SPECT/CT in Orthopedics
Bone scintigraphy is a well-established technique for the detection of early changes in bone metabolism and encompasses a wide spectrum of pathologies from malignant conditions to trauma, infection, and benign conditions. Despite recent advances in anatom
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SPECT/CT in Orthopedics Amir Sabet and Amin Sabet
8.1
Introduction
Bone scintigraphy is a well-established technique for the detection of early changes in bone metabolism and encompasses a wide spectrum of pathologies from malignant conditions to trauma, infection, and benign conditions. Despite recent advances in anatomical imaging such as magnetic resonance imaging (MRI) and computed tomography (CT), bone scintigraphy continues to play a major role in the diagnosis of bone pathology. The key advantages of bone scintigraphy are (1) the high sensitivity, (2) demonstrating pathology prior to the morphologic alterations, and (3) the ability to assess the integrity of the entire skeleton [1–11]. However, bone tissue binding of the tracers depends on osteoblast activity and the bone remodeling rate. Therefore, binding is not specific for a particular disease process, and the specificity is relatively poor. As a result, bone scintigraphy findings must often be interpreted in the light of information from structural imaging studies. Planar images frequently may not completely show pathologic changes because of the presence of overlying bone or artifacts. SPECT imaging increases sensitivity, but the lack of anatomical markers hinders the precise localization of the findings [12–14]. Hybrid imaging with SPECT/CT combines the advantages of both imaging techniques [15, 16]. The use of SPECT improves sensitivity compared to planar imaging, and the structural information obtained by CT provides an accurate assessment of the site, shape, and structure of the
A. Sabet, MD (*) Department of Nuclear Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, Bonn 53127, Germany e-mail: [email protected] A. Sabet, MD Department of Radiology, University of California, 200 West Arbor Drive, San Diego, CA 92103, USA H. Ahmadzadehfar, H.-J. Biersack (eds.), Clinical Applications of SPECT-CT, DOI 10.1007/978-3-642-35283-6_8, © Springer-Verlag Berlin Heidelberg 2014
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abnormalities. These morphological characteristics of the lesion are often needed to establish or confirm the diagnosis. Furthermore, CT may detect abnormalities such as spinal cord compression which cannot been seen by scintigraphy. SPECT/ CT has been significantly contributed to the diagnostic accuracy of skeletal scintigraphy [17–25] and increases the diagnostic confidence in both oncologic and nononcologic conditions [5, 21, 26–31]. This chapter will summarize the current and potential clinical applications of SPECT/CT in the assessment of benign bone disease [32, 33]. Clinical benefit of skeletal SPECT/CT in nononcologic disease has been systematically assessed in a study by Even-Sapir et al. [19]. The authors analyzed the images of 89 nononcologic patients with nonspecific lesions on planar skeletal scintigraphic images. SPECT/CT findings led to a definite diagnosis for 59 % of the patients and in 30 % of patients guided additional imaging. In another study only 11 % (9/71) with benign bone disease had no definite diagnosis
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