Evaluating and Managing the Painful Total Ankle Replacement

2021 ◽  
pp. 107110072110272
Author(s):  
Jensen K. Henry ◽  
Carson Rider ◽  
Elizabeth Cody ◽  
Scott J. Ellis ◽  
Constantine Demetracopoulos
Keyword(s):  
Single Photon ◽  
Imaging Techniques ◽  
Nerve Repair ◽  
Photon Emission ◽  
The United States ◽  
Implant Design ◽  
Emission Computed Tomography ◽  
Foot And Ankle ◽  
Contributing Factors ◽  
Level Of Evidence

The number of total ankle replacements (TARs) performed in the United States has dramatically increased in the past 2 decades due to improvements in implant design and surgical technique. Yet as the prevalence of TAR increases, so does the likelihood of encountering complications and the need for further surgery. Patients with new-onset or persistent pain after TAR should be approached systematically to identify the cause: infection, fracture, loosening/subsidence, cysts/osteolysis, impingement, and nerve injury. The alignment of the foot and ankle must also be reassessed, as malalignment or adjacent joint pathology can contribute to pain and failure of the implant. Novel advanced imaging techniques, including single-photon emission computed tomography and metal-subtraction magnetic resonance imaging, are useful and accurate in identifying pathology. After the foot and ankle have been evaluated, surgeons can also consider contributing factors such as pathology outside the foot/ankle (eg, in the knee or the spine). Treatment of the painful TAR is dependent on etiology and may include debridement, bone grafting, open reduction and internal fixation, realignment of the foot, revision of the implants, arthrodesis, nerve repair/reconstruction/transplantation surgery, or, in rare cases, below-knee amputation. Level of Evidence: Level V, expert opinion or review.

Nuclear Medicine for the Orthopedic Foot and Ankle Surgeon

2020 ◽  
Vol 41 (5) ◽  
pp. 612-623 ◽  
Author(s):  
Joseph Serino ◽  
Kyle N. Kunze ◽  
Stephen K. Jacobsen ◽  
Joel G. Morash ◽  
George B. Holmes ◽  
...  
Keyword(s):  
Nuclear Medicine ◽  
Single Photon ◽  
Photon Emission ◽  
Nuclear Imaging ◽  
Pain Syndrome ◽  
Osteochondral Lesions ◽  
Emission Computed Tomography ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Leukocyte Scintigraphy

Nuclear medicine has been widely applied as a diagnostic tool for orthopedic foot and ankle pathology. Although its indications have diminished with improvements in and the availability of magnetic resonance imaging, nuclear medicine still has a significant and valuable role. The present article offers a comprehensive and current review of the most common nuclear imaging modalities for the orthopedic foot and ankle surgeon. Methods discussed include bone scintigraphy, gallium citrate scintigraphy, labeled-leukocyte scintigraphy, and single-photon emission computed tomography (SPECT). We review the indications and utility of these techniques as they pertain to specific foot and ankle conditions, including osteomyelitis, stress fractures, talar osteochondral lesions, complex regional pain syndrome, oncology, plantar fasciitis, and the painful total ankle arthroplasty. We conclude with a discussion of our approach to nuclear medicine with illustrative cases. Level of Evidence: Level V, expert opinion.

scholarly journals Standardization of the [68Ga]Ga-PSMA-11 Radiolabeling Protocol in an Automatic Synthesis Module: Assessments for PET Imaging of Prostate Cancer

2021 ◽  
Vol 14 (5) ◽  
pp. 385
Author(s):  
Leonardo L. Fuscaldi ◽  
Danielle V. Sobral ◽  
Ana Claudia R. Durante ◽  
Fernanda F. Mendonça ◽  
Ana Cláudia C. Miranda ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Pet Imaging ◽  
Saline Solution ◽  
Serum Proteins ◽  
Single Photon ◽  
Imaging Techniques ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Lncap Cells ◽  
Automatic Synthesis

Prostate-specific membrane antigen (PSMA) is a glycoprotein present in the prostate, that is overexpressed in prostate cancer (PCa). Recently, PSMA-directed radiopharmaceuticals have been developed, allowing the pinpointing of tumors with the Positron Emission Tomography (PET) or Single Photon Emission Computed Tomography (SPECT) imaging techniques. The aim of the present work was to standardize and validate an automatic synthesis module-based radiolabeling protocol for [68Ga]Ga-PSMA-11, as well as to produce a radiopharmaceutical for PET imaging of PCa malignancies. [68Ga]Ga-PSMA-11 was evaluated to determine the radiochemical purity (RCP), stability in saline solution and serum, lipophilicity, affinity to serum proteins, binding and internalization to lymph node carcinoma of the prostate (LNCaP) cells, and ex vivo biodistribution in mice. The radiopharmaceutical was produced with an RCP of 99.06 ± 0.10%, which was assessed with reversed-phase high-performance liquid chromatography (RP-HPLC). The product was stable in saline solution for up to 4 h (RCP > 98%) and in serum for up to 1 h (RCP > 95%). The lipophilicity was determined as −3.80 ± 0.15, while the serum protein binding (SPB) was <17%. The percentages of binding to LNCaP cells were 4.07 ± 0.51% (30 min) and 4.56 ± 0.46% (60 min), while 19.22 ± 2.73% (30 min) and 16.85 ± 1.34% (60 min) of bound material was internalized. High accumulation of [68Ga]Ga-PSMA-11 was observed in the kidneys, spleen, and tumor, with a tumor-to-contralateral-muscle ratio of >8.5 and a tumor-to-blood ratio of >3.5. In conclusion, an automatic synthesis module-based radiolabeling protocol for [68Ga]Ga-PSMA-11 was standardized and the product was evaluated, thus verifying its characteristics for PET imaging of PCa tumors in a clinical environment.

scholarly journals Radionuclide-Based Imaging of Breast Cancer: State of the Art

Cancers ◽  
2021 ◽  
Vol 13 (21) ◽  
pp. 5459
Author(s):  
Huiling Li ◽  
Zhen Liu ◽  
Lujie Yuan ◽  
Kevin Fan ◽  
Yongxue Zhang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Molecular Imaging ◽  
Single Photon ◽  
Morphological Changes ◽  
Imaging Techniques ◽  
Rapid Development ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Biological Processes ◽  
Functional Perspective

Breast cancer is a malignant tumor that can affect women worldwide and endanger their health and wellbeing. Early detection of breast cancer can significantly improve the prognosis and survival rate of patients, but with traditional anatomical imagine methods, it is difficult to detect lesions before morphological changes occur. Radionuclide-based molecular imaging based on positron emission tomography (PET) and single-photon emission computed tomography (SPECT) displays its advantages for detecting breast cancer from a functional perspective. Radionuclide labeling of small metabolic compounds can be used for imaging biological processes, while radionuclide labeling of ligands/antibodies can be used for imaging receptors. Noninvasive visualization of biological processes helps elucidate the metabolic state of breast cancer, while receptor-targeted radionuclide molecular imaging is sensitive and specific for visualization of the overexpressed molecular markers in breast cancer, contributing to early diagnosis and better management of cancer patients. The rapid development of radionuclide probes aids the diagnosis of breast cancer in various aspects. These probes target metabolism, amino acid transporters, cell proliferation, hypoxia, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), gastrin-releasing peptide receptor (GRPR) and so on. This article provides an overview of the development of radionuclide molecular imaging techniques present in preclinical or clinical studies, which are used as tools for early breast cancer diagnosis.

Nuclear cardiology: state of the art

Heart ◽  
2021 ◽  
pp. heartjnl-2019-315628
Author(s):  
Rebecca Schofield ◽  
Leon Menezes ◽  
Stephen Richard Underwood
Keyword(s):  
Heart Failure ◽  
Myocardial Perfusion ◽  
Radionuclide Imaging ◽  
Single Photon ◽  
Imaging Techniques ◽  
Sympathetic Innervation ◽  
Photon Emission ◽  
Myocardial Inflammation ◽  
Emission Computed Tomography ◽  
Device Infection

Radionuclide imaging remains an essential component of modern cardiology. There is overlap with the information from other imaging techniques, but no technique is static and new developments have expanded its role. This review focuses on ischaemic heart disease, heart failure, infection and inflammation. Radiopharmaceutical development includes the wider availability of positron emission tomography (PET) tracers such as rubidium-82, which allows myocardial perfusion to be quantified in absolute terms. Compared with alternative techniques, myocardial perfusion scintigraphy PET and single photon emission computed tomography (SPECT) have the advantages of being widely applicable using exercise or pharmacological stress, full coverage of the myocardium and a measure of ischaemic burden, which helps to triage patients between medical therapy and revascularisation. Disadvantages include the availability of expertise in some cardiac centres and the lack of simple SPECT quantification, meaning that global abnormalities can be underestimated. In patients with heart failure, despite the findings of the STICH (Surgical Treatment for Ischemic Heart Failure) trial, there are still data to support the assessment of myocardial hibernation in predicting when abolition of ischaemia might lead to improvement in ventricular function. Imaging of sympathetic innervation is well validated, but simpler markers of prognosis mean that it has not been widely adopted. There are insufficient data to support its use in predicting the need for implanted devices, but non-randomised studies are promising. Other areas where radionuclide imaging is uniquely valuable are detection and monitoring of endocarditis, device infection, myocardial inflammation in sarcoidosis, myocarditis and so on, and reliable detection of deposition in suspected transthyretin-related amyloidosis.

scholarly journals Recent applications of nuclear medicine in diagnostics: II part

2013 ◽  
pp. 159-166
Author(s):  
Giorgio Treglia ◽  
Ernesto Cason ◽  
Giorgio Fagioli
Keyword(s):  
Nuclear Medicine ◽  
Single Photon ◽  
Imaging Techniques ◽  
Photon Emission ◽  
Cellular Level ◽  
Accurate Information ◽  
Emission Computed Tomography ◽  
Nuclear Medicine Imaging ◽  
Positron Emission ◽  
Artery Disease

Introduction: Positron-emission tomography (PET) and single photon emission computed tomography (SPECT) are effective diagnostic imaging tools in several clinical settings. The aim of this article (the second of a 2-part series) is to examine some of the more recent applications of nuclear medicine imaging techniques, particularly in the fields of neurology, cardiology, and infection/inflammation. Discussion: A review of the literature reveals that in the field of neurology nuclear medicine techniques are most widely used to investigate cognitive deficits and dementia (particularly those associated with Alzheimer disease), epilepsy, and movement disorders. In cardiology, SPECT and PET also play important roles in the work-up of patients with coronary artery disease, providing accurate information on the state of the myocardium (perfusion, metabolism, and innervation). White blood cell scintigraphy and FDG-PET are widely used to investigate many infectious/inflammatory processes. In each of these areas, the review discusses the use of recently developed radiopharmaceuticals, the growth of tomographic nuclear medicine techniques, and the ways in which these advances are improving molecular imaging of biologic processes at the cellular level.

scholarly journals Development of Antibody Immuno-PET/SPECT Radiopharmaceuticals for Imaging of Oncological Disorders—An Update

Cancers ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 1868
Author(s):  
Jonatan Dewulf ◽  
Karuna Adhikari ◽  
Christel Vangestel ◽  
Tim Van Den Wyngaert ◽  
Filipe Elvas
Keyword(s):  
Clinical Decision Making ◽  
Single Photon ◽  
Imaging Techniques ◽  
Photon Emission ◽  
Therapy Response ◽  
High Specificity ◽  
Clinical Decision ◽  
Disease Diagnosis ◽  
Emission Computed Tomography ◽  
Wide Range

Positron emission tomography (PET) and single-photon emission computed tomography (SPECT) are molecular imaging strategies that typically use radioactively labeled ligands to selectively visualize molecular targets. The nanomolar sensitivity of PET and SPECT combined with the high specificity and affinity of monoclonal antibodies have shown great potential in oncology imaging. Over the past decades a wide range of radio-isotopes have been developed into immuno-SPECT/PET imaging agents, made possible by novel conjugation strategies (e.g., site-specific labeling, click chemistry) and optimization and development of novel radiochemistry procedures. In addition, new strategies such as pretargeting and the use of antibody fragments have entered the field of immuno-PET/SPECT expanding the range of imaging applications. Non-invasive imaging techniques revealing tumor antigen biodistribution, expression and heterogeneity have the potential to contribute to disease diagnosis, therapy selection, patient stratification and therapy response prediction achieving personalized treatments for each patient and therefore assisting in clinical decision making.

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 Ocular Biodistribution Studies Using Molecular Imaging

Pharmaceutics ◽  
2019 ◽  
Vol 11 (5) ◽  
pp. 237 ◽  
Author(s):  
Ana Castro-Balado ◽  
Cristina Mondelo-García ◽  
Miguel González-Barcia ◽  
Irene Zarra-Ferro ◽  
Francisco J Otero-Espinar ◽  
...  
Keyword(s):  
Molecular Imaging ◽  
Single Photon ◽  
Imaging Techniques ◽  
Photon Emission ◽  
High Sensitivity ◽  
New Drugs ◽  
Emission Computed Tomography ◽  
Pharmacokinetic Data ◽  
Biodistribution Studies

Classical methodologies used in ocular pharmacokinetics studies have difficulties to obtain information about topical and intraocular distribution and clearance of drugs and formulations. This is associated with multiple factors related to ophthalmic physiology, as well as the complexity and invasiveness intrinsic to the sampling. Molecular imaging is a new diagnostic discipline for in vivo imaging, which is emerging and spreading rapidly. Recent developments in molecular imaging techniques, such as positron emission tomography (PET), single-photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI), allow obtaining reliable pharmacokinetic data, which can be translated into improving the permanence of the ophthalmic drugs in its action site, leading to dosage optimisation. They can be used to study either topical or intraocular administration. With these techniques it is possible to obtain real-time visualisation, localisation, characterisation and quantification of the compounds after their administration, all in a reliable, safe and non-invasive way. None of these novel techniques presents simultaneously high sensitivity and specificity, but it is possible to study biological procedures with the information provided when the techniques are combined. With the results obtained, it is possible to assume that molecular imaging techniques are postulated as a resource with great potential for the research and development of new drugs and ophthalmic delivery systems.

scholarly journals Beyond the bones and joints: a review of ligamentous injuries of the foot and ankle on 99mTc-MDP-SPECT/CT

2019 ◽  
Vol 92 (1104) ◽  
pp. 20190506
Author(s):  
Ramin Mandegaran ◽  
Sukhvinder Dhillon ◽  
Ho Jen
Keyword(s):  
Soft Tissues ◽  
Single Photon ◽  
Photon Emission ◽  
Tracer Uptake ◽  
Emission Computed Tomography ◽  
Foot And Ankle ◽  
Case Examples ◽  
Pictorial Review ◽  
Articular Pathology ◽  
Photon Emission Computed Tomography

99mTc-MDP-single photon emission computed tomography (SPECT)/CT has established itself as a useful modality in the assessment of the painful foot and ankle, owing to its ability to depict anatomical and functional information simultaneously. Despite its growing popularity, much of the literature describing the utility of 99mTc-MDP-SPECT/CT of the foot and ankle is limited to osseous and articular pathology, with descriptions of ligamentous pathology limited to just a handful of cases. Though assessment of soft tissues using a combination of bone tracer and CT is limited, with a sound understanding of the regional anatomy, it is certainly within the scope of 99mTc-MDP-SPECT/CT to accurately identify ligamentous injuries based on focal tracer uptake patterns and suspected ligamentous injuries should be reported as such. This article provides a case-based pictorial review of the 99mTc-MDP-SPECT/CT appearances of the various ligamentous injuries of the foot and ankle with case examples and MRI correlation where available, most of which have yet to be described. The typical patterns of bone tracer uptake and associated CT abnormalities that may be observed are discussed.

scholarly journals Single-Cell Resolution Mapping of Neuronal Damage in Acute Focal Cerebral Ischemia Using Thallium Autometallography

2013 ◽  
Vol 34 (1) ◽  
pp. 144-152 ◽  
Author(s):  
Franziska Stöber ◽  
Kathrin Baldauf ◽  
Iryna Ziabreva ◽  
Denise Harhausen ◽  
Marietta Zille ◽  
...  
Keyword(s):  
Cerebral Ischemia ◽  
Single Cell ◽  
Single Photon ◽  
Neuronal Damage ◽  
Focal Cerebral Ischemia ◽  
Imaging Techniques ◽  
Photon Emission ◽  
Early Time ◽  
Emission Computed Tomography ◽  
Time Points

Neuronal damage shortly after onset or after brief episodes of cerebral ischemia has remained difficult to assess with clinical and preclinical imaging techniques as well as with microscopical methods. We here show, in rodent models of middle cerebral artery occlusion (MCAO), that neuronal damage in acute focal cerebral ischemia can be mapped with single-cell resolution using thallium autometallography (TlAMG), a histochemical technique for the detection of the K+-probe thallium (Tl+) in the brain. We intravenously injected rats and mice with thallium diethyldithiocarbamate (TlDDC), a lipophilic chelate complex that releases Tl+ after crossing the blood–brain barrier. We found, within the territories of the affected arteries, areas of markedly reduced neuronal Tl+ uptake in all animals at all time points studied ranging from 15 minutes to 24 hours after MCAO. In large lesions at early time points, areas with neuronal and astrocytic Tl+ uptake below thresholds of detection were surrounded by putative penumbral zones with preserved but diminished Tl+ uptake. At 24 hours, the areas of reduced Tl+uptake matched with areas delineated by established markers of neuronal damage. The results suggest the use of 201TlDDC for preclinical and clinical single-photon emission computed tomography (SPECT) imaging of hyperacute alterations in brain K+ metabolism and prediction of tissue viability in cerebral ischemia.

Sign in / Sign up

Export Citation Format

Share Document