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(99m)Tc-DPD-SPECT/CT predicts the outcome of imaging-guided diagnostic anaesthetic injections: A prospective cohort study.
MedLine Citation:
PMID:  20951520     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
PURPOSE: We hypothesized that bone SPECT combined with multiplanar reconstructed CT can identify and target the pain-inducing focus in the foot and can be used to successfully guide anaesthetic infiltrations. Therefore we prospectively investigated feasibility and predictive value of bone SPECT/CT for image guided diagnostic infiltrations in patients with chronic foot pain.
METHODS: All patients received a standardized bone SPECT/CT of both feet. The scintigraphically most active structures were subsequently infiltrated with local anaesthetics under CT-guidance. The pre- and post-infiltration pain intensity was measured using the visual analogue scale (VAS). Then, we assessed (i) the agreement on pain originating structures determined by standard clinical assessment versus SPECT/CT and (ii) the predictive value of SPECT-CT in groups with and without agreement.
RESULTS: 27 of 30 participants reported a pain reduction on VAS of 50% or more, resulting in a response rate of 90%. When assessing the agreement on pain initiating structures determined by standard clinical assessment versus SPECT/CT, we found a disagreement in 16 of 30 (53%) cases. Particularly, disagreement appeared in all 9 participants with symptoms located in the mid-foot (100%). In participants with hind-foot pathology, disagreement was found in 7 of 21 cases (33%).
CONCLUSION: The present study shows the feasibility of (99m)Tc-DPD-SPECT/CT guided infiltration of osseous structures of patients with chronic foot pain. (99m)Tc-DPD-SPECT/CT had a higher predictive value on the clinical outcome than the clinical assessment. In the clinical setting (99m)Tc-DPD-SPECT/CT might overrule the clinical assessment in case of disagreement on the target lesion.
Authors:
Martin Kretzschmar; Martin Wiewiorski; Helmut Rasch; Augustinus L Jacob; Deniz Bilecen; Martin A Walter; Victor Valderrabano
Publication Detail:
Type:  Journal Article     Date:  2010-10-15
Journal Detail:
Title:  European journal of radiology     Volume:  80     ISSN:  1872-7727     ISO Abbreviation:  Eur J Radiol     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-11-07     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8106411     Medline TA:  Eur J Radiol     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  e410-5     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
Affiliation:
Division of Interventional Radiology, University Hospital, Petersgraben 4, CH-4031 Basel, Switzerland.
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