SLR - October 2022 - Joseph Cote, DPM
Title: The Added Value of Bloodpool SPECT/CT in painful Non-Operated Foot and AnkleUndiagnosed with Standard Three-Phase Bone Scintigraphy
Référence: Cuvilliers C, Palard-Novello X, Pontoizeau C, Meneret P, Devillers A, Le Jeune F,
Girard A. Front Med (Lausanne). March 2021; 8 634419
Level of Evidence: 2
Reviewed by: Joseph Cote, DPM
Residency program: UF Health, Jacksonville, FL
Podiatric relevance: Subacute and Chronic pain complaints are a common occurrence in a
Podiatric clinical setting. The inherent anatomy of the Foot & Ankle is intricate, with vast
amounts of interplaying structures packed into a small space precisely identifying the source of
pathologic origin proves challenging in the clinical setting. MRI is a gold standard imaging
modality for diagnostic aid. However, in a subacute or chronically pathologic foot, widespread
inflammation and progressive involvement of compensatory structures insult the reliability of
interpreted results. Bloodpool SPECT/CT offers the addition of metabolic insight. Information
that can be used to direct attention to the area of greatest energy imbalance, and inflammatory
source. For subacute and chronic conditions where diagnostic precision and specificity is
blunted for traditional imaging modalities, bloodpool SPECT/CT offers a unique avenue of
structural differentiation for diagnostic reliability.
Methods: Pts with complaint of LE pain >6weeks without previous surgery, underwent standard
3 phase bone scan including late phase SPECT/CT, modified with additional bloodpool
SPECT/CT acquisition. Two independent physicians interpreted scan results of both protocols.
Diagnostic conclusion, confidence and interrater agreements were compared.
Results: 118 lower extremities from 113 patients were scanned. 71 men, average age 53 years.
Addition of bloodpool SPECT/CT changed diagnostic conclusion in 29/118 lower extremities
,24.6%. Tendinopathies were diagnosed in 12.7% of lower extremities rather than 4.2% with
standard bone scan. Subjective diagnostic confidence of readers substantially increased, while
inter reader agreement was not significantly impacted.
Conclusions: Diagnostic confidence and conclusion influence is underwhelming at this point
being reflective of just two readers. Albeit, with Diagnostic conclusions changing in 24.6% of
patient cases after addition of bloodpool SPECT/CT it is apparent this modality reveals results
of clinical interest. Specifically Tendinopathies were observed to be diagnosed with heightened
frequency, whether these findings were relevant or a tangential finding is not confirmed.
Diagnostic confidence and conclusion influence is underwhelming at this point being reflective
of two readers. Further studies to follow patient outcomes with initiation of appropriate
treatment path is needed to determine precision and specificity of diagnostic value