Thesis

14 Chapter 1 Subsequently, simultaneously acquired CT increases the accuracy (both sensitivity and specificity) by a combination of improved attenuation correction, enhanced localization of the radiopharmaceutical and in longer-existing pathology, the CT may reveal pathological structural changes. Similarly, Positron Emission Tomography (PET) also benefits from integrated CT (PET/CT). With improved accuracy of SPECT/CT and PET/CT over previous techniques, clinical impact has substantially increased since the early 2000s and therefore, both have experienced substantial growth in requests by clinicians and especially PET/CT has gainedmore central positions within clinical guidelines ever since. The clinical role of SPECT/CT after total knee arthroplasty is still under debate and evidence is currently scarce. As the existing evidence remains limited, this thesis does not pretend to offer a definite evidence-based imaging solution for all patients with a painful knee arthroplasty. Instead, it aspires to offer a step towards more standardized imaging for optimal results by clarifying the current evidence and limitations. Currently, inmost hospitals the imaging strategy in patients with a painful postoperative knee is often based on local preferences and individual experience of the treating physician. An evidence-based, protocolled and patient-tailored imaging strategy for advanced imaging after plain radiographs in patients with unexplained pain after knee arthroplasty would be the ultimate goal for the future to further improve patient’s quality of life after knee arthroplasty. A wide range of operative wrist and hand interventions are performed in congenital, traumatic, degenerative, or inflammatory diseases. For patients with post-operative hand and wrist pain, structured scientific literature is in general evenmore limited and is nearly nonexistent in the post-operative situation. This patient category would also benefit from an evidence-based imaging strategy to replace local choices defining various treatment and clinical outcome. Several imaging modalities are being used to evaluate the reason for painful postoperative wrists, such as standard conventional plain radiographs, ultrasound, CT, MRI, or bone scintigraphy. Conventional plain radiographs are a first-line imaging modality in patients with pain after surgery of the hand or wrist and may establish a diagnosis, such as nonunion or malposition. In patients with soft tissue disorders, ultrasound can conclusively evaluate tendon abnormalities, ganglion cysts, or superficial tumors. MRI delivers second-line imaging inmore complex soft tissue abnormalities. Standalone-CT visualizes the integrity and position of bones and metallic implants by avoiding superposition and adding crosssectional visualization. Still, patients may experience pain which is unexplained by the aforementioned modalities. The possible additional value of bone scintigraphy including SPECT/CT in these patients is explored and reviewed in this thesis.

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