scholarly journals Influence on Therapeutic Decision Making of SPECT-CT for Different Regions of the Foot and Ankle

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Leif Claassen ◽  
Theodor Uden ◽  
Max Ettinger ◽  
Kiriakos Daniilidis ◽  
Christina Stukenborg-Colsman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pain Relief ◽  
Photon Emission ◽  
Treatment Decision ◽  
Emission Computed Tomography ◽  
Foot And Ankle ◽  
Predictive Values ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Background. Single-photon emission computed tomography and computed tomography (SPECT-CT) has a high impact on diagnosis and treatment decision of different joints. The aim of this study was to evaluate whether there is a different gain of SPECT-CT for different foot regions.Material and Methods. We retrospectively identified 86 patients who received a SPECT-CT of the foot and ankle between April 2011 and December 2012. We divided all patients into the following subgroups: ankle (group 1), subtalar (group 2), Chopart (group 3), and Lisfranc (group 4). The local ethical committee approved the study.Results. The clinical treatment decision was changed based on SPECT-CT results in 64.5% of group 1, 65.2% of group 2, and 75% each of groups 3 and 4. Eighty patients (93%) had pain relief after treatment based on SPECT-CT. The overall SPECT-CT sensitivity was 0.94 and the specificity was 0.57. The positive and negative predictive values were 0.87 and 0.75, respectively.Conclusion. The impact of SPECT-CT on treatment decision is slightly higher in diseases of the Chopart and Lisfranc joints than in the upper ankle and subtalar joints. The additional information has a clinical relevance due to the high rate of pain relief by treatment based on SPECT-CT diagnosis.

scholarly journals First results of balloon dacryoplasty in dacryostenosis

2015 ◽  
Vol 8 (2) ◽  
pp. 35-40 ◽  
Author(s):  
Evgeniya L’vovna At’kova ◽  
Vasiliy Dmitrievich Yartsev ◽  
Nikolay Nikolaevich Krakhovetskiy ◽  
Anna Olegovna Root ◽  
Lyudmila Vladimirovna Reznikova
Keyword(s):  
Computed Tomography ◽  
Single Photon ◽  
Single Case ◽  
Photon Emission ◽  
Functional Results ◽  
Positive Outcome ◽  
Nasolacrimal Duct ◽  
Emission Computed Tomography ◽  
Group 2 ◽  
Group 1

Background. Outpatient care is not widely spread in modern dacryology. At the same time, its necessity increases. There are no evidences of balloon dacryoplasty (BDP) application in Russian periodical literature. Material and methods. 50 surgical procedures in 30 patients with partial nasolacrimal duct obliteration were performed, among them 30 BDP without lacrimal pathways intubation (group 1) and 20 with bicanalicular Ritleng intubation of lacrimal pathways (group 2). Lacrimal scintigraphy, single photon emission computed tomography, combined with X-ray computed tomography, subjective tearing estimation in points, and health depending quality of life evaluation wre performed in all cases. Same tests were repeated in 3 months after surgery. Results. A positive outcome rate was 90 % in both groups. There were no complications in group 1. A single case of stent dislocation was recorded in group 2. Conclusion. BDP is an effective procedure in dacryostenosis of the lacrimal pathways vertical part obliteration. This procedure helps to avoid complications associated with long stent retention. It is possible to get good functional results even at short term after BDP surgery, and there is a possibility for this procedure to be carried out in an outpatient setting.

scholarly journals Neurologic Deterioration in Patients With Moyamoya Disease During Pregnancy, Delivery, and Puerperium

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Wonhyoung Park ◽  
Minwoo Kim ◽  
Jae Sung Ahn
Keyword(s):  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Single Photon Emission ◽  
Cerebrovascular Reserve ◽  
Neurologic Deterioration ◽  
Single Photon Emission Computed ◽  
Group 2 ◽  
Photon Emission Computed Tomography ◽  
Group 1

Abstract INTRODUCTION We reviewed our clinical experience of patients with moyamoya disease (MMD) who gave birth and assessed characteristics of those experiencing neurologic deterioration. METHODS The patients were classified into patients diagnosed with MMD during pregnancy and puerperium (group 1) and those diagnosed before pregnancy (group 2). We retrospectively reviewed patient characteristics, MMD treatment, neurologic symptoms before and during pregnancy and/after puerperium, obstetrical history, and delivery type in groups 1 and 2. RESULTS Group 1 included 2 patients with a deterioration of preexisting transient ischemic attacks (TIAs) and acute cerebral infarction and 1 patient with seizures and newly developed TIAs during pregnancy and/or puerperium. Group 2 included 20 patients with 23 pregnancies. In group 2, 4 patients had deterioration of TIAs during pregnancy and puerperium. There were significant differences between the cases without neurologic deterioration and with deterioration in group 2 (TIAs ! 10 before pregnancy, 0% vs 75%, P = .002; severely reduced regional cerebrovascular reserve on single-photon emission computed tomography, 10.5% vs 100%, P = .002; and surgical revascularization before pregnancy, 75% vs 15.8%, P = .04). In groups 1 and 2, 6 of the 7 cases in which TIAs occurred or worsened during pregnancy or puerperium recovered to prepregnancy TIA levels after puerperium. CONCLUSION Patients with severely reduced regional cerebrovascular reserve on single-photon emission computed tomography and frequent TIAs before pregnancy may experience neurologic deterioration during pregnancy, delivery, and puerperium. Surgical revascularization before pregnancy may decrease neurologic deterioration during these periods.

Relevance of SPECT-CT in Complex Cases of Foot and Ankle Surgery: A Comparison With MRI

2019 ◽  
Vol 13 (6) ◽  
pp. 451-462 ◽  
Author(s):  
Leif Claassen ◽  
Daiwei Yao ◽  
Sarah Ettinger ◽  
Matthias Lerch ◽  
Kiriakos Daniilidis ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Retrospective Study ◽  
Osteochondral Lesion ◽  
Treatment Decision ◽  
Emission Computed Tomography ◽  
Foot And Ankle ◽  
Intrarater Reliability ◽  
Final Treatment ◽  
Adjacent Structures ◽  
Ankle Surgery

Background. Finding the right diagnoses in patients with complex foot and ankle disorders can be challenging. Single-photon emission computed tomography and computed tomography (SPECT-CT) has shown to be feasible in foot and ankle surgery. The aim of this study was to evaluate the reliability and accuracy of SPECT-CT and thereby its impact on final treatment decision compared with magnetic resonance imaging (MRI). Methods. A retrospective study was performed on 49 patients treated at our institution. Experienced foot and ankle surgeons independently, and blinded, analyzed clinical data and radiographs together with MRI, SPECT-CT, or a combination of both. Based on the determined final treatment decision Cohen’s kappa values were calculated to illustrate interrater and intrarater reliability. Results. The kappa values for interrater reliability were higher for SPECT-CT at .68 and MRI + SPECT-CT at .71 compared to 0.38 for MRI alone (P < .05). The kappa values for intrarater reliability of MRI + SPECT-CT were higher at .75 compared with SPECT-CT alone at .67 (P < .05) and MRI at .35 (P < .01). Conclusion. We found a higher interrater and intrarater reliability for SPECT-CT compared with MRI alone for diagnosing complex foot and ankle pathologies. SPECT-CT has a high impact on final treatment decision. The main indications are bony pathologies with diagnostic uncertainty especially in closely adjacent structures as the joints of the midfoot, occult coalitio, stress fractures, verification or exclusion of nonfusion, periprosthetic disorders after total ankle replacement and osteochondral lesion in cases of combined pathologies. Levels of Evidence: Level IV: Retrospective study

scholarly journals Evaluation of the Diagnostic Value of SPECT/CT in Defining Foot and Ankle Pathologies

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0006
Author(s):  
Ippokratis Pountos ◽  
Christel Charpail ◽  
Nazzar Tellisi
Keyword(s):  
Computed Tomography ◽  
Single Photon ◽  
Photon Emission ◽  
Diagnostic Value ◽  
Emission Computed Tomography ◽  
Imaging Method ◽  
Foot And Ankle ◽  
Diagnostic Specificity ◽  
Ct Guided ◽  
Complex Anatomy

Category: Ankle Arthritis, Hindfoot, Midfoot/Forefoot Introduction/Purpose: The precise localisation of degenerative or inflammatory pathologies in foot and ankle can be difficult due to the complex anatomy of the joints. MRI plays a vital diagnostic role in these scenarios aiding the diagnosis and preoperative planning. Single-photon emission computed tomography combined with computed tomography (SPECT/CT) is a relatively new imaging technology that combines the sensitivity of nuclear medicine examinations with the anatomical detail of CT. The aim of this study is to analyse the diagnostic effectiveness of SPECT/CT in evaluating foot and ankle pathologies. Methods: The authors retrospectively reviewed the medical records of all patients with a foot and/or ankle -related complaint that received SPECT/CT. Exclusion criteria included patients with inadequate follow-up and those that were not initially assessed by a senior foot and ankle surgeon. Collected data included demographic information, results from imaging, clinical progress and outcomes. Results: 272 included in the study comprised of 156 females and 116 males with a mean age of 52,8 years (range 17-92 years). The acquisition of a SPECT/CT changed the initial diagnosis (from either clinical or radiographs or MRI) in 55% of the cases. SPECT/CT finding correlated with MRI only in 34% of the cases. From the remaining cases SPECT/CT partially correlated with MRI in 26% of cases no correlation was noted in 40%. In regards to patients that undergone a USS or CT guided injection following the finding of a SPECT/CT, 86% reported a transient or long-term improvement in the pain. Overall, the SPECT/CT added confidence to the clinical diagnosis in 89% of the cases while reduced the need of further investigations in 93%. Conclusion: SPECT/CT is a valuable tool in depicting foot and ankle pathologies. It was able to provide additional diagnostic value by demonstrating co-existing pathologies as a potential cause of pain. SPECT/CT and MRI exhibit different diagnostic specificity and the limitations of each scan should be taken into consideration. This study strongly supports the use of SPECT/CT as a complementary imaging method to MRI for enhancing diagnostic specificity and outcomes.

scholarly journals Difficulties of Diagnostics of Obstructive Coronary Artery Lesions in Patients with Stable Ischemic Heart Disease and Possibilities of Single-Photon Emission Computed Tomography

Kardiologiia ◽  
2019 ◽  
Vol 59 (1) ◽  
pp. 28-35
Author(s):  
A. N. Sumin ◽  
E. V. Korok ◽  
A. A. Korotkevitch ◽  
E. N. Kachurina ◽  
A. N. Kokov ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Single Photon ◽  
Photon Emission ◽  
Spect Imaging ◽  
Emission Computed Tomography ◽  
Single Photon Emission ◽  
Single Photon Emission Computed ◽  
Group 2 ◽  
Photon Emission Computed Tomography ◽  
Group 1

Purpose: to assess diagnostic capabilities of single-photon emission computed tomography (SPECT) in the detection of obstructive coronary artery (CA) lesions, depending on the meeting appropriate use criteria. Materials and Methods: We used in this retrospective analysis data from 107 patients with previously diagnosed ischemic heart disease (IHD) or in need to exclude it, who were hospitalized in inpatient departments of the Research Institute for Complex Issues of Cardiovascular Diseases in the period from 2012 to 2015. All patients underwent coronary angiography (CAG) and SPECT (the time interval between the studies did not exceed 3 months) for detection of hemodynamically significant CA stenoses. Patients were distributed into two groups according SPECT imaging appropriateness score: group 1–88 patients with score 7–9 (in whom SPECT imaging was appropriate), group 2–19 patients with score 1–6 (in whom SPECT imaging was uncertain, possibly appropriate, or inappropriate. Results. Clinical signs and symptoms of angina pectoris were predominantly found in group 1 patients (p=0.499). Asymptomatic patients were more likely to be found in group 2 (p<0.001). Group 1 patients commonly had high pretest probability (PTP) (over 90 %, p<0.001), whereas group 2 patients commonly had low PTP (5–10 %, p<0.001). Mean PTP was 77 and 58 % in groups 1 and 2, respectively (p=0.003). According to positive SPECT imaging, significant CA lesions were more often found in group 1 compared to group 2 (31.8 and 10.5 %, respectively, p=0.060). Two- and three-vessel disease prevailed in group 1 (25 % and 14.7 %) according the analysis of prevalence and location of hemodynamically significant CA lesions, although the data did not reach statistical significance (p=0.057 and p=0.073). Stenoses >70 % were more commonly detected in group 1, compared to group 2: in anterior descending artery 52.3 vs. 5.3 % (p<0.001), circumflex artery 35.2 vs. 10.5 %; (p=0.034), right coronary artery 34.1 vs. 10.5 % (p=0.041). The sensitivity in both groups was rather low (40 % vs. 25 %), whereas specificity was 83 % in group 1 and 93 % in group 2. Conclusion. According to clinical examination, patients with IHD and indications for SPECT imaging more often had obstructive CA lesions (63.6 %), than patients with questionable or no indications (21.1 %). However, rate of positive findings during stress tests with SPECT imaging was low in both groups and did not differ significantly (p=0.06). Despite high specificity of SPECT imaging, its sensitivity was low in both groups.

Efficacy of Neurolytic Celiac Plexus Block in Varying Locations of Pancreatic Cancer

2000 ◽  
Vol 92 (2) ◽  
pp. 347-347 ◽  
Author(s):  
Jan J. Rykowski ◽  
Maciej Hilgier
Keyword(s):  
Computed Tomography ◽  
Pancreatic Cancer ◽  
Pain Relief ◽  
Celiac Plexus ◽  
Celiac Plexus Block ◽  
Head Of The Pancreas ◽  
Group 2 ◽  
Effective Pain Relief ◽  
Plexus Block ◽  
Group 1

Background Neurolytic celiac plexus block (NCPB) is an effective way of treating severe pain in some patients with pancreatic malignancy. However, there are no studies to date that evaluate the effectiveness of NCPB related to the site of primary pancreas cancer. The aim of the study was to assess the effectiveness of NCPB in pancreatic cancer pain, depending on the location of the pancreatic tumor. Methods The prospective study was conducted in 50 consecutive patients diagnosed with pancreatic cancer. The patients were categorized into two different groups depending on tumor localization: group 1: patients with the cancer of the head of the pancreas and group 2: patients with the cancer of the body and tail of the pancreas. The qualitative and quantitative pain analyses were performed before and after NCPB. The patients underwent prognostic celiac plexus block with bupivacaine, followed by neurolysis during fluoroscopic control within the next 24 h. Results After NCPB, 37 patients (74%) had effective pain relief during the first 3 months or until death. Of the 37 patients who had effective pain relief, 33 (92%) were from group 1 and 4 (29%) were from group 2. In the remaining 13 patients (3 patients from group 1 and 10 patients from group 2), pain relief after NCPB was not satisfactory. Those patients were scheduled for repeated retrocrural neurolysis during computed tomography control. Computed tomography showed massive growth of the tumor around the celiac axis with metastases. After repeated neurolysis, pain relief clinically still was not satisfactory, necessitating additional opioid treatment. Conclusion In this study, unilateral transcrural celiac plexus neurolysis has been shown to provide effective pain relief in 74% of patients with pancreatic cancer pain. Neurolysis was more effective in cases with tumor involving the head of the pancreas. In the cases with advanced tumor proliferation, regardless of the technique used, the analgesic effects of NCPB were not satisfactory.

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