Abstract
BackgroundUnspecific pain of the hand/wrist is a diagnostic challenge. Radiographs and planar bone scan are useful diagnostic tools in patients with unspecific wrist pain. Both modalities are deficient, either by not presenting metabolic disorders or due to inadequate anatomical resolution. Single photon emission computed tomography/computed tomography (SPECT/CT) claims to fuse both features.MethodsFifty-one patients with persisting wrist pain were referred for evaluation by SPECT/CT. All patients received X-ray and early-phase/late-phase SPECT/CT imaging. SPECT/CT results were compared with X-ray alone and X-ray combined with planar bone scan. The therapeutic impact was evaluated in consensus with the referring hand surgeon.ResultsA total of 48 lesions were detected on plain radiographs, 117 on planar bone scan, and 142 on SPECT/CT. SPECT/CT detected significantly more lesions than the other imaging modalities. In 30 out of 51 patients (61%), a positive concordance between the clinical diagnosis and SPECT/CT findings was found. In 19 out of 51 patients (37%), SPECT/CT findings had significant impact on consecutive therapy.ConclusionsSPECT/CT showed higher lesion detection rates compared to standard X-rays and planar bone scan. Significant impact on patient management could be demonstrated. SPECT/CT might be added to the workup of such a specific patient population when standard imaging fails to detect the patient's main pathology.
Highlights
Unspecific pain of the hand/wrist is a diagnostic challenge
Lesion detection Plain radiography A total of 48 pathologies were detected on plain radiographs
single photon emission computed tomography (SPECT)/computed tomography (CT) proved to be superior compared to X-ray and planar bone scan concerning lesion detection
Summary
Radiographs and planar bone scan are useful diagnostic tools in patients with unspecific wrist pain. Both modalities are deficient, either by not presenting metabolic disorders or due to inadequate anatomical resolution. Unspecific pain of the hand and wrist is a diagnostic challenge, clinically for the hand surgeon and for diagnostic imaging. Imaging results often do not correlate with clinical symptoms or fail to detect any significant lesion which could possibly explain the clinical symptoms. Plain radiographs scintigraphy has a disadvantage concerning lesion localization due to the complex anatomy of the wrist. Modern SPECT/CT systems allow for detection of metabolic pathologies and exact concomitant anatomical localization which has significant therapeutic impact [3]. The available CT component with highresolution capabilities can provide additional diagnostic clarity of the metabolically active pathology and may detect additional, non-active pathologies
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