Role of 99mTc-MDP bone SPECT/CT in localisation, diagnosis and treatment of patients with wrist pain

Objectives The anatomy of the wrist is complex and accurate diagnosis and management of wrist injuries are challenging. The integration of SPECT and CT provides precise localisation and may enable characterisation of abnormalities identified on planar or SPECT. In addition, it offers the advantage of distinguishing individual carpal bones unlike conventional bone scans. The aim of this study is to assess the role of multislice SPECT/CT in localisation, characterisation and management of patients with wrist pain.

Methods Fifty-three patients with persistent wrist pain were referred for dual-phase 99mTc-MDP bone scan. Patients underwent dual-phase bone scan following followed by SPECT/CT. The images were acquired on multislice Philips Precedence SPECT/CT system. The evaluation was performed with respect to anatomical localisation, characterisation, and final diagnosis. Patient management and follow up details were recorded.

Results SPECT/CT Localisation: Lesion localisation improved in 42/53 (79%) patients. Management: Following SPECT/CT, change in the management was noted in 47 patients (88%). (a) Diagnostic arthroscopies were avoided in 8 patients and surgery in 20 patients. (b) 12 patients underwent surgical intervention (fixation of non-united fractures, fusion of joints, traphezectomies, tumour excision and denervation procedures), 8 patients had local steroid injections, and 4 patients had therapeutic arthroscopies. One patient was referred to rheumatology department for possible rheumatoid arthritis and two patients became asymptomatic, therefore no further interventions were required.

Conclusions Early diagnosis of wrist pain can lead to effective management and prevention of further complications. Multislice SPECT/CT is useful in localisation and characterisation of wrist joint pathology. Multislice SPECT/CT may be used as a one “Stop-imaging” in the management of wrist joint pathology