nach oben

03.01.2019 | Original Article

Distribution of bone tracer uptake in symptomatic knees after ACL reconstruction compared to asymptomatic non-operated knees: a method for better differentiating patient-specific from disease-specific bone tracer uptake in SPECT/CT

verfasst von: Dominic T. Mathis, Lukas Büel, Helmut Rasch, Felix Amsler, Michael T. Hirschmann, Rolf W. Hügli

Erschienen in: Annals of Nuclear Medicine

Einloggen, um Zugang zu erhalten

Abstract

Objective

To evaluate the differences of bone tracer uptake (BTU) in symptomatic and asymptomatic contralateral knees in patients after reconstruction of the anterior cruciate ligament (ACL-R) and to identify typical BTU patterns and threshold values to differentiate pathological from physiological BTU.

Methods

53 patients after unilateral ACL-R were retrospectively included in the study. The population was subdivided into a group of symptomatic operated knees and a group of contralateral asymptomatic non-operated knees. BTU was measured in SPECT/CT using a validated anatomical localization-scheme and normalized mean BTU values were calculated in both knees. Wilcoxon signed rank-test and Pearson’s rank-correlation coefficient were used (p < 0.05).

Results

Symptomatic knees after ACL-R showed significantly more BTU than asymptomatic ones (p < 0.01).Based on the measured BTU activity in SPECT/CT in symptomatic operated and asymptomatic non-operated knees, intensity thresholds of pathological BTU were established. A BTU threshold of greater than the Median + 1 SD of the asymptomatic non-operated knee was defined as pathological. In both groups the highest mean BTU was found on the femoral, tibial and patellar articular surfaces, the lowest BTU in femoral and tibial regions far from the joint.

Conclusions

The established BTU thresholds for SPECT/CT in knees after ACL-R help to differentiate disease-specific from patient-specific BTU. It could be speculated that BTU in asymptomatic knees equates to the preoperative condition of the knee joint before ACL-R. Therefore, the results of this study help to understand in-vivo loading of the knee and ultimately lead to prediction of development of osteoarthritis in an early stage.

Hirschmann MT, Schon S, Afifi FK, Amsler F, Rasch H, Friederich NF, et al. Assessment of loading history of compartments in the knee using bone SPECT/CT: a study combining alignment and 99mTc-HDP tracer uptake/distribution patterns. J Orthop Res. 2013;31(2):268–74.CrossRefPubMed

Hirschmann MT, Wagner CR, Rasch H, Henckel J. Standardized volumetric 3D-analysis of SPECT/CT imaging in orthopaedics: overcoming the limitations of qualitative 2D analysis. BMC Med Imaging. 2012;12:5.CrossRefPubMedPubMedCentral

Suter B, Testa E, Stampfli P, Konala P, Rasch H, Friederich NF, et al. A novel standardized algorithm using SPECT/CT evaluating unhappy patients after unicondylar knee arthroplasty–a combined analysis of tracer uptake distribution and component position. BMC Med Imaging. 2015;15:11.CrossRefPubMedPubMedCentral

Mathis DT, Rasch H, Hirschmann MT. In vivo bone tunnel remodeling in symptomatic patients after ACL reconstruction: a retrospective comparison of articular and extra-articular fixation. Muscles Ligaments Tendons J. 2015;5(4):316–24.CrossRefPubMed

Mathis DT, Hirschmann A, Falkowski AL, Kiekara T, Amsler F, Rasch H, et al. Increased bone tracer uptake in symptomatic patients with ACL graft insufficiency: a correlation of MRI and SPECT/CT findings. Knee Surg Sports Traumatol Arthrosc. 2018;26(2):563–73.CrossRefPubMed

Hirschmann MT, Amsler F, Rasch H. Clinical value of SPECT/CT in the painful total knee arthroplasty (TKA): a prospective study in a consecutive series of 100 TKA. Eur J Nucl Med Mol Imaging. 2015;42(12):1869–82.CrossRefPubMed

Awengen R, Rasch H, Amsler F, Hirschmann MT. Symptomatic versus asymptomatic knees after bilateral total knee arthroplasty: what is the difference in SPECT/CT? Eur J Nucl Med Mol Imaging. 2016;43(4):762–72.CrossRefPubMed

Cook GJ, Ryan PJ, Clarke SE, Fogelman I. SPECT bone scintigraphy of anterior cruciate ligament injury. J Nucl Med. 1996;37(8):1353–6.PubMed

Dye SF, Chew MH. The use of scintigraphy to detect increased osseous metabolic activity about the knee. Instr Course Lect. 1994;43:453–69.PubMed

10.

Graute V, Feist M, Lehner S, Haug A, Muller PE, Bartenstein P, et al. Detection of low-grade prosthetic joint infections using 99mTc-antigranulocyte SPECT/CT: initial clinical results. Eur J Nucl Med Mol Imaging. 2010;37(9):1751–9.CrossRefPubMed

11.

Cachovan M, Vija AH, Hornegger J, Kuwert T. Quantification of 99mTc-DPD concentration in the lumbar spine with SPECT/CT. EJNMMI Res. 2013;3(1):45.CrossRefPubMedPubMedCentral

12.

Kim J, Lee HH, Kang Y, Kim TK, Lee SW, So Y, et al. Maximum standardised uptake value of quantitative bone SPECT/CT in patients with medial compartment osteoarthritis of the knee. Clin Radiol. 2017;72(7):580–9.CrossRefPubMed

13.

Beck M, Sanders JC, Ritt P, Reinfelder J, Kuwert T. Longitudinal analysis of bone metabolism using SPECT/CT and (99 m)Tc-diphosphono-propanedicarboxylic acid: comparison of visual and quantitative analysis. EJNMMI Res. 2016;6(1):60.CrossRefPubMedPubMedCentral

14.

Hirschmann MT, Mathis D, Afifi FK, Rasch H, Henckel J, Amsler F, et al. Single photon emission computerized tomography and conventional computerized tomography (SPECT/CT) for evaluation of patients after anterior cruciate ligament reconstruction: a novel standardized algorithm combining mechanical and metabolic information. Knee Surg Sports Traumatol Arthrosc. 2013;21(4):965–74.CrossRefPubMed

15.

Hirschmann MT, Mathis D, Rasch H, Amsler F, Friederich NF, Arnold MP. SPECT/CT tracer uptake is influenced by tunnel orientation and position of the femoral and tibial ACL graft insertion site. Int Orthop. 2013;37(2):301–9.CrossRefPubMed

16.

Rubello D, Caricasulo D, Borsato N, Chierichetti F, Zanco P, Ferlin G. Three-phase bone scan pattern in asymptomatic uncemented total knee arthroplasty. Eur J Nucl Med. 1996;23(10):1400–3.CrossRefPubMed

17.

Henckel J, Richards R, Lozhkin K, Harris S, Baena FM, Barrett AR, Cobb JP. Very low-dose computed tomography for planning and outcome measurement in knee replacement. The imperial knee protocol. J Bone Joint Surg Br. 2006;88(11):1513–8.CrossRefPubMed

18.

Hirschmann MT, Davda K, Iranpour F, Rasch H, Friederich NF. Combined single photon emission computerised tomography and conventional computerised tomography (SPECT/CT) in patellofemoral disorders: a clinical review. Int Orthop. 2011;35(5):675–80.CrossRefPubMed

19.

Horger M, Eschmann SM, Pfannenberg C, Storek D, Vonthein R, Claussen CD, et al. Added value of SPECT/CT in patients suspected of having bone infection: preliminary results. Arch Orthop Trauma Surg. 2007;127(3):211–21.CrossRefPubMed

20.

Hirschmann MT, Iranpour F, Konala P, Kerner A, Rasch H, Cobb JP, et al. A novel standardized algorithm for evaluating patients with painful total knee arthroplasty using combined single photon emission tomography and conventional computerized tomography. Knee Surg Sports Traumatol Arthrosc. 2010;18(7):939–44.CrossRefPubMed

21.

Fritschy D, Daniel DM, Rossman D, Rangger C. Bone imaging after acute knee hemarthrosis. Knee Surg Sports Traumatol Arthrosc. 1993;1(1):20–7.CrossRefPubMed

22.

Buck FM, Hoffmann A, Hofer B, Pfirrmann CW, Allgayer B. Chronic medial knee pain without history of prior trauma: correlation of pain at rest and during exercise using bone scintigraphy and MR imaging. Skeletal Radiol. 2009;38(4):339–47.CrossRefPubMed

23.

Sharif M, George E, Dieppe PA. Correlation between synovial fluid markers of cartilage and bone turnover and scintigraphic scan abnormalities in osteoarthritis of the knee. Arthritis Rheum. 1995;38(1):78–81.CrossRefPubMed

24.

Kim HR, So Y, Moon SG, Lee IS, Lee SH. Clinical value of (99 m)Tc-methylene diphosphonate (MDP) bone single photon emission computed tomography (SPECT) in patients with knee osteoarthritis. Osteoarthr Cartil. 2008;16(2):212–8.CrossRefPubMed

25.

Torres L, Dunlop DD, Peterfy C, Guermazi A, Prasad P, Hayes KW, et al. The relationship between specific tissue lesions and pain severity in persons with knee osteoarthritis. Osteoarthr Cartil. 2006;14(10):1033–40.CrossRefPubMed

26.

Rechsteiner J, Hirschmann MT, Dordevic M, Falkowski AL, Testa EA, Amsler F, et al. Meniscal pathologies on MRI correlate with increased bone tracer uptake in SPECT/CT. Eur Radiol. 2018;28(11):4696–704.CrossRefPubMed

27.

Blake GM, Frost ML, Fogelman I. Quantitative radionuclide studies of bone. J Nucl Med. 2009;50(11):1747–50.CrossRefPubMed

28.

Filippi L, Manni C, Pierantozzi M, Brusa L, Danieli R, Stanzione P, et al. 123I-FP-CIT semi-quantitative SPECT detects preclinical bilateral dopaminergic deficit in early Parkinson’s disease with unilateral symptoms. Nucl Med Commun. 2005;26(5):421–6.CrossRefPubMed

29.

Shiraishi S, Tomiguchi S, Utsunomiya D, Kawanaka K, Awai K, Morishita S, et al. Quantitative analysis and effect of attenuation correction on lymph node staging of non-small cell lung cancer on SPECT and CT. Am J Roentgenol. 2006;186(5):1450–7.CrossRef

30.

Schweizer T, Schiapparelli FF, Rotigliano N, Rasch H, Amsler F, Hirschmann MT. Patterns of bone tracer uptake on SPECT-CT in symptomatic and asymptomatic patients with primary total hip arthroplasty. Eur J Nucl Med Mol Imaging. 2018;45(2):283–91.CrossRefPubMed

Titel: Distribution of bone tracer uptake in symptomatic knees after ACL reconstruction compared to asymptomatic non-operated knees: a method for better differentiating patient-specific from disease-specific bone tracer uptake in SPECT/CT
verfasst von: Dominic T. Mathis
Lukas Büel
Helmut Rasch
Felix Amsler
Michael T. Hirschmann
Rolf W. Hügli
Publikationsdatum: 03.01.2019
Verlag: Springer Singapore
Erschienen in: Annals of Nuclear Medicine
Print ISSN: 0914-7187
Elektronische ISSN: 1864-6433
DOI: https://doi.org/10.1007/s12149-018-01324-7