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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 9, 1191-1196.
doi: 10.1302/0301-620X.91B9.22570  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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SPECT-CT imaging in degenerative joint disease of the foot and ankle

G. I. Pagenstert, MD, Consultant Orthopaedic Surgeon1; A. Barg, MD, Orthopaedic Resident3; A. G. Leumann, MD, Orthopaedic Resident1; H. Rasch, MD, Radiologist2; J. Müller-Brand, MD, Professor2; B. Hintermann, MD, Professor3; and V. Valderrabano, MD, PhD, Professor1

1 Department of Orthopaedic and Trauma Surgery
2 Department of Nuclear Medicine, University Hospital of Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland.
3 Department of Orthopaedic and Trauma Surgery, Kantonsspital Liestal, affiliate Hospital University of Basel, Rheinstrasse 26, CH-4401 Basel, Switzerland.

Correspondence should be sent to Dr G. I. Pagenstert; e-mail: geert.pagenstert{at}ukb.uni-bonn.de

The precise localisation of osteoarthritic changes is crucial for selective surgical treatment. Single photon-emission CT-CT (SPECT-CT) combines both morphological and biological information. We hypothesised that SPECT-CT increased the intra- and interobserver reliability to localise increased uptake compared with traditional evaluation of CT and bone scanning together. We evaluated 20 consecutive patients with pain of uncertain origin in the foot and ankle by radiography and SPECT-CT, available as fused SPECT-CT, and by separate bone scanning and CT. Five observers assessed the presence or absence of arthritis. The images were blinded and randomly ordered. They were evaluated twice at an interval of six weeks. Kappa and multirater kappa values were calculated.

The mean intraobserver reliability for SPECT-CT was excellent ({kappa} = 0.86; 95% CI 0.81 to 0.88) and significantly higher than that for CT and bone scanning together. SPECT-CT had significantly higher interobserver agreement, especially when evaluating the naviculocuneiform and tarsometatarsal joints.

SPECT-CT is useful in localising active arthritis especially in areas where the number and configuration of joints are complex.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General