James Patrick Connelly MBBS, Presenter: Nothing to Disclose

Suat Jin Lu FRCR, Abstract Co-Author: Nothing to Disclose

Fahim-Ul Hassan, Abstract Co-Author: Nothing to Disclose

Sanjay Vijayanathan MBBS, Abstract Co-Author: Nothing to Disclose

Gopinath Gnanasegaran MD, Abstract Co-Author: Nothing to Disclose

Bone Scan (BS) has limited specificity owing to the non-specific nature of tracer uptake. SPECT offers better contrast resolution, lesion localization and characterization but  with limited spatial resolution improved by CT.  This study aims to address this issue of how much incremental value SPECT/CT adds by directly comparing BS and SPECT/CT in the detection, localization and characterization of wrist and hand lesions

Fifty-three patients (28 men and 25 women; median age, 42 years; range, 21 to 78 years) who presented with pain in the wrist (n = 41) or hand (n = 12), and had undergone BS and SPECT/CT (16-slice CT system) of the wrist/hand in the same sitting were included in this retrospective study. Lesions detected by BS or SPECT/CT in the clinically symptomatic regions were analyzed and the patients were followed up for at least one year. BS and SPECT/CT studies were separately and independently assessed. Imaging findings of BS and SPECT/CT were directly compared based on detection; localization and characterization of lesions. Statistical significance was determined using the McNemar test. Statistical significance of the differences in performance between different regions of the wrist and hand was determined using Fisher’s exact test (using P < 0.05 for statistical significance).  

BS and SPECT/CT of the wrists and hands were abnormal in 53 patients with 84 lesions detected of which 66 lesions were in the wrists and 18 lesions were in the hands. Lesion detection: BS detected 63/84 (75%) and SPECT/CT 84/84 (100%) lesions [SPECT/CT detected 21 more lesions than BS (25%, P < 0.0001)] Lesion Localization: BS accurately localized 32/63 (51%) and SPECT/CT 63/63 (100%) lesions SPECT/CT localized 31 more lesions than BS (49%, P < 0.0001)] Lesion characterization: BS accurately characterized 21/63 (33.3%) and SPECT/CT 61/63 (97%) lesions. [SPECT/CT characterized 40 more lesions than BS (63%, P < 0.0001)]. Follow-up in these patients revealed change in the management in 47 patients (88%) following SPECT/CT.  

SPECT/CT provides important and significant value over BS with improvement of detection, localization and characterization of wrist lesions and hence improvement in sensitivity and specificity

SPECT/CT provides improvement of detection, localization and characterization of wrist lesions over BS and can influence management decisions

Connelly, J, Lu, S, Hassan, F, Vijayanathan, S, Gnanasegaran, G, 99mTc-MDP Two-Phase Bone Scan vs SPECT/CT in Evaluation of Patients with Wrist/Hand Pain.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12035850.html