SPECT/CT arthrography of the wrist in ulnocarpal impaction syndrome

Abstract

Ulnar-sided wrist pain is a diagnostic challenge for hand surgeons and radiologists due to the complex anatomy of the involved small structures. Along with the clinical history and physical examination, imaging is important in the evaluation of ulnar-sided wrist pain [1–4]. Ulnocarpal impaction syndrome can lead to severe damage to the cartilage, triangular fibrocartilagecomplex (TFCC) and bone. The new generation of SPECT/CT devices allow SPECT and high-resolution CT imaging of the wrist with a spatial resolution of 0.33 mm in one imaging step [5]. CT arthrography of the wrist is a wellestablished investigation [6]. Combining wrist arthrography (arrowheads intraarticular contrast medium) and SPECT/CT (Arthro-SPECT/CT) offers a one-stop shop imaging approach for patients with ulnocarpal impaction. In our 63-year-old male patient with ulnar-sided wrist pain for 3 months, Arthro-SPECT/CT demonstrated severe osteoarthritis of the distal radioulnar joint (DRUJ), profound damage to the cartilage of the ulnotriquetral joint (short arrow) and a large defect in the central part of the TFCC (short arrow). Concomitant increased uptake was observed in the triquetral bone (long arrow )a nd DRUJ. Arthro-SPECT/CT of the wrist is feasible and offers unique anatomic and metabolic information to the hand surgeon in patients with ulnar-sided wrist pain. Arthro-SPECT/CTseems to be a promising alternative to wrist MRI. Conflicts of interest None.