Use of Hybrid SPECT/CT for Diagnosis of Radiographic Occult Fractures of the Wrist

Abstract

Wrist and hand traumas represent most traumatic lesions. Any delay in treatment involves complications compromising the functional prognosis. We report typical examples illustrating the incremental diagnosis value of hybrid SPECT/CT compared with planar scintigraphy with semiquantitative analysis in the diagnosis of radiographic occult fractures of the wrist. Hybrid imaging diagnoses much more of scaphoid lesions because bone disruptions cannot always be shown on CT, as well as carpal-associated lesions and differentiates chronic arthritis or ligament lesions. This noninvasive approach could lead to improved therapeutic strategies with a beneficial impact on prognosis.

The use of single photon emission computed tomography/computed tomography to differentiate between pain arising from trapeziometacarpal joint and scaphotrapeziotrapezoid joint osteoarthritis

“…They stated that SPECT/CT detects more lesions than conventional imaging. Allainmat et al (2013) used SPECT/CT in patients with post-traumatic wrist pain. They stated that hybrid imaging diagnoses more lesions because bone disruptions and ligamentous injuries of the carpus cannot always be shown on a CT scan.…”

Clinical applications of SPECT/CT in imaging the extremities

“…SPECT/CT is valuable for the assessment of patients with painful conditions of the wrist [8][9][10][11][12], providing good sensitivity and specificity. Its main strengths are detecting pathologies not shown by other imaging modalities, such as posttraumatic bone remodelling and occult fractures, and precise localization of hot spots found on bone scan.…”

“…With anatomical information from coregistered SPECT/CT images, ulnocarpal impaction, ulnar styloid impingement and Kienböck's disease can be distinguished easily. Allainmat et al reported improved diagnosis of occult fractures of the wrist using SPECT/CT as compared to CT alone [11]. At the metacarpal interface, occult fracture and carpal boss ( Fig.…”

Radiographically Occult and Subtle Fractures: A Pictorial Review

“…Regarding Fluorine-18 2-deoxy-D-glucose (FDG) positron emission tomography (PET), it is critical to be aware that occult fractures may be responsible of marked metabolic uptake, and, thus, represent a potential false positive of metastatic disease [28]. Integrated hybrid single-photon emission computerized tomography (SPECT)/CT combines the detection of abnormal bone metabolism with SPECT, to the precise anatomical detail provided by high resolution CT. For instance, SPECT/CT may be interesting in the detection of radiographic occult fractures of the wrist [29] and other sport-related injuries [30]. …”