Three-phase bone quantitative-SPECT of navicular bones with a high-sensitivity whole-body CZT-camera in a Müeller-Weiss syndrome

Excerpt

The Veriton 360° CZT-SPECT/CT system provides high-quality bone SPECT images displayed with SUV scales [1]. We present a three-phase scintigraphy application to analyze small bones, i.e., the navicular bones involved in a typical Müeller-Weiss syndrome (MWS) [2] in a 21-year-old woman suffering from bilateral foot pain for several months. Both navicular bones exhibited the typical compression and fragmentation of a chronic phase on CT images (A), corresponding to a Maceira stage-3 [3], as well as high ^99mTc-hydroxydiphosphonate (HDP) activity on the 5-min SPECT recorded from the 5^th- to 10^th-min post-injection (blood-pool phase of inflammation detection (B)) and 3 h later (delayed phase of bone-metabolism analysis (A, B)). By contrast, on consecutive 3-s SPECT images recorded throughout the 2 min following injection, the flow curves were set in the inferior range of what is observed for normal navicular bones (see the upper and lower normal limits in figure B for apparently healthy navicular bones from 10 patients investigated for a contralateral foot disease (40 ± 11 years, 7 women)). However, in the absence of any vascular disease, an increased flow should constantly accompany the inflammatory stages of bone diseases [4, 5]. This point is illustrated in a supplementary information by images from a patient affected by a left calcaneum fracture several months ago. Our observation thus strengthens the common consideration that an inappropriate blood flow is involved in the complex pathogeny of the MWS [2‐5]. An inappropriate blood flow also constitutes a major diagnostic criterion for necrosis- and ischemia-related bone diseases, and it may now be quantitatively assessed on small bones using high-sensitivity CZT-SPECT/CT systems.

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