Abstract
Purpose: To evaluate the interest of adding a bloodpool SPECT/CT to standard three-phase bone scintigraphy (BS) for etiological diagnosis of subacute and chronic lower extremity pains.Methods: We prospectively included patients addressed for pain of lower extremities lasting for at least 6 weeks, without previous surgery. They underwent a standard three-phase BS including late phase SPECT/CT, modified with an additional bloodpool SPECT/CT acquisition. Two independent physicians interpreted the images provided by both protocols. Diagnostic conclusion, diagnostic confidence, and interrater agreements were compared.Results: One hundred and eighteen lower extremities from 113 patients were analyzed (71 men, median age of 53 years). Adding bloodpool SPECT/CT to standard three-phase BS changed diagnostic conclusions in 24.6% (29/118) of lower extremities. The modified protocol revealed at least one diagnostic conclusion explaining the pain in 89% of extremities, rather than 83.1% with the standard protocol (p = 0.02). Tendinopathies were diagnosed in 12.7% of lower extremities, rather than 4.2% with standard BS (p = 0.002). Adding bloodpool SPECT/CT substantially increased overall confidence of each reader (p < 0.001). Inter-reader agreement was not significantly impacted.Conclusion: Adding bloodpool SPECT/CT to standard three-phase BS impacted diagnostic conclusion in a quarter of the patients with painful lower extremities, notably by revealing significantly more tendonitis.
Highlights
Subacute and chronic pains of foot and ankle are common reasons for healthcare encounter [1]
98 (83.1%) lower extremities were found with at least one diagnostic conclusion explaining the symptoms with standard 3pBS including late-phase single photon emission computed tomography (SPECT)/CT, 105 (89.0%) (p = 0.02) showed at least one diagnostic conclusion with the modified imaging protocol including supplementary bloodpool SPECT/CT
The only diagnostic category that detection was significantly impacted by adding bloodpool SPECT/CT was “tendinopathy,” revealed in 15 (12.7%) lower extremities with modified protocol, rather than five (4.2%) with standard 3pBS with late-phase SPECT/CT (p = 0.002)
Summary
Subacute and chronic pains of foot and ankle are common reasons for healthcare encounter [1]. Bloodpool SPECT/CT in Painful Foot clinical examination and initial radiography. This frequently makes further imaging explorations necessary [2]. Threephase bone scintigraphy (3pBS) is an imaging method of choice to establish etiological diagnosis of painful lower extremities [3]. The rise of late-phase single photon emission computed tomography (SPECT) has dramatically increased diagnostic performances of bone scintigraphy by enhancing its sensitivity [4], and its localization ability [5]. With the advent of hybrid imaging, specificity was increased by adding CT to SPECT. These technical developments provided substantial improvement in diagnosis and management of patients with pain, regarding painful lower extremities [6]
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