lee,Gi Jeong Cheon,Keon Wook Kang,Amitabh Arya,Jie Tian

doi:10.1371/journal.pone.0117583

Seunggyun Ha, Jin Chul Paeng + Show 8 more

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https://doi.org/10.1371/journal.pone.0117583

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Abstract

PurposeThe purpose of this study was to compare the diagnostic performance of SPECT/CT and MRI in patients with ankle and foot pain, with regard to the lesion types.Materials and MethodsFifty consecutive patients with ankle and foot pain, who underwent 99mTc-MDP SPECT/CT and MRI, were retrospectively enrolled in this study. Symptomatic lesions were determined based on clinical examination and response to treatment. On MRI and SPECT/CT, detected lesions were classified as bone, ligament/tendon, and joint lesions. Uptake on SPECT/CT was assessed using a 4-grade system. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of SPECT/CT and MRI were evaluated in all detected lesions and each lesion type. Diagnostic value of uptake grade was analyzed using receiver-operating characteristics (ROC) curve analysis, and diagnostic performance was compared using Chi-square or McNemar tests.ResultsIn overall lesions, the sensitivity, PPV and NPV of SPECT/CT for symptomatic lesions were 93%, 56%, 91%, and they were 98%, 48%, 95% for MRI. There was no significant difference between SPECT/CT and MRI. However, the specificity of SPECT/CT was significantly higher than that of MRI (48% versus 24%, P = 0.016). Uptake grade on SPECT/CT was significantly higher in symptomatic lesions (P < 0.001), and its area under curve on ROC analysis was 0.787. In the analysis of each lesion type, the specificity of SPECT/CT was poor in joint lesions compared with other lesion types and MRI (P < 0.001, respectively). MRI exhibited lower specificity than SPECT/CT in bone lesions (P = 0.004) and ligament/tendon lesions (P < 0.001).ConclusionsSPECT/CT has MRI-comparable diagnostic performance for symptomatic lesions in ankle and foot pain patients. SPECT/CT and MRI exhibit different diagnostic specificity in different lesion types. SPECT/CT may be used as a complementary imaging method to MRI for enhancing diagnostic specificity.

Highlights

In diagnosing ankle and foot pain, clinical examination is a basic process and may provide accurate diagnosis in many cases
Uptake grade on single photon emission computed tomography (SPECT)/computed tomography (CT) was significantly higher in symptomatic lesions (P < 0.001), and its area under curve on receiver-operating characteristics (ROC) analysis was 0.787
SPECT/CT may be used as a complementary imaging method to magnetic resonance imaging (MRI) for enhancing diagnostic specificity

Summary

Introduction

In diagnosing ankle and foot pain, clinical examination is a basic process and may provide accurate diagnosis in many cases. Clinical examination is often limited, in patients with vague and chronic pain. Imaging studies are effective for diagnosis and planning of surgical treatment. Magnetic resonance imaging (MRI) is the most effective diagnostic imaging method in ankle and foot pain, with strengths such as high image resolution and excellent soft tissue contrast. In an expert consensus report, MRI was recommended as the most appropriate imaging method for ankle and foot pain when simple X-ray images are negative [1]. Clinical MRI is based on structural changes, and may have limitations when there are only subtle structural changes or when there are several coexistent lesions [2,3]

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