Evaluation of the diagnostic accuracy of skeletal scintigraphy for the causes of front foot pain determined by magnetic resonance imaging.

Abstract

There is good correlation between increased radiopharmaceutical uptake anywhere in the feet of sports or leisure horses and the presence of foot pain. However, low sensitivity of scintigraphy for identifying lesions contributing to foot pain as determined by magnetic resonance imaging (MRI) has been reported. The aim of this retrospective, cross-sectional, analytical study was to assess the accuracy of scintigraphy for identifying the cause(s) of foot pain, using MRI as the reference standard. Sports and leisure horses that underwent both skeletal scintigraphy and MRI of the front feet between March 2008 and December 2014 and for which a definitive diagnosis of the cause(s) of front foot pain was reached were included (121 feet of 70 horses). Imaging studies were evaluated retrospectively, blindly. Agreements between scintigraphic localization of increased radiopharmaceutical uptake and subjective categorization of lesions with MRI diagnosis were assessed using Kappa statistics (κ). Measures of diagnostic accuracy were calculated. Sensitivity of increased radiopharmaceutical uptake varied among regions (31.8-76.2%) but specificity was at least high for all (84.6-100%). Agreements between both scintigraphy measures and MRI diagnosis were substantial for the distal phalanx (palmar processes and body) (κ=0.77 and κ=0.74, respectively), and ungular cartilages and chondral ligaments (κ=0.62, for both). When all regions were combined, agreements of increased radiopharmaceutical uptake (κ=0.49) and relevance categorization (κ=0.45) with MRI diagnosis were moderate. In conclusion, skeletal scintigraphy does not meet the minimum reliability level for a diagnostic test, but is reliable for identification of osseous trauma to the distal phalanx and ungular cartilages.