Martin W Huellner MD, Presenter: Research grant, Siemens AG Research grant, Bayer AG

Florian Schleich, Abstract Co-Author: Nothing to Disclose

Alexander Bürkert, Abstract Co-Author: Nothing to Disclose

Urs Hug, Abstract Co-Author: Nothing to Disclose

Klaus Strobel MD, Abstract Co-Author: Nothing to Disclose

Patrick Veit-Haibach MD, Abstract Co-Author: Research grant, Bayer AG

To compare the diagnostic and therapeutic impact of SPECT/CT vs. MRI in patients with unspecific pain of the hand and wrist.

21 patients (mean age: 36 (18-73) years; 17 female, 4 male) with unspecific pain of the hand/wrist were retrospectively evaluated. All patients were referred for SPECT/CT and MRI after conventional clinical and imaging work-up. All received planar, early-phase imaging and late-phase SPECT/CT imaging as well as MRI imaging. Region-based evaluation of SPECT/CT and MRI was performed by a board certified nuclear medicine physician and radiologist. Pathologies were divided into clinically / therapeutically relevant and irrelevant lesions based on the clinical follow-up and in consensus with the referring hand surgeon.

X-ray showed pathologic lesions in 9 regions (6 pat.). MRI detected pathologies in 34 regions (19 pat.), SPECT/CT detected pathologies in 27 regions (15 pat.). Localisation of pathological lesions for MRI / SPECT/CT were: radioulnocarpal 21/12, midcarpal 6/8, carpometacarpal 4/4, metacarpophalangeal 1/1, disseminate 2/2 lesions. MRI detected significantly more lesions than SPECT/CT (p<0.05) in the radioulnocarpal compartment. Osseous edema in MRI was present in 11/21 patients, elevated tracer uptake in SPECT/CT was found in 9/11 patients in the same location. SPECT/CT yielded a higher specificity (100% vs. 20%), but lower sensitivity (71% vs. 86%) than MRI concerning the evaluation of clinically/therapeutically relevant pathologies.

While MRI detects significantly more lesions, SPECT/CT showed superiority in detecting clinically / therapeutically relevant lesions. Osseous edema shows good correlation with tracer accumulation on SPECT/CT. Overall, SPECT/CT might be a valuable tool in the diagnostic work-up when MRI failed to detect the clinically / therapeutically relevant lesion in this selective patient population.

SPECT/CT might be a valuable tool in the diagnostic work-up when MRI failed to detect the clinically / therapeutically relevant lesion in this selective patient population.

Huellner, M, Schleich, F, Bürkert, A, Hug, U, Strobel, K, Veit-Haibach, P, Diagnostic and Therapeutic Impact of SPECT/CT vs MRI in Patients with Unspecific Pain of the Hand and Wrist.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11007551.html