Hybrid SPECT/CT for the assessment of a painful hip after uncemented total hip arthroplasty

Abstract

BackgroundThe diagnosis of hip pain after total hip replacement (THR) represents a highly challenging question that is of increasing concern to orthopedic surgeons. This retrospective study assesses bone scintigraphy with Hybrid SPECT/CT for the diagnosis of painful THR in a selected cohort of patients.MethodsBone SPECT/CT datasets of 23 patients (mean age 68.9 years) with a painful hip after THR were evaluated. Selection of the patients required an inconclusive radiograph, normal serum levels of inflammatory parameters (CRP and ESR) or a negative aspiration of the hip joint prior to the examination. The standard of reference was established by an interdisciplinary adjudication-panel using all imaging data and clinical follow-up data (>12 month). Pathological and physiological uptake patterns were defined and applied.ResultsThe cause of pain in this study group could be determined in 18 out of 23 cases. Reasons were aseptic loosening (n = 5), spine-related (n = 5), heterotopic ossification (n = 5), neuronal (n = 1), septic loosening (n = 1) and periprosthetic stress fracture (n = 1). In (n = 5) cases the cause of hip pain could not be identified. SPECT/CT imaging correctly identified the cause of pain in (n = 13) cases, in which the integrated CT-information led to the correct diagnosis in (n = 4) cases, mainly through superior anatomic correlation. Loosening was correctly assessed in all cases with a definite diagnosis.ConclusionsSPECT/CT of THA reliably detects or rules out loosening and provides valuable information about heterotopic ossifications. Furthermore differential diagnoses may be detected with a whole-body scan and mechanical or osseous failure is covered by CT-imaging. SPECT/CT holds great potential for imaging-based assessment of painful prostheses.

Heterotopic ossification and the elucidation of pathologic differentiation

“…Surgeons increasingly rely on the use of established technology, SPECT-CT prominently among them, to clarify diagnosis and refine indications for surgical resection [113]. The use of SPEC-CT allows visualization of HO lesions to demarcate proximity to, and entrapment of, vital structures, allowing for better informed decisions on when to take patients to the OR [114]. When employed with careful planning and sound surgical technique, surgery proves an efficacious solution.…”

The role of hybrid bone SPECT/CT imaging in the work-up of the limping patient: a symptom-based and joint-oriented review

“…Nevertheless, the advent of hybrid imaging in nuclear medicine has transformed bone scintigraphy into a comprehensive tool that not only enables whole-body skeletal assessment, in contrast to MRI, but also allows for a detailed regional evaluation using targeted SPECT/CT acquisitions. The major driver for this improvement in impact on patient management has been the increase in specificity, a traditional weak-point of conventional bone scintigraphy (Dobrindt et al 2015 ). Current indications for the use of bone SPECT/CT in the painful adult hip include, assessment of joint replacements for loosening/infection, heterotopic ossification, impingement, stress fractures, avascular necrosis, hip pain unexplained by other imaging modalities, and ruling-out metastatic disease or systemic arthropathy.…”

“…Similarly, increased uptake at the bone-prosthesis interface – in contrast to uptake in the surrounding bone – in areas associated with prosthesis fixation requires careful assessment of the appearance on CT to exclude loosening (Tam et al 2014 ). Using this approach, bone SPECT/CT can identify the source of pain and impact management in approximately 65% of patients with pain after hip arthroplasty and negative conventional imaging (Dobrindt et al 2015 ; Berber et al 2015 ). Nevertheless, dedicated follow-up infection imaging may be required, but is beyond the scope of this review.…”

SCreg: a registration-based platform to compare unicondylar knee arthroplasty SPECT/CT scans

“…Nevertheless, due to differences in patient positioning within the scanner or anthropometric differences between patients, SPECT/CT scans are usually not mutually aligned and thus cannot be directly compared. To overcome this challenge, regional classification systems, in which several regions are manually defined based on anatomic landmarks and/or predefined dimensions, have been developed for evaluating unicondylar knee [14,18], total knee [9,10,19], total hip [20,21] and shoulder [22] arthroplasty. Despite prior success with this approach, it is limited in that it significantly reduces data resolution as thousands of SPECT voxels are reduced into just a few regions for analysis (around 200 voxels per region) leading to the loss of local information.…”