The Value of SPECT-CT in Diagnosing Complex Non-Arthritic and Non-Neoplastic Conditions of the Foot and Ankle.

Abstract

Introduction: There is little information on the value of using single photon emission computerized tomography-computed tomography (SPECT-CT) in non-arthritic and non-neoplastic conditions of the foot and ankle (F&A). The vast majority of studies have investigated the role of SPECT-CT in degenerative conditions, bony pathology, and neoplastic conditions. The diagnostic value of SPECT-CT in purely non-arthritic and non-neoplastic conditions, in the absence of other conclusive radiological findings, is yet to be clarified. The aim of this study was to evaluate the value of SPECT-CT in a cohort of patients with complex F&A pathology, in whom diagnostic uncertainty existed after conventional imaging techniques, and to assess its added value in routine clinical practice.

Methodology: A retrospective analysis of 297 SPECT-CTs from 2010 to 2017 found 18 SPECT-CTs (age = 16-56 years) performed for non-arthritic F&A pathology. Changes in diagnosis, management, and clinical outcome scores were recorded before and after SPECT-CT imaging.

Results: The results demonstrated that the provisional diagnosis was different from the SPECT-CT diagnosis in 10 (56%) out of the 18 patients and led to a modified treatment plan, which was successful in 8 (80%) out of the 10 patients. The post-intervention Manchester Oxford Foot Questionnaire (MOX-FQ) and Visual Analogue Scale (VAS) score improved from 76 ± 18 to 58 ± 24 (P = .02), and from 72 ± 17 to 49 ± 32 (P = .01), respectively. The SPECT-CT scan was useful in confirming the provisional diagnosis in the remaining 8 patients where a diagnostic uncertainty existed after conventional imaging techniques. Overall, a total of 15 out of 18 patients (83%) showed an improvement in their symptoms after management led by SPECT-CT diagnosis.

Conclusion: Our study highlights the added value of SPECT-CT in patients presenting with non-arthritic and non-neoplastic F&A conditions in which there is diagnostic uncertainty after conventional imaging. In 80% of cases, a change in management driven by the SPECT-CT findings led to a successful outcome. We have found SPECT-CT to be a useful investigative modality in assessing these complex F&A cases.

Levels of evidence: Level IV.