Thesis

133 Review of the role of bone-SPECT/CT in tarsal coalitions Bone-SPECT/CT will typically show normal bone turnover at the complete osseous CNC (Figure 10 panel A lower images, green circle); however, with increased bone turnover (Figure 10 panel A; blue arrow) and slightly reactive blood pool (Figure 10 panel A; red arrow, upper image) in the navicular bone and the articulation of the navicular with the intermediate and the lateral cuneiform bone. This is consistent with secondary degeneration (with slightly reactive inflammation) at these two joints adjacent to the CNC in flat foot deformity in the right foot. Figure 10. Same patient as Figure 9 with bilateral calcaneonavicular. (a) Bone-SPECT/CT with normal bone turnover at the complete osseous calcaneonavicular (lower images, green circle, concerning the same patient as from plain radiographs and MRI (Fig. 9) with bilateral complete osseous calcaneonavicular, right foot is shown). Also note increased bone turnover (blue arrow) and slightly elevated blood pool (red arrow, upper image) in the navicular bone and the articulation of the navicular with the intermediate and the lateral cuneiform bone. This is consistent with secondary degeneration (with slightly reactive inflammation) at these two joints adjacent to the calcaneonavicular in flat foot deformity in the right foot. (b) Some increased blood pool on bone-SPECT/ CT is a sign of (reactive) inflammation (red arrow, upper image). This panel also shows increased bone turnover (blue arrow) in the navicular bone and the articulation of the navicular with lateral cuneiform consistent with degeneration. Next to increased bone turnover, also some increased blood pool may occur on bone-SPECT/CT as a sign of (reactive) inflammation (Figure 10 panel B: red arrow, upper image). Figure 10 panel B also shows increased bone-turnover (blue arrow) in the navicular bone and the articulation of the navicular with lateral cuneiform consistent with degeneration. Therefore, bone-SPECT/CT might reveal a combination of complete osseous CNC and adjacent osteoarthritis, with the consequence for management of conservative approach for both findings. To conclude, bone-SPECT/ CT is often used to pinpoint the causative adjacent structure (often a joint) of pain next to a complete osseous CNC. 5

RkJQdWJsaXNoZXIy MjY0ODMw