Abstract
Introduction
The advantage of using SPECT-CT over conventional bone scanning is that it has the promise of linking the multiplanar reconstructional images of CT with the functional analysis of bone scintigraphy. It delivers information regarding new pathology and is regarded as more sensitive and specific. We present our experience of use of the SPECT-CT in the analysis of continued or recurrent pain post-foot and ankle arthrodesis.
Methods and Materials
A retrospective analysis of all post-arthrodesis patients with continued pain who underwent SPECT-CT was carried out. The scans and notes from clinical examination were evaluated. The request for the scan was at the clinician's discretion and was reserved for presentations where the diagnosis was unclear on clinical and radiological grounds.
Results
A total of 30 patients matched our inclusion criteria. The scan proved helpful in 27/30 (90%) cases in determining the cause of continued pain. Non-union with increased uptake at the site of the fusion was identified in 8 cases. All the other cases showed successful arthrodesis. Other abnormalities identified were metalwork impingement (13%), adjacent joint degeneration (40%) and pathology distinct from the arthrodesis site such as a stress fracture (10%).
Discussion
Determining the exact cause of continued pain in patients with previous foot and ankle surgery can be difficult. Conventional methods include injection studies along with CT, MRI and bone scanning. SPECT-CT has the potential advantage of combining multiplanar CT to identify the anatomy with bone scintigraphy to identify areas of active inflammation or degenerate changes. In our group of patients we have found this modality to be useful in the majority of presentations in determining the site of pain.
Conclusion
SPECT-CT is a useful adjunct to clinical and plain radiological assessment in the management of patients presenting with continued pain post-arthrodesis procedure in the foot and ankle.
