Role of bone SPECT/CT in Kienbock’s disease

Introduction: Kienbock’s disease is avascular necrosis of the lunate bone in the wrist. In this study, we evaluated the role of bone SPECT/CT in Kienbock’s disease.

Methods: We retrospectively reviewed the patients with Kienbock’s disease, who underwent SPECT/CT between May-2015 and Oct-2021. Kienbock’s disease was diagnosed based on clinical history, physical examination, plain x-ray (or CT) and MRI. For bone scintigraphy, 740MBq of Tc-99m hydroxymethylene diphosphonate was injected, and wholebody, regional static and SPECT/CT for hand and wrist area were obtained. Bone scintigraphic images were analyzed by a nuclear medicine physician.

Results: Twenty-seven patients were enrolled in this study. 13 patients were male and mean age was 48.2 ± 17.5 years old. SPECT/CT can perform exact localization of uptake and successfully discriminate the bone uptake and joint uptake. On SPECT/CT, 20 patients (74.1%) showed focal increased tracer uptake at the lunate bone, 4 patients (14.8%) showed equivocal uptake of lunate bone compared with adjacent wrist bones, 3 patients (11.1%) showed decreased uptake at lunate bone. Nineteen patients (70.4%) showed increased carpal joints uptake. Among these patients, 1 patients (66.7%) showed midcarpal uptake, 6 patients (22.2%) showed radiocarpal joint uptake on SPECT/CT. Among these patients, 19 patients underwent follow-up evaluation (18.6 ± 19.7 months) and 9 patients (47.4%) showed aggravated findings during follow-up. Eight (66.7%) of 12 patients with carpal joints uptake showed aggravation, and only 1 (14.3%) of 7 patients without carpal joints uptake showed aggravation.

Conclusions: Variable uptake at the lunate bone on bone SPECT/CT was demonstrated in Kienbock’s disease. And patients with carpal joint uptake seems to be aggravated during the follow-up period. Bone SPECT/CT might be used to predict the lunate collapse, and patients with the collapse could be warned and surgical treatment could be considered.