Thesis

112 Part I Chapter 4 With SPECT/CT carpal boss can be evaluated regarding anatomy and metabolic activity [38]. In case of persisting pain after resection or arthrodesis SPECT/CT can be used to identify probable causes: recurrent bony protuberance, OA or infection might be complications after carpal boss surgery. Complex regional pain syndrome The complex regional pain syndrome (CRPS) is a challenging condition with pain, swelling and regional vasomotor instability that can have a serious impact on the patient`s quality of life and is associated with a significant socioeconomic impact [39]. CRPS type I, the more common type without a nerve lesion, has a reported incidence of 1-37% after distal radius fracture [40]. The pathophysiology of CRPS has not yet been elucidated and its treatment remains empirical and symptom oriented [41]. Early diagnosis and treatment is important andmight improve outcome. Roh, et al. reported that female gender, high energy trauma and severe fracture type were significant risk factors for CRPS after wrist surgery for distal radius fractures [40]. The typical pattern of CRPS I is an increased uptake in the soft tissues of the forearm and hand in the perfusion and blood pool phases and increased uptake in the carpal joints and finger joints in the late phase [42, 43]. For CRPS I high sensitivity (94-96%) and specificity (86100%) is reported in the literature [44, 45]. For stage II – III CRPS scintigraphic activity and consequently diagnostic accuracy decreases. The additional value of SPECT/CT for the diagnosis of CRPS has not been evaluated yet. From our clinical experience, SPECT/CT is not necessary if the typical CRPS pattern can be observed on planar images. It might be even more challenging to diagnose CRPS on a limited field of view SPECT/CT of the wrist compared with planar images covering the whole forearm and hand. To obviate this pitfall, we recommend to display MIP images or fused volume rendered SPECT/CT images of the whole hand in patients where CRPS is suspected. SPECT/CT might add important information in the detection of other findings of postoperativewrist patients. Imaging of infection following wrist surgery Infection rates after wrist surgery range between 2-34% and depends on the complexity of the procedure and patient related factors [46, 47]. For decades planar bone, white blood cell and antigranulocyte scintigraphy have been used to image musculoskeletal infections, including wrist and hand infection. Planar imaging is limited, especially when it comes to the exact differentiation of soft tissue and bone infection. The supplemental use of SPECT/CT has improved the localization of musculoskeletal infections and increased the accuracy to > 80% [48]. The added value of SPECT/CT compared with SPECT and planar images alone inmusculoskeletal infections has been demonstrated in several studies with various tracers and summarized in review articles, but no specific data regarding the wrist/hand is

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