Combined single photon emission computerised tomography and conventional computerised tomography (SPECT/CT) in patellofemoral disorders: a clinical review

Abstract

Patellofemoral disorders are common conditions seen in a knee clinic but can present a great diagnostic challenge to the orthopaedic surgeon. Combined single photon emission computerised tomography with conventional computer tomography (SPECT/CT) provides the clinician with precise anatomical and physiological information of the patellofemoral joint. We present a clinical review that highlights the value of SPECT/CT in patients with patellofemoral disorders, where other modalities such as radiographs, MRI, and conventional CT did not provide sufficient information. SPECT/CT has proven to be helpful for establishing the diagnosis and guidance for further treatment. SPECT/CT should be recognised as a valuable diagnostic tool in orthopaedic patients.

Fig. 1

Combined single photon emission computerised tomography with conventional computer tomography (SPECT/CT) images (coronal, lateral and axial) of the left knee of a 45-year-old male patient showing an increased signal activity to the pseudoarthrosis between the main body of the patella and lateral pole

Fig. 2

Combined single photon emission computerised tomography with conventional computer tomography (SPECT/CT) images of both knees of a 60-year-old female patient showing a localised area of increased tracer uptake to the lateral femoral condyle and patellofemoral joint (PFJ). The intensity is greatest on the left knee, corresponding with the patient’s symptoms

Fig. 3

Anteroposterior, lateral and skyline radiographs of the right knee of a 50-year-old male patient taken 2.5 years after primary total knee arthroplasty

Fig. 4

Combined single photon emission computerised tomography with conventional computer tomography (SPECT/CT) images of the right knee of a 50-year-old male patient showing a focal increased activity at the retro patellar surface with otherwise unsuspicious knee after total knee arthroplasty

Fig. 5

MRI of left knee joint of a 35-year-old female patient

Fig. 6

Combined single photon emission computerised tomography with conventional computer tomography (SPECT/CT) images of the left knee of a 35-year-old female patient showing the former osteochondritis dissecans lesion 20 years after microfracturing. The increased tracer activity in combination with the osteoarthritic changes clearly indicated the patellofemoral osteoarthritis as cause of the anterior knee pain