SPECT-CT versus MRI. in patients with hindfoot pain associated with foot and ankle disease. Hidenori Matsubara Hiroyuki Tsuchiya

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1 SPECT-CT versus MRI in patients with hindfoot pain associated with foot and ankle disease Kanazawa University Hospital Takao Aikawa Yasuhisa Yoshida Hidenori Matsubara Hiroyuki Tsuchiya

2 NO CONFLICT TO DISCLOSE < Single-photon emission computed tomography versus magnetic resonance imaging in patients with hindfoot pain associated with foot and ankle disease > < Takao Aikawa > My disclosure is in the Final AOFAS Mobile App. I have no potential conflicts with this presentation.

3 Background Foot and ankle pain is a diagnostic challenge because of the complex anatomy of the various bones and joints involved. Bone marrow edema (BME) is useful for diagnosing pain derived from bones. Recently, some studies have reported that single-photon emission computed tomography and computed tomography (SPECT-CT) is also useful for diagnosing osteoarthritis of the foot and ankle. Aim To evaluate SPECT-CT in comparison to magnetic resonance imaging (MRI) for diagnosing and interpreting hindfoot pain. MRI SPECT-CT

4 Materials and Methods 29 feet 28 patients with hindfoot pain associated with foot and ankle diseases underwent MRI and SPECT-CT for bone scintigraphy. 15 male, 13 female Age 49.4 y.o. (11~77 y.o.) Ankle osteoarthritis Subtalar osteoarthritis AAFD Other diseases 18 cases 4 cases 4 cases 3 cases

5 To evaluate each imaging study, the lesions were divided into five regions Ankle joint 1 Medial region 2 Central region 3 Lateral region Tarsal sinus Subtalar joint

6 The BME changes observed on MRI were compared with focally increased tracer uptake observed on the SPECT-CT images at each regions. MRI : BME (+) / (-) Bone Marrow Edema (BME) : T2 fat suppression (stir) high and/or T1 low SPECT-CT : Activity (+) / (-) (bone scintigraphy)

7 Additionally, the findings at each tender area were compared to the imaging findings. (1) Tenderness at medial side <Imagig findings> Ankle joint (medial region) Subtalar joint (2) (2) Tenderness at central side <Imagig findings> Ankle joint (central region) (3) Tenderness at lateral side <Imagig findings> Ankle joint (lateral region) Subtalar joint Tarsal sinus

8 Results: imaging findings 15 feet 26 feet BME (+) Activity (+) (At least one region was positive.) BME (+), Activity (+) BME (+), Activity (-) BME (-), Activity (+) 18 regions 10 regions 29 regions

9 BME Results: association with tender area and imaging findings MRI Tenderness (+) (-) (+) (-) Sensitivity 55.6% Specificity 75.8% Activity SPECT-CT Tenderness (+) (-) (+) (-) Sensitivity 86.1% Specificity 60.6% We excluded 18 areas (both image findings negative and tederness positive) because we thought in these cases hindfoot pains were not derived from bones.

10 Discussion Advantage of SPECT-CT for diagnosing in foot and ankle 単純 X 線 CT SPECT SPECT-CT SPECT-CT is a new daignostic tool which fuses the morphological and biological information of CT and scintigraphy. SPECT-CT is useful in localizing active arthritis especially in areas where the number and configuration of joints are complex. ( Pagenstert GI, et al. J Bone Joint Surg Br, 2009 )

11 Discussion Advantage of bone scintigraphy for evaluation of pain In chronic medial knee pain BME vs Bone scintigraphic uptake Increased tracer uptake in bone scintigraphy (sensitivity 70%) is more sensitive for medial knee pain than BME on MRI (sensitivity 60%). In our study, (Buck FM, et al. Skeletal Radiol, 2009) SPECT-CT was more sensitive, but MRI was more specific in the evaluation of hindfoot pain.

12 Conclusion SPECT-CT provides additional information and was more sensitive for hindfoot tenderness. We believe that SPECT-CT can be a useful problem-solving tool for diagnosing hindfoot pain. References 1. Buck FM, Hoffmann A, Hofer B, et al. Chronic medial knee pain without history of prior trauma: correlation of pain at rest and during exercise using bone scintigraphy and MR imaging. Skeletal Radiol, 38: , Orthopaedic Surgery, Kanazawa University Medical School