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 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 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 Variations in the Anatomy of Sphenoid Sinus: A Computed Tomography Investigation

2019 ◽  
pp. 1-7
Author(s):  
Mohammad Taghi Joghataei ◽  
Amir Hosseini ◽  
Javad Mohajer Ansari ◽  
Ehsan Golchini ◽  
Zeinab Namjoo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Retrospective Study ◽  
Sphenoid Sinus ◽  
Internal Carotid ◽  
Anterior Clinoid Process ◽  
3D Images ◽  
Maxillary Nerve ◽  
Adjacent Structures ◽  
Neurovascular Structures ◽  
Greater Wing

Aims: The sphenoid sinus is surrounded by many neurovascular structures which are very vulnerable to intrasphenoid sinus surgeries. The purpose of this study is to investigate the variation of sphenoid sinus structure by CT scan imaging. Methodology: This is a retrospective study of 3D images of a paranasal sinus in 129 cases. In this study, three-way metering of the sphenoid sinus, additional septum, pneumatization of the period process (PP), anterior clinoid process (ACP) and greater wing of sphenoid and protrusion and dehiscence of adjacent structures will be assessed. Results: Protrusion of internal carotid artery (ICA), a vidian nerve, maxillary nerve (V2) and optical canal were seen respectively 50.4%, 57.36%, 62.5% and 54.3% but dehiscence of this structure was seen 8.5%, 7%, 3.9% and 6.2%. penumtazition of PP, ACP and greater wing of sphenoid were seen 96.87%, 43.9% and 41.1%. Additional septum also is seen in 76% of the population. Conclusion: This study demonstrates numerous variations in sphenoid sinus structure. Some of the variations cause many problems during intrasphenoidal surgery. Therefore, physicians should evaluate patients completely before surgery.

scholarly journals Hindfoot alignment using weight-bearing computed tomography

2020 ◽  
Vol 14 (3) ◽  
pp. 239-242
Author(s):  
Eduardo Pires ◽  
Carlos Lôbo ◽  
Cesar De Cesar Netto ◽  
Alexandre Godoy-Santos
Keyword(s):  
Computed Tomography ◽  
Weight Bearing ◽  
Treatment Decision ◽  
Metatarsal Head ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
Treatment Decision Making ◽  
First Metatarsal ◽  
Block Test

Measurement of hindfoot malalignment and flexibility is essential for treatment decision-making in cavovarus foot deformity. Weight-bearing computed tomography (WBCT) shows greater diagnostic accuracy and allows the study of osteoarticular alignment in the physiological upright position. The most commonly used method for measurements on WBCT scans is the foot and ankle offset (FAO), which is based on the structural tripod of the foot: the calcaneus and the first and fifth metatarsal heads. During the Coleman block test, the first metatarsal head is not resting on the ground and, therefore, does not represent the physiological support of the tripod. We describe a new measurement, the forefoot/hindfoot offset (FHO), for assessing hindfoot alignment on WBCT scans. Level of Evidence V; Diagnostic Studies; Expert Opinion.

Preoperative Guidance With Weight-Bearing Computed Tomography and Patient-Specific Instrumentation in Foot and Ankle Surgery

2021 ◽  
pp. 155633162110263
Author(s):  
Jacob Zeitlin ◽  
Jensen Henry ◽  
Scott Ellis
Keyword(s):  
Computed Tomography ◽  
3D Imaging ◽  
Weight Bearing ◽  
Patient Specific ◽  
Foot And Ankle ◽  
Review Of The Literature ◽  
3 Dimensional ◽  
Implant Positioning ◽  
Patient Specific Instrumentation ◽  
Ankle Surgery

The use of preoperative and intraoperative guidance in foot and ankle surgery has grown substantially in recent years. Weight-bearing computed tomography (WBCT) and patient-specific instrumentation (PSI) are used in total ankle arthroplasty (TAA) to achieve precise bone cutting and implant positioning, and intraoperative 3-dimensional (3D) imaging has been used to reduce complications and improve clinical outcomes in other foot and ankle surgical procedures. This narrative review of the literature focuses on the evidence supporting the use of WBCT and PSI in TAA and looks at other promising technologies used to guide foot and ankle surgery.

Intraoperative 3-Dimensional Computed Tomography and Navigation in Foot and Ankle Surgery

Orthopedics ◽  
2016 ◽  
Vol 39 (5) ◽  
pp. e1005-e1010 ◽  
Author(s):  
Ashwin Chowdhary ◽  
Lisca Drittenbass ◽  
Victor Dubois-Ferrière ◽  
Richard Stern ◽  
Mathieu Assal
Keyword(s):  
Computed Tomography ◽  
Foot And Ankle ◽  
3 Dimensional ◽  
Ankle Surgery
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