SPECT-CT – Chancen in der Gelenkdiagnostik und ­Beurteilung von Patienten nach Endoprothetik

Zusammenfassung

Die Einführung der SPECT-CT hat die orthopädische Bildgebung wesentlich erweitert. Die Auflösung moderner Hybridgeräte erlaubt die Untersuchung aller Gelenkregionen bis zu kleinen Fuß- und Handgelenken. Bei bestehenden Kontraindikationen für eine MRT stellt die SPECT-CT in vielen Fällen eine gleichwertige Alternative zur Bildgebung dar. In der Abklärung nach Endoprothetik ist sie aufgrund der Metallartefaktproblematik dem MRT überlegen. Die Kombination von metabolischen, strukturellen und biomechanischen 3D-Informationen in einer Untersuchung verbessert die Einordnung szintigrafischer Befunde entscheidend und erhöht damit signifikant die Diagnosesicherheit, verbunden mit einem verbesserten Therapiemanagement. Abschließend bleibt anzumerken, dass diese multimodale Bildgebung viel fachübergreifendes Wissen vom Nuklearmediziner verlangt, welches aus eigener Erfahrung nur im Rahmen einer engen interdisziplinären Zusammenarbeit mit dem zuweisenden Kliniker erreicht werden kann.

Abstract

In the last few years SPECT-CT has expanded the application of bone scanning in orthopedic ­imaging. The high resolution of modern Hybrid scanners facilitates imaging of every joint inclusively small joints in foot and ankle. In case of contraindications for MRI and the presence of metall artefacts SPECT CT mostly provides an equivalent or superior imaging procedure. The combination of metabolism, morphology and 3D biomechanics in one examination improves ­diagnostic accuracy and thereby therapeutic decision and managment. The multimodality approach is challenging and needs close collabaration between nuclear physican and orthopedic specialist.

Schlüsselwörter

SPECT-CT - Endoprothetik - Prothesenposition - Knochenszintigrafie - Prothesenlockerung - Infekt

Key words

SPECT-CT - arthroplasty - prosthesis alignment - bone scan - prosthesis loosening - infection

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