Thesis

97 SPECT/CT in post-operative hand and wrist pain Introduction Hand and wrist surgery is performed mainly in traumatic, degenerative, malformed, neoplastic or inflammatory/infectious diseases and various open or minimal invasive operative procedures like osteosynthesis, joint replacement, resection, arthrodesis, osteotomy, arthroscopy and others are performed regularly. In trauma all wrist and finger bones can be affected while distal radius fracture in elderly osteoporotic patients and scaphoid fracture in younger patients are common conditions. After conservative or osteosynthesis of fractures persistent pain can be caused by nonunion, malposition, secondary osteoarthritis (OA), infection and many other disorders, requiring adequate imaging. If bone pathology or position of bones and surgically placed foreign material has to be evaluated in the acute or postoperative setting, conventional X-rays serve as first line imaging modality. In patients with inconclusive radiographs, CT enables superposition-free cross-sectional visualization of bony structures. In patients with metallic hardware the use of metal artifact suppression techniques can increase its diagnostic value. CT arthrography further enables the evaluation of cartilage and ligaments [1]. Bone scintigraphy with planar images alone might be sufficient for the diagnosis of several diseases like postoperative CRPS but often fails to provide exact correlation between increased bonemetabolismand correspondingmorphologic bone alterations. The combination of SPECT and diagnostic CT as one-step imaging SPECT/CT approach opens new fields for the evaluation of patients with postoperative wrist pain [2, 3]. Evidence and published literature regarding SPECT/CT in the field of postoperative wrist and hand are still very limited. This review paper focuses on several postoperative situations where SPECT/CT might play an important role as an advanced imaging method. Furthermore, we provide herein several cases where SPECT/CT images are correlated with the findings on imaging modalities such as radiographs and MR, to highlight the considerable clinical potential of this new hybrid imaging technology. SPECT/CT in Post-Operative Hand and Wrist Pain Wrist Bone-SPECT/CT acquisition protocol According to guidelines and the literature the following SPECT/CT imaging protocol is recommended for postoperative wrist cases: The administered activity usually ranges between 8-10 MBq/kg of Tc99m bisphosphonates for adults [4]. Blood pool planar images are performed 5 min. after injection (matrix 256x256 pixels, LEHR collimator, 5 min/500 kcts per view). In our experience perfusion images are helpful covering the whole forearm and hand, especially in cases where CRPS is suspected but can be omitted in many other situations. Late phase planar images 3h-4h after injection 4

RkJQdWJsaXNoZXIy MjY0ODMw