SPECT/CT bei degenerativen und entzündlichen Erkrankungen sowie Überlastungen des Skelettes

Zusammenfassung

Die SPECT/CT-Untersuchung des Skelettes bereichert die nuklearmedizinische Knochendiag­nostik. Hierzu tragen die CT-basierte Photonenschwächungskorrektur der SPECT-Bilder, hohe Spezifität der Diagnose sowie CT-basierte akkurate Befundlokalisation am Knochen bzw. am Knochen umgebenden Weichteilgewebe bei. Durch diese Vorteile wird aus einem hochsensitiven, aber unspezifischen skelettszintigrafischen Befund ein hoch sensitiver und hoch spezifischer 2-in-1-SPECT/CT-Befund eines Knochenabschnittes, eines Skelettteilkörperabschnittes bzw. eines Skelett-Ganzkörper-SPECT/CT in analoger Weise wie bei der PET/CT und PET/MRT. Keine Frage, dass auch SPECT/MRT des Skelettes in absehbarer Zeit Eingang in die klinische Diag­nostik finden wird. Die SPECT/CT ergänzt die bildgebende Diagnostik angefangen bei häufigen Erkrankungen wie Rückenschmerzen über komplexe Krankheitsbilder wie das diabetische Fußsyndrom bis hin zu SPECT/CT-navigierten interventionellen Eingriffen am Skelett und Operations- bzw. Therapieplanungen. Die Bandbreite der SPECT/CT und die intensivierte kooperative Befundung seitens Nuklearmedizin und Radiologie erfreuen sich wachsender klinischer Wertschätzung z. B. in der Rheumatologie, Orthopädie, (Sport)Traumatologie und Onkologie und stellt eine willkommene Ergänzung bewährter Verfahren wie konventioneller Röntgenuntersuchung und MRT des Skelettes dar.

Abstract

SPECT/CT examination of the skeleton expands nuclear medicine bone diagnostics. Contributing benefits are CT-based photon attenuation correction of SPECT images, high specificity of diagnosis, as well as CT-based accurate localization of findings within the bone or the bone surrounding soft tissue respectively. By these advantages, a highly sensitive but unspecific focal finding in planar skeletal scintigraphy is converted into a highly sensitive and specific 2 in 1 SPECT/CT finding of an affected bone segment, skeletal trunk of the body or skeletal whole body SPECT/CT in the same way as with PET/CT and PET/MRI. No question that also SPECT/MRI of a skeleton will be in the clinical diagnostics in the near future. SPECT/CT broadens the scope of diagnostic imaging ranging from common conditions such as back pain to more complex conditions such as the diabetic foot syndrome and SPECT/CT navigation of interventions at the skeleton and, surgery and overall therapy planning. The extended range of SPECT/CT examinations and the intensified cooperative diagnostics by nuclear medicine physicians and radiologists enjoy growing clinical appreciation for example in rheumatology, orthopedics, (sports)traumatology and oncology, and therefore represents a welcome addition to conventional X-ray and MRI imaging of the ­skeleton.

Schlüsselwörter

Skelettszintigramm - SPECT/CT - degenerative ­Skeletterkrankung - entzündliche ­Skeletterkrankung - Skelettüberlastung

Key words

bone scan - SPECT/CT - degenerative bone disease - inflammatory bone disease - skeletal overstress

• Literatur

• 1 Beck M, Mittelmeier T. Metatarsale Frakturen. Der Unfallchirurg 2008; 111: 829-840
• 2 Bruni C, Padovano F, Travascio L et al. Usefulness of hybrid SPECT/CT for the 99mTc-HMPAO-labeled leucocyte scintigraphy in a case of cranial osteomyelitis. Braz J Infect Dis 2008; 12: 558-560
• 3 Carstensen M, Al-Harbi M, Urbaine JL et al. SPECT/CT imaging of the lumbar spine in chronic low back pain: a case report. Chiropractic & Manual Therapies 2011; 19: 2
• 4 Chou R, Qaseem A, Snow V et al. For the Clinical Effi­cacy Assessment Subcommittee of the American College of Physicians and the American College of Physicians/American Pain Society Low Back Pain Guidelines Panel* . Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007; 147: 478-491
• 5 Cooper R, Allwright S, Anderson J. Atlas of Nuclear Imaging in Sports Medicine. Mc Graw Hill 2003; (3) The ankle, foot and heel: 15-114
• 6 Damgaard M, Nimb L, Madsen JL. The role of bone SPECT/CT in the evaluation of lumbar spinal fusion with metallic fixation devices. Clin Nucl Med 2010; 35: 234-236
• 7 Deyo RA, Nachemson A, Mirza SK. Spinal-fusion surgery – the case for restraint. N Engl J Med 2004; 350: 722-726
• 8 Eidgenössische Kommission für Strahlenschutz und Überwachung der Radioaktivität. Stellungnahme der KSR zur SPECT-CT (Kombination nuklearmedizinischer Untersuchungsmodalitäten und der Computertomographie). www.bag.admin.ch/ksr-cpr/04309/04310/
• 9 Graute V, Feist M, Lehner S et al. Detection of low-grade prosthetic joint infections using 99mTc-antigranulocyte SPECT/CT: initial clinical results. Eur J Nucl med Mol Imaging. 2010. 37. 1751-1759
• 10 Heiba SI, Kolker D, Mocherla B et al. The optimized evaluation of diabetic foot infection by dual isotope SPECT/CT imaging protocol. J Foot Ankle Surg 2010; 49: 529-536
• 11 Horger M, Bares R. The role of single-photon emis­sion computed tomography/computed tomography in benign and malignant bone disease. Sem Nucl Med 2006; 36: 286-294
• 12 Horger M, Eschmann SM, Pfannenberg C et al. Added value of SPECT/CT in patients suspected of having bone infection: preliminary results. Arch Orthop Trauma Surg 2007; 127: 211-221
• 13 Huellner M, Bürkert A, Schleich F et al. SPECT/CT versus MRI in patients with nonspecific pain of the hand and wrist – a pilot study. Eur J Nucl Med Mol Imaging 2012; 39: 750-759
• 14 Kretzschmar M, Wiewiorski M, Rasch H et al. 99mTc-DPD-SPECT/CT predicts the outcome of imaging-guided diagnostic anaesthetic injections: a prospective study. Eur J Radiol 2011; 80 (03) e410-e415
• 15 Leumann A, Valderrabano V, Plaass C et al. A novel imaging method for osteochondral lesions of the talus – comparison of SPECT/CT with MRI. Am J Sports Med 2011; 39: 1095-1101
• 16 Rager O, Schaller K, Payer M et al. SPECT/CT in the differentiation of pseudarthrosis from other causes of back pain in lumbar spinal fusion: report of 10 consecutive cases. Clin Nucl Med 2012; 37: 339-343
• 17 Roub LW, Gumerman LK, Hanley EN et al. Bone stress: a radionuclide imaging perspective. Radiology 1979; 132: 431-438
• 18 Sarikaya I, Sarikaya A, Holder LE. The role of single emission computer tomography in bone imaging. Semin Nucl Med 2001; 31: 3-16
• 19 Sheehan NJ. Magnetic resonance imaging for low back pain: indications and limitations. Ann Rheum Dis 2010; 69: 7-11
• 20 Sola M, Perez R, Cuadras P et al. Value of bone SPECT-CT to predict chronic pain relief after percutaneous vertebroplasty in vertebral fractures. The Spine Journal 2011; 11: 1102-1107
• 21 Windhager R. Increase of muskuloskeletal pain in Austria – what are we waiting for?. Wien Klin Wochenschrift 2006; 118: 67-68