Ramin Mandegaran MBBS, Presenter: Nothing to Disclose

Kanhaiyalal Agrawal MBBS, MD, Abstract Co-Author: Nothing to Disclose

Amidevi Desai MRCP, FRCR, Abstract Co-Author: Nothing to Disclose

Mohan Hosahalli FRCR, Abstract Co-Author: Nothing to Disclose

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

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

Hip arthroplasties are commonly performed orthopaedic procedures. Assessment of definitive cause for the pain post-arthroplasty with existing modalities is challenging. The spectrum of post-arthroplasty complications include infection, aseptic loosening, heterotopic ossification, periprosthetic fractures etc. Existing radiological and radionuclide scintigraphic techniques are often used together as complementary modalities to improve the diagnostic accuracy. Radionuclide bone scans (two or three phases) are often used to confirm or exclude post-arthroplasty complications such as loosening and infection. However, planar bone scans lack anatomical detail and specificity. In addition, in patients with bone scan findings favoring infection, further investigation with radiolabelled white cell and/or marrow scan is mandatory to confirm infection. Currently SPECT/CT is widely used in the assessment of musculoskeletal pathologies. The aim of our study is to assess the incremental value of SPECT/CT over two-phase planar bone scan in the evaluation of painful hip prostheses. 

Retrospective data of 42 patients from June 2006 to November 2013 with painful prostheses were evaluated. All patients underwent 99mTc-MDP two-phase bone scan followed by SPECT/CT. The two-phase bone scan and SPECT/CT were reviewed independently by two Nuclear Medicine Physicians and a Musculoskeletal Radiologist.

In comparision to conventional two-phase bone scan, SPECT/CT (a) provided incremental information in 11/42 (26%) patients (b) alternative diagnosis apart from loosening or infection in 8/42 (19%) patients. The alternative diagnoses included heterotopic ossification, stress remodeling, superior sublaxation of the prosthesis and enthesopathy. In the remaining 23/42 (55%) patients, SPECT/CT was useful to confirm the two-phase bone scan diagnosis.

99mTc-MDP Bone SPECT/CT provides incremental information over two-phase planar bone scan in identifying pain generators post-hip arthroplasty. 99mTc-MDP Bone SPECT/CT increases the diagnostic confidence to make a reliable diagnosis and direct further management.

99mTc-MDP Bone SPECT/CT provides incremental information and improved diagnostic confidence over conventional two-phase planar bone scan in identifying the aetiology of pain post-hip arthroplasty. 

Mandegaran, R, Agrawal, K, Desai, A, Hosahalli, M, Vijayanathan, S, Gnanasegaran, G, 99mTc-MDP Bone SPECT/CT over Conventional Two-phase Planar Bone Scan in Assessment of Patients with Pain Post-hip Arthroplasty.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14003069.html