Fig 4 - uploaded by Michael Tobias Hirschmann
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Illustration of BTU measurements with IntroSPECT©. Top left: Axial view of the talus surface. Red is the measurement box, placed in the six square grid for a measurement. The lesion is visible in purple. Top right: Sagital view with the center through the talar dome. The red box shows the measurement volume with the included bone. Low left: Sagital view. This time the red box includes only the center of the talus to make the last measurement in the talar center. In this measurement the volume is defined but not the position. Top left: Axial view on the talus surface with the measurement voxel box (red). The six squares divide the surface of the talus. Purple is the plane for adjustment of the patients foot position. Green and red are the plane which go through the talus. Top right: Sagittal view. Red is the measurement volume. It shows all the bone which is included into the measurement. Low left: Sagittal view. Red is the measurement volume (VOI) in the talus centre. The volume is defined, the position is not
Source publication
Background
Single Photon Emission Computed Tomography-Computed Tomography (SPECT/CT) gains an important part of diagnostics in patients with osteochondral lesions (OCL). SPECT/CT is a hybrid imaging modality, which combines a 3D scintigraphy (SPECT) and computerized tomography (CT) into one single procedure and combines metabolic data, structural a...
Similar publications
Osteochondral lesions (OCL) of the talus occur in 2 to 6% of ankle sprains and may present with concurrent ankle sprains as a result of an inverted ankle. Lesions that are chronic in nature, have failed conservative management, or have displaced fragments or a complete fracture are amenable to surgical intervention. Arthroscopic surgery is the main...
Citations
... 24,25 Single-positron Emission Computed Tomography/Computed Tomography SPECT/CT assesses osteoblastic activity within the affected subchondral bone, providing a measure of bone remodeling activity and vitality. 26,27 SPECT/CT scintigraphic uptake is strongly associated with pain score in talar dome OCLs. 18 Magnetic Resonance Imaging MRI, in detecting OCLs with near absolute positive and negative predictive value, has completely changed the recognition, characterization, and knowledge of talar dome OCLs over the past 30 years. ...
We suggest a similar approach to evaluating osteochondral lesions of the talar dome both pre- and postoperatively. This review addresses the etiology, natural history, and treatment of talar dome osteochondral lesions with an emphasis on imaging appearances. High-resolution magnetic resonance imaging, ideally combining a small field-of-view surface coil with ankle traction, optimizes visibility of most of the clinically relevant features both pre- and postoperatively.
... The application of SPECT/CT, a new multimodality imaging method for patients with cystic lesions of the talus, allows assessment of the hemodynamic metabolic status of OLTs in real-time. The subchondral bone cystic lesion and surrounding area show the highest activity, whereas the rest of the talus presents a normal physiological bone metabolic zone [24][25][26]. The sclerotic zone is located at the junction of the lesion area and normal tissue, which is a zone rich in blood flow and new capillaries and shows active bone metabolism. ...
Background
Osteochondral lesions of the talus (OLTs) are a common orthopedic condition. The image presentation is very similar to that of ischemic necrosis of the talus complicated by a talar neck fracture, but the two are very different lesions. When abnormalities in bone density (or signal) of the talar body (apex of the fornix) with concomitant bone defects and cystic changes are found on X-ray, computed tomography (CT), or magnetic resonance imaging, it is important to accurately determine the nature of the lesion and make a correct diagnosis for the treatment and prognosis of the patient. The purpose of this study was to explore the imaging features of three-phase single-photon emission computed tomography (SPECT)/CT images of cystic lesions of the talus.
Methods
A total of 189 patients with chronic pain in the ankle joint suspected to be caused by cystic degeneration of the talus were enrolled. All patients underwent 99mTc-methyl diphosphonate (99mTc-MDP) three-phase SPECT/CT bone imaging and delayed scans in our hospital. The location, range of involvement, classification, CT value, and radioactivity uptake of the sclerotic areas of cystic lesions on the talus, and the continuity of the articular surface, were recorded. All recorded parameters were analyzed in comparison with pathological results.
Results
Eighty-three percent (157/189) of the talar cysts were located on the medial fornix, largely involving the anterior middle part (43.27%), with larger cysts involving the posterior part (9.6%). Sixty-three percent (119/189) of the patients had type I lesions and 37% (70/189) had type II lesions. The articular surface of the medial dome of the talus was intact in all patients, but the subchondral bony articular surface was rough in 88% (166/189) of patients. The coincidence rate for the location, type, and range of involvement of cystic lesions with the pathological results was 87.83% (166/189). The mean CT value of the cystic lesions was 45 ± 15 HU (30–60 HU). The percentages of pathological chondrogenesis in high CT value ≥ 50 HU (19/70) and low CT value < 50 HU (51/70) groups were 89.47% (17/19) and 29.14% (15/51) (χ² = 20.12, p < 0.001), respectively. The target/background ratio (T/B ratio) of the radioactivity-uptake area of the talus vault was 2.0 ± 0.5 (1.5–2.5). The percentages of pathological new trabecular bone in those with a T/B ratio ≥ 2.0 (157/189) and T/B ratio < 2.0 (32/189) were 82.80% (130/157) and 25.00% (8/32; χ² = 45.08, p < 0.001), respectively.
Conclusions
Three-phase bone imaging could identify damage of the talus caused by cystic degeneration, while delayed SPECT/CT images showed advantages for displaying bone microstructure, blood supplement, and bone metabolism when examining the location, range of involvement, classification, and repair of cystic lesions of the talus.
... The application of SPECT/CT, a new multimodality imaging method for patients with cystic lesions of the talus, re ects the hemodynamic metabolic status of the osteochondral lesions of the talus in real-time. The subchondral bone cystic lesion and the surrounding area showed the highest active area, and the rest of the talus was a normal physiological bone metabolic zone [24][25][26]. The sclerotic zone is located at the junction of the lesion area and normal tissue, a zone rich in blood ow, rich in new capillaries, and active in bone metabolism. ...
Objective: To explore the imaging features of three-phase bone and SPECT/CT images of cystic lesions on the talus.
Methods: A total of 189 patients with suspected chronic pain in the ankle joint of the talus cystic degeneration were enrolled in this retrospective study, who underwent 99mTc-MDP three-phase bone imaging and delayed SPECT/CT scans in our hospital. The location, range of involvement, classification, CT value, and radioactivity uptake of the sclerosis of cystic lesions on the talus, and the continuity of articular surface were observed. Comparisons were analyzed with the pathological results.
Results: Totally, 83% (157/189) of the talar cysts were located to the medial fornix, most of which involved the anterior middle part (43.27%), and the larger cysts involved the posterior part (9.6%). 63% (119/189) of the patients were type I, and 37% (70/189) of the patients were type II. The articular surface of the medial dome of the talus of all of the patients was intact, and the subchondral bony articular surface of 88% (166/189) patients was rough. The coincidence rate of the location, type, range of involvement of cystic lesions with pathological results was 87.83% (166/189). The CT value of cystic lesions was 45 15Hu (30-60Hu). The percentage of pathological chondrogenesis in the high CT value ≥ 50Hu (19/70) group and the low CT value < 50Hu (51/70) group were 89.47% (17/19) and 29.14% (15/51) (c2=20.12, P＜0.001), respectively. The T/B ratio of the radioactivity uptake area of the talus vault was 2.0±0.5(1.5-2.5). The percentage of pathological new trabecular bones in T/B ratio≥2.0 (157/189) group and T/B ratio＜2.0 (32/189) group (c2=45.08，P＜0.001) were 82.80% (130/157) and 25.00% (8/32), respectively.
Conclusions: Three-phase bone imaging could identify the damage of the talus caused by cystic degeneration, and delayed SPECT/CT images have certain advantages in display the location, range of involvement, classification, and repair of cystic lesions of the talus.
... [46][47][48][49] Some authors are using the technetium-99m methylene diphosphonate single photon emission CT (SPECT). 50,51 This procedure combines this sensitivity with the superior anatomical detail of CT, enabling better localization of pathological uptake and evaluation of associated structural changes. ...
This is a review on talus osteochondritis dissecans and talus osteochondral lesions. A majority of the osteochondral lesions are associated with trauma while the cause of pure osteochondritis dissecans is still much discussed with a possible cause being repetitive microtraumas associated with vascular disturbances causing subchondral bone necrosis and disability. Symptomatic nondisplaced osteochondral lesions can often be treated conservatively in children and adolescents while such treatment is less successful in adults. Surgical treatment is indicated when there is an unstable cartilage fragment. There are a large number of different operative technique options with no number one technique to be recommended. Most techniques have been presented in level II to IV studies with a low number of patients with short follow ups and few randomized comparisons exist. The actual situation in treating osteochondral lesions in the ankle is presented and discussed.
... En un estudio con 15 pacientes con LOC, Wierwiorski et al. valoraron la mejoría tras inyección con anestésico guiado por SPECT/TC, observando una correlación altamente significativa entre el dolor y la captación patológica observada en SPECT/TC, indicando que el tejido óseo patológicamente remodelado fue un importante contribuyente al dolor en la LOC y que debe tenerse en cuenta en la planificación quirúrgica. El principal beneficio potencial de la SPECT/TC es la evaluación del hueso y la placa subcondral 12 . Leumann et al. evaluaron el papel de la SPECT/TC en comparación con la RM en la interpretación y en la toma de decisiones en paciente con LOC del astrágalo. ...
Disorders of the foot and ankle are some of the most frequent ones affecting the musculoskeletal system and have a great impact on patients’ quality of life. Accurate diagnosis is an important clinical challenge because of the complex anatomy and function of the foot that make it difficult to locate the source of the pain by routine clinical examination. In the study of foot pathology, anatomical imaging (radiography, magnetic resonance imaging [MRI], ultrasound and computed tomography [CT]) and functional imaging (bone scan, positron emission tomography [PET] and MRI) techniques have been used. Hybrid imaging combines the advantages of morphological and functional studies in a synergistic way, helping the clinician manage complex problems. In this article we delve into the anatomy and biomechanics of the foot and ankle and describe the potential indications for the current hybrid techniques available for the study of foot and ankle disease.
... En un estudio con 15 pacientes con LOC, Wierwiorski et al. valoraron la mejoría tras inyección con anestésico guiado por SPECT/TC, observando una correlación altamente significativa entre el dolor y la captación patológica observada en SPECT/TC, indicando que el tejido óseo patológicamente remodelado fue un importante contribuyente al dolor en la LOC y que debe tenerse en cuenta en la planificación quirúrgica. El principal beneficio potencial de la SPECT/TC es la evaluación del hueso y la placa subcondral 12 . Leumann et al. evaluaron el papel de la SPECT/TC en comparación con la RM en la interpretación y en la toma de decisiones en paciente con LOC del astrágalo. ...
Resumen
La patología del pie y tobillo es una de las más frecuentes del sistema musculoesquelético y de gran repercusión en la calidad de vida de los pacientes. El diagnóstico preciso supone un desafío clínico importante debido a que la compleja anatomía y la función del pie dificultan la localización del origen del dolor por un examen clínico de rutina. En el estudio de la patología del pie se han utilizado técnicas anatómicas (radiografía, resonancia magnética [RM], ultrasonido y tomografía computarizada [TC]) y funcionales (gammagrafía ósea [GO], tomografía de emisión de positrones [PET] y RM). La imagen híbrida combina las ventajas de los estudios morfológicos y funcionales de forma sinérgica, ayudando al clínico en la gestión de problemas complejos. En este artículo profundizamos en la anatomía y en la biomecánica del pie y tobillo y describimos las indicaciones potenciales de las técnicas hibridas actuales disponibles para el estudio de la patología del pie y tobillo.
Osteochondral lesions of the talus (OLTs) are common injuries among athletes who experience acute ankle sprains, chronic ankle instability, or ankle fracture. Such lesions often cause athletes lasting pain and disability that can limit their participation in sport. It is unclear which of these lesions will become symptomatic, however those with persistent symptoms may be indicated for operative management given the limited ability of cartilage to regenerate. In the case of the athlete, an expectation of high physical function must factor into this decision-making alongside the postoperative recovery period. This article will briefly describe the wide range of surgical options available for treating OLTs and their respective indications. It will go on to elaborate on the author's preferred operative techniques for athletic patients and their associated outcomes. For small lesions, the author favors arthroscopic treatment involving debridement and placement of an extracellular matrix mixed with bone marrow aspirate concentrate. For larger or cystic lesions, osteochondral autograft transplantation is typically preferred.
Zusammenfassung
Beim SPECT-CT erfolgt die Fusionierung der Bilder der funktionellen Bildgebung der Szintigraphie mit der strukturellen Darstellung des CT. Hierdurch lassen sich hohe Ortsauflösungen erzielen. Die erhobenen Befunde korrelieren gut mit der tatsächlichen Schmerzgenese. Insbesondere am Fuß kann diese Technik bei komplexen Fragestellungen einen Mehrwert liefern.
Purpose:
Third-generation total ankle replacement (TAR) is an increasingly popular and effective treatment for end-stage osteoarthritis, yet identifying causes of failure remains challenging. We evaluated integrated bone SPECT/CT in recurrent pain after TAR by validating a standardized reporting scheme, identifying uptake patterns, and assessing diagnostic performance and impact on clinical management.
Patients and methods:
A total of 24 TARs in 16 patients with persistent or recurrent pain received integrated bone SPECT/CT using diagnostic CT settings. Images were retrospectively reviewed, and a novel localization scheme was validated by assessing interrater agreement. Distinct uptake patterns were identified, and diagnostic test characteristics were estimated. Reference standard consisted of clinical follow-up, laboratory findings, and subsequent procedures, including revision surgery.
Results:
Standardized scoring of bone SPECT/CT uptake was highly reproducible (intraclass correlation coefficient, 0.79; 95% confidence interval [CI], 0.75-0.82). The final diagnoses were gutter impingement (n = 12), periprosthetic (stress) fracture (n = 5), loosening (n = 5), tarsal arthritis (n = 1), and erysipelas (n = 1). Overall, the diagnostic test characteristics of bone SPECT/CT were as follows: sensitivity of 100% (95% CI, 82%-100%), specificity of 80% (95% CI, 28%-99%), and accuracy of 96% (95% CI, 79%-100%). Gutter impingement, periprosthetic fracture, and loosening were correctly identified in all cases revealing distinct uptake patterns. Importantly, persistent diffuse uptake was frequently observed, warranting cautious interpretation. Bone SPECT/CT impacted clinical management in 86%, with symptomatic improvement in 83% of patients.
Conclusions:
Integrated bone SPECT/CT of painful TARs may benefit from standardized localization to reveal distinct uptake patterns representing common complications after TAR. Initial results show highly promising diagnostic value with potentially important impact on clinical management.
