Risk Stratification for Avascular Necrosis of the Femoral Head After Internal Fixation of Femoral Neck Fractures by Post-Operative Bone SPECT/CT / 대한핵의학회잡지

PURPOSE: Avascular necrosis (AVN) of the femoral head is a major complication after internal fixation of a femoral neck fracture and determines the functional prognosis. We investigated postoperative bone single-photon emission computed tomography/computed tomography (SPECT/CT) for assessing the risk of femoral head AVN.METHODS: We retrospectively reviewed 53 consecutive patients who underwent bone SPECT/CT within 2 weeks of internal fixation of a femoral neck fracture and follow-up serial hip radiographs over at least 12 months.RESULTS: Nine patients developed femoral head AVN. In 15 patients who showed normal uptake on immediate postoperative SPECT/CT, no AVN occurred, whereas 9 of 38 patients who showed cold defects of the femoral head later developed AVN. The negative predictive value of immediate postoperative SPECT/CT for AVN was 100 %, whereas the positive predictive value was 24 %. Among 38 patients with cold defects, 1 developed AVN 3 months postoperatively. A follow-up bone SPECT/CT was performed in the other 37 patients at 2??0 months postoperatively. The follow-up bone SPECT/CT revealed completely normalized femoral head uptake in 27, partially normalized uptake in 8, and persistent cold defects in 2 patients. AVN developed in 3.7 % (1/27), 62.5 % (5/8), and 100 % (2/2) of each group, respectively.CONCLUSION: According to the time point of imaging, radiotracer uptake patterns of the femoral head on postoperative bone SPECT/CT indicate the risk of AVN after internal fixation of femoral neck fractures differently. Postoperative bone SPECT/CT may help orthopedic surgeons determine the appropriate follow-up of these patients.

Osteoporotic Vertebral Fractures: SPECT findings / 대한핵의학회잡지

PURPOSE: The purpose of this study was to evaluate the usefulness of single photon emission computed tomography (SPECT) of bone using Tc-99m MDP in the diagnosis of osteoporotic vertebral fractures. MATERIALS AND METHODS: Thirty two patients with osteoporotic vertebral fracture were included in this study (mean age: 67 +/- 8, male: 5, female: 27). Seventy nine vertebral fractures were detected (38 thoracic/thoracolumbar lesions and 41 lumbar lesions), which were classified by type of deformity (wedge, biconcave or compression). The patterns and locations of increased uptakes were examined and analyzed. RESULTS: Forty seven wedge fractures, 20 biconcave fractures and 12 compression fractures were found. Diffuse and asymmetric uptakes were common in fractured bodies. More than one uptake were examined in 69 posterior elements of fractured vertebrae (87.3%) including 40 of 47 wedge fractures (85.1%), 17 of 20 biconcave fractures (85.0%) and 12 of 12 compression fractures (100%). Wedge fractures were predominant fracture in thoracic/thoracolumbar spine whereas incidence of biconcave or compression type was similar to that of wedge fracture in lumbar spine (p=0.04). Spinous process uptake was more frequently seen in lumbar lesions than thoracic/thoracolumbar lesions (p=0.009). Facet joint uptake in biconcave fracture was more common in lumbar spine (92.3%) than thoracic/thoracolumbar spine (57.1%). Spinous process uptake in biconcave fracture was also more frequently detected in lumbar spine (p=0.043). CONCLUSION: Bone SPECT was useful in the evaluation of osteoporotic vertebral fracture, especially posterior elements of vertebrae.

Role of Bone Scan in Rheumatic Diseases / 대한핵의학회잡지

Rheumatic diseases can be categorized by pathology into several specific types of musculoskeletal problems, including synovitis (e.g. rheumatoid arthritis), enthesopathy (e.g. ankylosing spondylitis) and cartilage degeneration (e.g. osteoarthritis). Skeletal radiographs have contributed to the diagnosis of these articular diseases, and some disease entities need typical radiographic changes as a factor of the diagnostic criteria. However, they sometimes show normal radiographic findings in the early stage of disease, when there is demineralization of less than 30-50 %. Bone scans have also been used in arthritis, but not widely because the findings are nonspecific and it is thought that bone scans do not add significant information to routine radiography. Bone scans do however play a different role than simple radiography, and it is a complementary imaging method in the course of management of arthritis. The image quality of bone scans can be improved by obtaining regional views and images under a pin-hole collimator, and through a variety of scintigraphic techniques including the three phase bone scan and bone SPECT. Therefore, bone scans could improve the diagnostic value, and answer multiple clinical questions, based on the pathophysiology of various forms of arthritis.

Efficacy of Bone SPECT for Diagnosis of Meniscal tear / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the efficacy of bone SPECT for the diagnosis of meniscal tear. MATERIALS AND METHODS: 63 cases that had undergone bone SPECT were evaluated for sensitivity and specificity by comparing arthroscopy and MRI findings. RESULTS: Bone SPECT showed a sensitivity of 93.8% and a specificty of 71% for medial meniscus and a sensitivity of 85.7% and a specificty of 87.8% for lateral meniscus tear. MRI was performed on 21 cases simultaneously, and agreement was obtained on the presence or absence, and on the nature of the pathology with bone SPECT in 15 cases (71.4%). CONCLUSION: Bone SPECT is believed to be an effective and economic way of screening for meniscal tear prior to arthroscopy, in suspected cases of meniscal tear.

A comparison of Bone SPECT, MRI, and Arthroscopy for the Evaluation of Chronic Knee Pain / 대한류마티스학회지

OBJECTIVE: This study was undertaken to evaluate the value of bone single photon emission computed tomography(SPECT), simply radiography, magnetic resonance imaging(MRI), and arthroscopy to see the severity of osteoarthritis(OA) and the meniscal tear in patients with chronic knee pain. METHOD: Total 25 patients who had chronic knee pain and suspected meniscal tear during the period from May 1997 through June 1998 were included in the study. The simple radiography, bone SPECT and MRI were performed in all 25 patients. The arthroscopy was done in 17 patients and arthroplasty in four. In order to see the severity of OA, the arbitrary grading was done by SPECT, and kellgren-Lawrence grading by simple radiography and Outerbridge grading by arthroscopy were used. RESULTS: In 21 patients, bone SPECT and MRI with either arthroscopy or arthroplasty were done. Among the seventeen of these 21 patients who had a meniscal tear either by arthroscopy or arthroplasty, the meniscal tears were found in 15 patients by SPECT, and 14 patients by MRI. Spearman rank correlation coefficient between SPECT grading and arthroscopic grading was 0.814, and the coefficient between simple radiographic grading and arthroscopid grading was 0.360. CONCLUSION: The bone SPECT of the knee seems to be more cost-effective in comparison to MRI and arthroscopy to see the severity of OA and the meniscal tear in patients who has chronic knee pain.

Bone SPECT, Simple Radiography , and Operative Findings in Osteoarthritic Knee with or without Anterior Cruciate Ligament Injury / 대한정형외과학회잡지

In so-called primary osteoarthritic knees, there may be secondary osteoarthritis due to the instability from chronic cruciate ligament and/or meniscal tear. The purpose of this study is to compare the findings of bone single-photon emission computed tomography(SPECT) and those of simple radiography in osteoarthritic knees which we consider as primary on the status of anterior cruciate ligament(ACL). We reviewed the preoperative bone SPECT and simple radiography of forty-three osteoarthritic knees in 23 patients who underwent total knee arthroplasty between 1995 and l996. We divided the cases into two groups on the status of ACL: thirty intact ACLs(Group I), thirteen insufficient ACLs(Group II). Meniscal tear and/or ACL insufficiency were found in 38 of 43 knees, As regards with presence of osteophytes and sclerotic changes on simple radiograph, there was no significant differences between group I and II. Joint space narrowing was more prominent and diffuse in group I(medial 29, lateral 24) than group II(medial 7, lateral 6). Bone SPECT showed diffuse uptake in group I(medial 30, lateral 23), but less uptake on the lateral compartment(medial 13, lateral 3) in group II. In ACL-intact osteoarthritic knees, joint space narrowing on simple radiograph and hot uptake on bone SPECT were more prominent and diffuse than in ACL-insufficient knees. Clinical relevance is still uncertain and further investigation is needed.

Utility of Bone SPECT in Temporomandibular Joint Pain / 대한핵의학회잡지

Temporomandibular (TM) joint pain results from many etiologic factors. The aim of this study was to evaluate the utility of Bone SPECT in patients with TM joint pain. The subjects were 34 patients with TM joint pain. All patients underwent plain radiography, planar bone scan, and Bone SPECT. The intensity of radioisotope uptake at TM joint was graded into three; no increased uptake above three background activity as grade 0, uptake similar to occipital bone as grade I, and uptake similar to maxillary sinus as grade II. Clinical findings and therapeutic methods were reviewed. Twenty-seven patients (80%) out of 34 patients with TM joint pain had increased uptake in bone SPECT. Twenty-one (78%) out of 27 patients had increased uptake in the mandibular condyle and remaining six patients (22%) had uptake in the mandibular and maxillary arch, which proved to be dental problem. Seven patients out of 34 were grade as 0, four (12%) were grade I, 23 (68%) were grade II. Four patients with grade I had clicking sound and symptoms which were subsided with medication in all cases. Among 23 patients with grade II, 7 patients had clicking sound and 14 patients underwent medication and decompression therapy. With Planar bone scan, 11 cases (32%) had increased uptake in TM joint area. Plain radiography revealed narrowing, distension, erosion and limitation of TM joint in 16 cases (47%). Bone SPECT can be valuable for screening and managing the patients with TM joint pain. Patients with grade II needed intensive treatment such as joint aspiration. However degree of the radioisotope uptake did not well correlated with clinical symptoms.