SPECT-CT imaging in degenerative joint disease of the foot and ankle
01 Sep 2009-Journal of Bone and Joint Surgery-british Volume (British Editorial Society of Bone and Joint Surgery)-Vol. 91, Iss: 9, pp 1191-1196
TL;DR: SPECT-CT had significantly higher interobserver agreement, especially when evaluating the naviculocuneiform and tarsometatarsal joints, which is useful in localising active arthritis especially in areas where the number and configuration of joints are complex.
Abstract: The precise localisation of osteoarthritic changes is crucial for selective surgical treatment. Single photon-emission CT-CT (SPECT-CT) combines both morphological and biological information. We hypothesised that SPECT-CT increased the intra- and interobserver reliability to localise increased uptake compared with traditional evaluation of CT and bone scanning together. We evaluated 20 consecutive patients with pain of uncertain origin in the foot and ankle by radiography and SPECT-CT, available as fused SPECT-CT, and by separate bone scanning and CT. Five observers assessed the presence or absence of arthritis. The images were blinded and randomly ordered. They were evaluated twice at an interval of six weeks. Kappa and multirater kappa values were calculated. The mean intraobserver reliability for SPECT-CT was excellent (kappa = 0.86; 95% CI 0.81 to 0.88) and significantly higher than that for CT and bone scanning together. SPECT-CT had significantly higher interobserver agreement, especially when evaluating the naviculocuneiform and tarsometatarsal joints. SPECT-CT is useful in localising active arthritis especially in areas where the number and configuration of joints are complex.
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TL;DR: Metal-on-metal stemmed articulations give poor implant survival compared with other options and should not be implanted, and all patients with these bearings should be carefully monitored, particularly young women implanted with large diameter heads.
502 citations
TL;DR: Syndesmotic screw and TightRope had similar postoperative malreduction rates and functional outcomes and quality of life showed no significant difference between groups, but the incidence of ankle joint osteoarthritis nor functional outcome significantly differed between the fixation methods.
Abstract: Background The accuracy and maintenance of syndesmosis reduction are essential when treating ankle fractures with accompanying syndesmosis injuries. The primary aim of this study was to compare syndesmosis screw and TightRope fixation in terms of accuracy and maintenance of syndesmosis reduction using bilateral computed tomography (CT). Study design Single centre, prospective randomised controlled clinical trial; Level of evidence 1. Methods This study (ClinicalTrials.gov, NCT01742650) compared fixation with TightRope ® (Arthrex, Naples, FL, USA) or with one 3.5-mm tricortical trans-syndesmotic screw in terms of accuracy and maintenance of syndesmosis reduction in Lauge-Hansen pronation external rotation, Weber C-type ankle fractures with associated syndesmosis injury. Twenty-one patients were randomised to TightRope fixation and 22 to syndesmotic screw fixation. Syndesmosis reduction was assessed using bilateral CT intraoperatively or postoperatively, and also at least 2 years after surgery. Functional outcomes and quality of life were assessed using the Olerud–Molander score, a 100-mm Visual Analogue Scale, the Foot and Ankle Outcome Score, and the RAND 36-Item Health Survey. Grade of osteoarthritis was qualified with follow-up cone-beam CT. Results According to surgeons’ assessment from intraoperative CT, screw fixation resulted in syndesmosis malreduction in one case whereas seven syndesmosis were considered malreduced when TightRope was used. However, open exploration and postoperative CT of these seven cases revealed that syndesmosis was well reduced if the ankle was supported at 90˚. Retrospective analysis of the intra- and post-operative CT by a radiologist showed that one patient in each group had incongruent syndesmosis. Follow-up CT identified three patients with malreduced syndesmosis in the syndesmotic screw fixation group, whereas malreduction was seen in one patient in the TightRope group ( P = 0.33). Functional scores and the incidence of osteoarthritis showed no significant difference between groups. Conclusion Syndesmotic screw and TightRope had similar postoperative malreduction rates. However, intraoperative CT scanning of ankles with TightRope fixation was misleading due to dynamic nature of the fixation. After at least 2 years of follow-up, malreduction rates may slightly increase when using trans-syndesmotic screw fixation, but reduction was well maintained when fixed with TightRope. Neither the incidence of ankle joint osteoarthritis nor functional outcome significantly differed between the fixation methods.
152 citations
Cites methods from "SPECT-CT imaging in degenerative jo..."
...The same musculoskeletal radiologist assessed syndesmosis reduction with follow-up CBCT performed with the same parameters as intra-operative CT. OA of both ankle joints was assessed via CBCT in accordance with the classification of Morrey and Wiedeman [54,55] (grade 0 = no signs of OA, grade 1 = minimal narrowing of joint space and the formation of osteophytes, grade 2 = marked narrowing of joint space and the formation of osteophytes, and grade 3 = total degeneration of the joint and gross deformity or ankylosis)....
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...OA of both ankle joints was assessed via CBCT in accordance with the classification of Morrey and Wiedeman [54,55] (grade 0 = no signs of OA, grade 1 = minimal narrowing of joint space and the formation of osteophytes, grade 2 = marked narrowing of joint space and the formation of osteophytes, and grade 3 = total degeneration of the joint and gross deformity or ankylosis)....
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TL;DR: The onset and development of posttraumatic ankle OA is described, the most common form of OA in the tibiotalar joint, and various methods of clinical and radiographic assessment are described in detail.
Abstract: Osteoarthritis (OA) is defined as the syndrome of joint pain and dysfunction caused by substantial joint degeneration. In general, OA is the most common joint disease and is one of the most frequent and symptomatic health problems for middle-aged and older people: OA disables more than 10% of people who are older than 60 years. This article reviews the etiology of ankle OA, and describes the onset and development of posttraumatic ankle OA, the most common form of OA in the tibiotalar joint. Various methods of clinical and radiographic assessment are described in detail.
141 citations
Cites background from "SPECT-CT imaging in degenerative jo..."
...This radiographic modality may also help to assess the osteoarthritic changes in the neighboring joints of the hindfoot and midfoot, where the number and configuration of joints are very complex.(63) Pagenstert and colleagues(63) have demonstrated that SPECT-CT has significantly higher interobserver and intraobserver reliability than measurement using CT alone or CT and bone scanning together....
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TL;DR: This review will focus on those multimodality image techniques more commonly used in the field of diagnostic imaging (SPECT-CT, PET-CT) and new developments (as PET-MR); the technological innovations and development of new tracers and smart probes are the main key points that will condition multi-modality image and diagnostic imaging professionals' future.
Abstract: In multimodality imaging, the need to combine morphofunctional information can be approached by either acquiring images at different times (asynchronous), and fused them through digital image manipulation techniques or simultaneously acquiring images (synchronous) and merging them automatically. The asynchronous post-processing solution presents various constraints, mainly conditioned by the different positioning of the patient in the two scans acquired at different times in separated machines. The best solution to achieve consistency in time and space is obtained by the synchronous image acquisition. There are many multimodal technologies in molecular imaging. In this review we will focus on those multimodality image techniques more commonly used in the field of diagnostic imaging (SPECT-CT, PET-CT) and new developments (as PET-MR). The technological innovations and development of new tracers and smart probes are the main key points that will condition multimodality image and diagnostic imaging professionals' future. Although SPECT-CT and PET-CT are standard in most clinical scenarios, MR imaging has some advantages, providing excellent soft-tissue contrast and multidimensional functional, structural and morphological information. The next frontier is to develop efficient detectors and electronics systems capable of detecting two modality signals at the same time. Not only PET-MR but also MR-US or optic-PET will be introduced in clinical scenarios. Even more, MR diffusion-weighted, pharmacokinetic imaging, spectroscopy or functional BOLD imaging will merge with PET tracers to further increase molecular imaging as a relevant medical discipline. Multimodality imaging techniques will play a leading role in relevant clinical applications. The development of new diagnostic imaging research areas, mainly in the field of oncology, cardiology and neuropsychiatry, will impact the way medicine is performed today. Both clinical and experimental multimodality studies, in humans and animals, will have to demonstrate an efficient use of the imaging information provided by the modalities to affect the future of medical imaging.
122 citations
TL;DR: A new treatment paradigm for conservative management of chronic ankle instability is proposed with the aim of assessing and treating specific deficits exhibited by individual patients with CAI.
Abstract: Lateral ankle sprains have been shown to be one of the most common musculoskeletal injuries in both athletes and the recreationally active population. Moreover, it is estimated that approximately 30% of people who incur a lateral ankle sprain will sustain recurrent ankle sprains and experience symptoms of pain and instability that last > 1 year. Chronic ankle instability (CAI) is the term used to describe cases involving repetitive ankle sprains, multiple episodes of the ankle "giving way," persistent symptoms, and diminished self-reported function for > 1 year after the initial ankle sprain. The optimal conservative treatment for CAI is yet to be determined; however, comparison between patients with CAI and individuals showing no history of ankle sprain has revealed several characteristic features of CAI. These include diminished range of motion, decreased strength, impaired neuromuscular control, and altered functional movement patterns. We propose a new treatment paradigm for conservative management of CAI with the aim of assessing and treating specific deficits exhibited by individual patients with CAI.
108 citations
References
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TL;DR: A general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies is presented and tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interob server agreement are developed as generalized kappa-type statistics.
Abstract: This paper presents a general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies. The procedure essentially involves the construction of functions of the observed proportions which are directed at the extent to which the observers agree among themselves and the construction of test statistics for hypotheses involving these functions. Tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interobserver agreement are developed as generalized kappa-type statistics. These procedures are illustrated with a clinical diagnosis example from the epidemiological literature.
64,109 citations
Book•
01 Jan 1956
TL;DR: This is the revision of the classic text in the field, adding two new chapters and thoroughly updating all others as discussed by the authors, and the original structure is retained, and the book continues to serve as a combined text/reference.
Abstract: This is the revision of the classic text in the field, adding two new chapters and thoroughly updating all others. The original structure is retained, and the book continues to serve as a combined text/reference.
35,552 citations
TL;DR: At a mean of twenty-two years, the majority of the patients had substantial, and accelerated, arthritic changes in the ipsilateral foot but not the knee, and they were often limited functionally by foot pain.
Abstract: Background: Ankle arthrodesis is considered by many to be the standard operative treatment for end-stage ankle arthritis; however, the long-term effect of ankle arthrodesis on other lower-extremity joints remains largely unknown. The purpose of this study was to perform a clinical and radiographic review to determine the effect of ankle arthrodesis on the development of osteoarthritis in other lower-extremity joints.
Methods: Twenty-three patients who had had an isolated ankle arthrodesis for the treatment of painful post-traumatic arthritis of the ankle were followed for a mean of twenty-two years (range, twelve to forty-four years) after the operation. Each completed standardized, self-reported outcome questionnaires (the Foot Function Index, Western Ontario and McMaster University Osteoarthritis Index [WOMAC], and Short Form-36 [SF-36]), was examined clinically by two of the investigators, and underwent complete radiographic examination of the knee, ankle, and foot bilaterally. The radiographic grade of osteoarthritis was determined for each joint, and the levels of overall activity limitation, pain, and disability were determined for each patient from the clinical findings and questionnaire information.
Results: Osteoarthritis of the ipsilateral subtalar (p < 0.0001), talonavicular (p < 0.0001), calcaneocuboid (p < 0.0001), naviculocuneiform (p = 0.0012), tarsometatarsal (p = 0.0009), and first metatarsophalangeal joints (p = 0.0012) was consistently more severe than the osteoarthritis of those joints on the contralateral side. Osteoarthritis did not develop more frequently in the ipsilateral knee or lesser metatarsophalangeal joints than it did on the contralateral side. Significant differences between the two sides were found with regard to overall activity limitation (p < 0.0001), pain (p < 0.0001), and disability (p < 0.0001), with the involved side consistently more symptomatic.
Conclusions: To our knowledge, the present series represents the longest follow-up study of ankle arthrodesis to date. Our cohort of patients all had isolated post-traumatic ankle arthritis, and each underwent a successful isolated ankle arthrodesis. At a mean of twenty-two years, the majority of the patients had substantial, and accelerated, arthritic changes in the ipsilateral foot but not the knee. They were often limited functionally by foot pain. Although ankle arthrodesis may provide good early relief of pain, it is associated with premature deterioration of other joints of the foot and eventual arthritis, pain, and dysfunction.
719 citations
TL;DR: For example, the authors combined positron emission tomography and computed tomography (CT), or PET/CT, has grown because the PET portion provides information that is very different from that obtainable with other imaging modalities.
Abstract: For the past 5 years, combined positron emission tomography (PET) and computed tomography (CT), or PET/CT, has grown because the PET portion provides information that is very different from that obtainable with other imaging modalities. However, the paucity of anatomic landmarks on PET images makes a consistent "hardware fusion" to anatomic cross-sectional data extremely useful. Clinical experience indicates a single direction: Addition of CT to PET improves specificity foremost, but also sensitivity, and the addition of PET to CT adds sensitivity and specificity in tumor imaging. Thus, PET/CT is a more accurate test than either of its individual components and is probably also better than side-by-side viewing of images from both modalities. The synergistic advantage of adding CT is that the attenuation correction needed for PET can also be derived from the CT data, an advantage not obtainable by integrating PET and magnetic resonance imaging. This makes PET/CT 25%-30% faster than PET alone with standard attenuation-correction methods, leading to higher patient throughput and a more comfortable examination, which typically last 30 minutes or less. Fluorodeoxyglucose (FDG) PET/CT appears to provide relevant information in the staging and therapy monitoring of many tumors, including lung carcinoma, mesothelioma, colorectal cancer, lymphoma, melanoma, and many others, with the notable exception of prostatic cancer. For prostatic cancer, choline derivatives may become useful radiopharmaceuticals. The published literature on the applications of FDG PET/CT in oncology is still limited, but several well-designed studies have demonstrated the benefits of PET/CT.
556 citations
TL;DR: Scintigraphy predicts subsequent loss of joint space in patients with established OA of the knee joint, and the finding suggests that the activity of the subchondral bone may determine loss of cartilage.
Abstract: OBJECTIVES--To test the hypothesis that bone scintigraphy will predict the outcome of osteoarthritis (OA) of the knee joint. METHODS--Ninety four patients (65 women, 29 men; mean age 64.2 years) with established OA of one or both knee joints were examined in 1986, when radiographs and bone scan images (early and late phase) were also obtained. The patients were recalled, re-examined, and had further radiographs taken in 1991. Paired entry and outcome radiographs were read by a single observer, blinded to date order and other data. Scan findings and other entry variables were related to outcome. Progression of OA of the knee was defined as an operation on the knee or a decrease in the tibiofemoral joint space of 2 mm or more. RESULTS--Over the five year study period 10 patients died and nine were lost to follow up. Fifteen had an operation on one or both knees (22 knees). Of the remaining 120 knees (60 patients) analysed radiographically, 14 (12%) had progressed in the manner defined. Of 32 knees with severe scan abnormalities, 28 (88%) showed progression, whereas none of the 55 knees with no scan abnormality at entry progressed. The strong negative predictive power of scintigraphy could not be accounted for by disease severity or any combination of entry variables. Pain severity predicted a subsequent operation, but age, sex, symptom duration, and obesity had no predictive value. CONCLUSIONS--Scintigraphy predicts subsequent loss of joint space in patients with established OA of the knee joint. This is the first description of a powerful predictor of change in this disease. The finding suggests that the activity of the subchondral bone may determine loss of cartilage.
429 citations