Clinical value of SPECT/CT in sport injuries

Objectives Hybrid SPECT/CT system combines information on abnormal bone metabolism through high contrast-resolution bone SPECT and precise anatomical detail with high spatial resolution of CT. The aim of this study was to investigate the incremental diagnostic value of SPECT/CT in comparison with planar and SPECT bone scintigraphy on the diagnosis and management of sport injuries.

Methods Twenty- four consecutive patients who had pain in their foot, ankle and legs after intense physical activity and referred for the investigation of sport injuries included in this study. Standard 3 phase bone scintigraphy and SPECT/CT was performed in each patient. Planar, SPECT and SPECT/CT images were interpreted independently from each other.

Results Five patients had no abnormal bone metabolism or CT abnormality. SPECT/CT identified stress fractures of the tarsal bones (2 navicular, 1 cuneiform) in 3 patients, fractures of metatarsal bones in two patients, fracture of calcaneus in one patient and fracture of tibia in 3 patients. SPECT/CT detected enthesitis or traction injury of Achilles tendon in 3 patients, peroneous brevis tendon in one patient and gluteus minimus tendon insertion in one patient. One patient with Achilles tendonitis also had plantar fasciitis. Talar dome injury (osteocondral defect) was detected in two patients and shin splints were identified in three patients. Although most of the pathologies were also positive in planar and SPECT images, SPECT/CT improved diagnostic accuracy providing anatomic and morphologic information about the lesions.

Conclusions Our preliminary study clearly showed that SPECT/CT added valuable information to planar and SPECT bone scintigraphy, increased diagnostic accuracy and shortened the diagnostic process in sport injuries.