SPECT-CT improves preop foot diagnosis

By Lynda Williams, Senior medwireNews Reporter

Research demonstrates the usefulness of radionuclide bone scans with single photon-emission computed tomography and computed tomography (SPECT-CT) for the assessment of patients awaiting foot or angle surgery.

SPECT-CT findings changed the clinical diagnosis and led to a change in treatment plan for 78% of 50 patients with foot and ankle pain, report Vinay Kumar Singh (Epsom and St Helier University Hospital NHS Trust, Carshalton, UK) and co-workers.

Initial diagnoses made by clinical examination and plain radiographs were altered in 14 patients with ankle and hindfoot conditions, 11 patients with midfoot conditions, and 14 patients with forefoot problems, most commonly due to correct identification of the midfoot joint affected by osteoarthritis.

Fluoroscopic-guided injection arthrograms improved symptoms in 16 of 17 patients, while other surgical procedures resolved issues in 13 patients. Nine patients were treated conservatively and six had complete resolution of their pain. Thus, just four (8%) patients did not experience improvement after SPECT-CT-guided treatment.

SPECT-CT results matched the original clinical diagnosis in 22% of patients. Symptoms improved or resolved in all nine patients who underwent fluoroscopic-guided arthrogram and the two who underwent sesamoid bone excision.

"The proximity of small joints, the presence of co-existent multiple pathologies and the poor localisation of pain on clinical examination are the usual hindrance in clinching a diagnosis," the researchers explain in Foot and Ankle Surgery.

"In our study we observed that SPECT-CT was able to address these issues by accurately localising the site of pathology and allow the precise identification of the joint responsible for patient's symptoms in cases of co-existent multiple pathologies," they write, noting particular benefits for patients with hindfoot and midfoot arthritis.

Overall, SPECT-CT findings were 94% accurate, 95% sensitive, and 83% specific for diagnosis, with positive and negative predictive values of 98% and 71%, respectively.

Singh et al therefore conclude: "We recommend the use of SPECT-CT in diagnostic uncertainty to aid diagnosis and initiate appropriate management especially in midfoot arthritis."

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