SPECT/CT arthrography

Abstract

Single photon emission CT (SPECT)/CT arthrography, the combination of CT arthrography and late phase bone SPECT/CT, has been developed in 2011 and so far used in knee, ankle and wrist joints. SPECT/CT offers functional information about increased bone turnover in combination with morphological details. Compared with SPECT/CT alone, additional intra-articular contrast enables the assessment of cartilage, menisci, ligaments and loose bodies. SPECT/CT arthrography is a promising alternative technique for the evaluation of internal derangement of joints in patients with MR contraindications and/or metallic implants. In this article, we review and report our 5-year experience with this technique illustrated with patient examples and give a perspective for future applications.

Figure 1.

SPECT/CT arthrography images of an 18-year-old female patient with persisting load-dependent pain 3 years after conservative therapy of a distal radius fracture. (a) puncture (arrow: needle tip) of the distal radioulnar joint under fluoroscopic guidance and injection of contrast. Contrast passover through the TFCC into the distal radiocarpal joint. (b) Early phase planar images of both wrists without pathologic uptake. (c) Late phase planar images of both wrists with increased uptake (arrow) at the ulnar edge of distal radius. (d) Coronal CT arthrography image showing an additional small bony fragment (arrow) and degenerative changes at the neighbouring radius edge. (e) Coronal SPECT/CT arthrography image with markedly increased uptake at the distal ulnar edge of the radius and the adjacent ossicle (arrow). CT arthrography (f) and SPECT/CT arthrography (g) image with defect of the TFCC (arrow). The ossicle was afterwards removed arthroscopically with good clinical success. SPECT, single photon emission CT; TFCC, triangular fibrocartilage complex.

Figure 2.

SPECT/CT arthrography images of a 24-year-old male after femur osteotomy and refixation of an osteochondral defect with recurrent blockages. (a) Arthrography with needle (arrowhead) in the retropatellar joint space and correct distribution of contrast (arrow) intraarticularly. Planar early phase (b) and late phase (c) images of the knee joints with increased uptake in the femur condyles (arrows). Coronal CT arthrography (d) and SPECT/CT arthrography (e) images with preserved cartilage (d, arrow) over the refixed osteochondral defect in the medial femur condyle and increased uptake (e, arrow) around the screw. Axial (f) SPECT/CT image with loose body (arrow) in the medial recess. The loose body (synovial fragment) was removed arthroscopically. SPECT, single photon emission CT.

Figure 3.

SPECT/CT arthrography images of a 59-year-old patient with persisting pain in the upper ankle joint 4 months after trauma. (a) Injection of contrast under fluoroscopic guidance in the upper ankle joint. (b) Planar late phase bone scintigraphy images with increased uptake (arrow) in the medial subchondral talus. (c, d) Coronal CT arthrography and SPECT/CT arthrography with a subchondral lesion in the medial talus with increased uptake (arrow) and corresponding cartilage defect (Grade IV). SPECT, single photon emission CT.