Qitao Song's research while affiliated with Government of the People's Republic of China and other places

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.

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.

Background: This study aimed to evaluate fused images of single-photon emission computed tomography/computed tomography (SPECT/CT), stand-alone whole-body scintigraphy (WBS) and stand-alone CT in the diagnosis of post-traumatic chronic-infected nonunion osteomyelitis (OST) of the lower limb. Patients and methods: The imaging data from 144 patients with known/suspected chronic-infected fracture nonunion in the lower limbs following internal/external fixation between June 2015 and December 2017 were reviewed retrospectively. Technetium-99m-methylene diphosphonate SPECT/CT scans were performed on the patients. For each patient, the diagnosis on the basis of each imaging approach was classified as yes (OST), no (no OST), or equivocal by experienced nuclear medicine physicians and radiologists. An intraoperative bacterial culture experiment was conducted as our gold standard. The diagnostic sensitivity, specificity, accuracy, positive predictive value, negative predictive value, κ coefficient, significance level, and agreement level were analyzed. Results: The diagnosis on the basis of SPECT/CT fused images showed a sensitivity of 91.3%, a specificity of 84.6%, and accuracy of 88.9% compared to that based on WBS, with a sensitivity of 52.2%, a specificity of 15.4%, accuracy of 38.9%, and CT, with a sensitivity of 65.2%, a specificity of 23.1%, accuracy of 50.0%. The fused images can show the precise sites of post-traumatic chronic-infected OST. Considerable agreement (κ=0.679) was found between the SPECT/CT diagnosis and an intraoperative bacterial culture test (WBS, κ=0.218; CT, κ=0.184). Conclusion: Technetium-99m-methylene diphosphonate SPECT/CT imaging fusion can improve diagnostic confidence for post-traumatic patients with chronic nonunion OST. This imaging approach can achieve an accurate diagnosis by revealing the precise location and scope of OST with high sensitivity and specificity, which has important implications for surgical guidance by providing the precise location of OST.