SPECT/CT in the Management of Osteochondral Lesions of the Talus

Abstract

We believe SPECT/CT was able to provide additional diagnostic value by demonstrating a co-existing pathology as a potential cause of pain and in preoperative planning by showing the depth of activity and the precise location of the active segment in multiple lesions.

Influence on Therapeutic Decision Making of SPECT-CT for Different Regions of the Foot and Ankle

“…CT scan can illustrate bony pathologies with a high resolution but still there is missing information about the activity of the pathology. For complex and difficult cases SPECT-CT has been widely described as an adjuvant and effective tool to reach a diagnosis [2, 3, 6, 8–11]. …”

“…While bone scan alone has a lack of spatial resolution, the combination of bone scan and CT offers morphological and functional data [2, 5–7]. Common indications in foot and ankle surgery are exact localization of arthritis, osteochondrosis dissecans, coalitio, stress fractures, and sesamoiditis [8–11]. The advantages of SPECT-CT led to an increasing use [2, 6, 8].…”

“…Common indications in foot and ankle surgery are exact localization of arthritis, osteochondrosis dissecans, coalitio, stress fractures, and sesamoiditis [8–11]. The advantages of SPECT-CT led to an increasing use [2, 6, 8]. Scharf assumed that, within orthopedic practice, SPECT-CT has the biggest impact in foot and ankle surgery [4].…”

Answer to ‘A 28-year-old snowboarder presents with chronic ankle pain’

“…CT is critical in providing exact measurements of the bony component of the osteochondral lesion to facilitate meticulous preoperative planning. However, owing to the insensitivity of CT for identifying cartilage damage and subtle injury to cancellous bone, the place of CT as a standalone modality in the initial diagnosis of osteochondral lesions has been questioned 10 11…”

Diagnostic imaging modalities for osteochondral defects of the talus

“…This is useful when a patient has chronic OCD and pain after recent trauma, as one can determine if the OCD is active. In two patients the MRI showed minimal subchondral edema, but the SPECT-CT showed a significant activity over the subchondral surface, which can implicate an early onset of the OCD [18].…”