The Value of SPECT/CT in the Diagnostic Process of Chronic Non-Specific Wrist Pain

Purpose: Chronic non-specific wrist pain is a diagnostic challenge. The purpose of this study was to evaluate the benefit of 3D-scintigraphy (Single Photon Emission Tomography (SPECT)) combined with high resolution computed tomography (CT) compared to established standard imaging modalities in a clinical workup. Methods: From March 2010 to March 2013, 36 consecutive patients with chronic nonspecific wrist pain undergoing SPECT/CT were reviewed retrospectively. All patients were initially evaluated by non-conclusive standard imaging modalities, such as bi-/multi-planar xrays of the wrist (n=36), CT (n=2), sonography (n=17), MRI (n=10), MR arthrography (n=7), conventional scintigraphy (n=2) or diagnostic arthroscopy (n=2), before SPECT/CT was employed. The new diagnostic information gained by SPECT/CT was grouped according to its effects on the diagnosis and the therapeutic management. These effects were defined as confirmation or correction of the diagnosis and the maintenance or change of treatment. In addition, subjective patient outcome was evaluated with a minimum follow-up of 12 months. Results: Twenty-one females, 15 males, mean age 43±12 years, range 20-64 years were included. In 26 the chronic wrist pain originated from an initial trauma, in 10 the onset of symptoms was not trauma related. Twenty had a history of previous wrist surgery. SPECT/CT was performed 6.3 ± 12.9 months after the onset of pain. The findings of SPECT/CT confirmed the previously suspected diagnosis in 4 patients (11%). In 30 patients (83%) the diagnosis was modified. In 2 cases (6%), SPECT/CT was non-conclusive. The information gained by SPECT/CT led to a change of the therapeutic management in 21 patients (58%). Patient satisfaction and ability to work increased after the therapeutic changes based on SPECT/CT findings. Conclusions: The diagnostic information gained by SPECT/CT in patients with chronic nonspecific wrist pain altered the therapeutic management and patient satisfaction in the majority of our study group.