Abstract
BackgroundSingle photon emission tomography/computed tomography (SPECT/CT) combines the strengths of bone scintigraphy and CT and serve as an important alternative to magnetic resonance (MR) imaging in carpal trauma patients if conventional x-rays are equivocal.Case presentationIn a young patient with pain 4 days after carpal trauma conventional x-rays were negative for fracture and MR showed only bone bruise. SPECT/CT arthrography one month later revealed intensive uptake in the capitate bone corresponding to a fracture through a bone island on the CT part of the study.ConclusionSPECT/CT combines the sensitivity of bone scintigraphy and specificity of (diagnostic) CT and might serve as an important second line imaging modality for the detection of occult carpal fracture.
Highlights
Single photon emission tomography/computed tomography (SPECT/ CT) combines the strengths of bone scintigraphy and CT and serve as an important alternative to magnetic resonance (MR) imaging in carpal trauma patients if conventional x-rays are equivocal.Case presentation: In a young patient with pain 4 days after carpal trauma conventional x-rays were negative for fracture and MR showed only bone bruise
CT and bone scintigraphy are superior to conventional x-rays in the detection of carpal fractures (Akdemir et al, 2004; Welling et al, 2008)
MR (Fig. 1) showed some bone bruise (A,B short arrows) and a bone island (A,B, long arrow) and the patient was referred for SPECT/CT arthrography
Summary
Fractures of the carpals are very rare and sometimes difficult to detect with conventional x-rays. CT and bone scintigraphy are superior to conventional x-rays in the detection of carpal fractures (Akdemir et al, 2004; Welling et al, 2008). Since SPECT/ CT is available it has been successfully used for imaging of patients with unclear carpal and wrist pain (Huellner et al, 2012). MR (Fig. 1) showed some bone bruise (A,B short arrows) and a bone island (A,B, long arrow) and the patient was referred for SPECT/CT arthrography. SPECT/CT arthrography (Fig. 2) was performed one month later with the technique described before (Bhure et al, 2017). Planar bone scintigraphy (A) and SPECT (C) images showed intensive focal uptake in the capitate bone (long arrows) corresponding to a transverse fracture on CT (D, short arrow). CT follow-up after 3 months showed successful fracture healing
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