Determination of the Vitality of the Femoral Head with<sup>99m</sup>Tc-Sn-Pyrophosphate Scintigraphy

Greiff, Jørgen

doi:10.3109/17453678008990775

Cited by 18 publications

(5 citation statements)

References 15 publications

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“…Scintigraphy has its advantage in the early detection of perfusion or metabolism defects before radiologic abnormalities would appear. Scintigraphy can reflect perfusion defects within 24 h if the test is available and also diagnose and predict ONFH about 14 months earlier than simple radiography [19,26]. Meyers et al reported a 95% diagnostic accuracy of scintigraphy in predicting avascular necrosis in his prospective study on FNF patients [27].…”

Section: Discussionmentioning

confidence: 99%

The diagnostic value of SPECT/CT in predicting the occurrence of osteonecrosis following femoral neck fracture: a prospective cohort study

Yoon

Lee

Yoon

et al. 2020

BMC Musculoskelet Disord

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Backgrounds: One of the most significant complications after a femoral neck fracture is osteonecrosis of the femoral head (ONFH). The concomitant use of single-photon emission computed tomography (SPECT) with computed tomography (CT) increases the sensitivity for detecting the anatomic location and severity of ONFH. In this study, we evaluated the diagnostic value of SPECT/CT for the occurrence of ONFH by quantifying the perfusion status of the femoral head. Methods: A total of 30 patients who had multiple pinnings for femur neck fractures were included in this study. We classified the perfusion status into three groups: normal perfusion, decreased perfusion, and avascular groups, and compared the occurrence of femoral head necrosis between them. For quantitative analysis, we evaluated the uptake ratio of both femur heads (head-to-head uptake ratio). If the patient's contralateral hip was incomparable, we measured the uptake ratio from the superior dome of the ipsilateral acetabulum (head-to-acetabulum uptake ratio). Results: Twenty-four patients out of 30 achieved bone union, whereas the others developed ONFH. When the population was divided into intact and defective perfusion groups on scintigraphy, the sensitivity, specificity, and accuracy of the test were 83.3, 75.0, and 76.7%, respectively. The mean head-to-head uptake ratio value with a 95% confidence interval (CI) was 1.10 (95% CI: 0.85-1.36). In the osteonecrosis group, the mean value of the head-to-head uptake ratio was 0.33 (95% CI: 0.28-0.38). In contrast, the ratio was 1.30 (95% CI: 1.03-1.57) in the non-osteonecrosis group, demonstrating a significant difference in the uptake ratio (P < 0.001). When the cutoff value of the uptake ratio was set to 0.5, both the sensitivity and specificity were 100%. There was also a significant difference in the head-toacetabulum uptake ratio between the two groups (P < 0.001). Conclusions: SPECT/CT was useful in evaluating the perfusion status of the femoral head, showing high accuracy in predicting the occurrence of avascular necrosis. To demonstrate the reliability and validity of SPECT/CT, further prospective studies on a larger scale are warranted.

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Section: Discussionmentioning

confidence: 99%

The diagnostic value of SPECT/CT in predicting the occurrence of osteonecrosis following femoral neck fracture: a prospective cohort study

Yoon

Lee

Yoon

et al. 2020

BMC Musculoskelet Disord

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“…Scintigraphy has its advantage in the early detection of perfusion or metabolism defects before radiologic abnormalities would appear. Scintigraphy can re ect perfusion defects within 24 hours if the test is available and also diagnose and predict ONFH about 14 months earlier than simple radiography [19,26]. Meyers et al reported a 95% diagnostic accuracy of scintigraphy in predicting avascular necrosis in his prospective study on FNF patients [27].…”

Section: Discussionmentioning

confidence: 99%

The Diagnostic Value of SPECT/CT in Predicting the Occurrence of Osteonecrosis following Femoral Neck Fracture : a prospective cohort study

Yoon

Lee

Yoon

et al. 2020

Preprint

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Backgrounds One of the most significant complications after a femoral neck fracture is osteonecrosis of the femoral head (ONFH). The concomitant use of single-photon emission computed tomography (SPECT) with computed tomography (CT) increases the sensitivity for detecting the anatomic location and severity of ONFH. In this study, we evaluated the diagnostic value of SPECT/CT for the occurrence of ONFH by quantifying the perfusion status of the femoral head. Methods A total of 30 patients who had multiple pinnings for femur neck fractures were included in this study. We classified the perfusion status into three groups: normal perfusion, decreased perfusion, and avascular groups, and compared the occurrence of femoral head necrosis between them. For quantitative analysis, we evaluated the uptake ratio of both femur heads (head-to-head uptake ratio). If the patient’s contralateral hip was incomparable, we measured the uptake ratio from the superior dome of the ipsilateral acetabulum (head-to-acetabulum uptake ratio). Results Twenty-four patients out of 30 achieved bone union, whereas the others developed ONFH. When the population was divided into intact and defective perfusion groups on scintigraphy, the sensitivity, specificity, and accuracy of the test were 83.3%, 75.0%, and 76.7%, respectively. The mean head-to-head uptake ratio value with a 95% confidence interval (CI) was 1.10 (95% CI: 0.85 – 1.36). In the osteonecrosis group, the mean value of the head-to-head uptake ratio was 0.33 (95% CI: 0.28 – 0.38). In contrast, the ratio was 1.30 (95% CI: 1.03 – 1.57) in the non-osteonecrosis group, demonstrating a significant difference in the uptake ratio ( P < 0.001). When the cutoff value of the uptake ratio was set to 0.5, both the sensitivity and specificity were 100%. There was also a significant difference in the head-to-acetabulum uptake ratio between the two groups ( P < 0.001). Conclusions SPECT/CT was useful in evaluating the perfusion status of the femoral head, showing high accuracy in predicting the occurrence of avascular necrosis. To demonstrate the reliability and validity of SPECT/CT, further prospective studies on a larger scale are warranted.

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“…In the past 10 years, radionuclide tracers have been used to judge the vitality of the femoral head after intracapsular femoral neck fkactures (DAmbrosia et al 1975, Greiff 1980, Greiffet al 1980, Strijmqvist 1983) and after transient synovitis of the hip in children (Wingstrand et al 1985a). Wingstrand et al (1985b) and Kallio & Ryoppy (1985) reported a very high (130-170 mm Hg) intraarticular pressure in children with symptoms of transient synovitis of the hip, when the hips were extended and rotated inward.…”

Section: Discussionmentioning

confidence: 99%

Scintimetry of hip joint tamponade in dogs

Krebs

Falstie-Jensen

et al. 1986

Acta Orthopaedica Scandinavica

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Determination of the Vitality of the Femoral Head with^99mTc-Sn-Pyrophosphate Scintigraphy

Cited by 18 publications

References 15 publications

The diagnostic value of SPECT/CT in predicting the occurrence of osteonecrosis following femoral neck fracture: a prospective cohort study

The diagnostic value of SPECT/CT in predicting the occurrence of osteonecrosis following femoral neck fracture: a prospective cohort study

The Diagnostic Value of SPECT/CT in Predicting the Occurrence of Osteonecrosis following Femoral Neck Fracture : a prospective cohort study

Scintimetry of hip joint tamponade in dogs

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Determination of the Vitality of the Femoral Head with99mTc-Sn-Pyrophosphate Scintigraphy

Cited by 18 publications

References 15 publications

The diagnostic value of SPECT/CT in predicting the occurrence of osteonecrosis following femoral neck fracture: a prospective cohort study

The diagnostic value of SPECT/CT in predicting the occurrence of osteonecrosis following femoral neck fracture: a prospective cohort study

The Diagnostic Value of SPECT/CT in Predicting the Occurrence of Osteonecrosis following Femoral Neck Fracture : a prospective cohort study

Scintimetry of hip joint tamponade in dogs

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Determination of the Vitality of the Femoral Head with^99mTc-Sn-Pyrophosphate Scintigraphy