Chronic knee pain assessed by SPECT: comparison with other modalities

Area of Science:

• Orthopedics
• Radiology
• Nuclear Medicine

Background:

• Chronic knee pain affects numerous patients, often necessitating accurate diagnostic methods.
• Conventional radiography, radionuclide angiography, and bone scintigraphy are used to assess knee pathology.
• Distinguishing between osteoarthritis, synovitis, and septic processes can be challenging.

Purpose of the Study:

• To compare the sensitivity of various noninvasive imaging techniques for evaluating knee osteoarthritis.
• To assess the utility of bone scintigraphy in detecting articular cartilage damage, synovitis, and meniscal tears.
• To determine the potential of bone scintigraphy as a pre-arthroscopic screening tool.

Main Methods:

• Prospective examination of 27 patients with chronic knee pain.
• Utilized conventional radiography, radionuclide angiography, planar bone scintigraphy, and single-photon emission computed tomographic (SPECT) bone scintigraphy.
• Correlated imaging results with subsequent arthroscopic findings.

Main Results:

• SPECT bone scintigraphy demonstrated the highest sensitivity in evaluating the extent of knee osteoarthritis.
• Significant differences in detecting articular cartilage damage and synovitis were observed in the patellofemoral compartment.
• Hyperemia associated with cartilage damage and synovitis suggests osteoarthritis can cause increased perfusion, complicating differentiation from septic knee processes.
• SPECT and planar bone scintigraphy showed high sensitivity (1.00 and 0.91, respectively) for torn menisci in a subgroup.

Conclusions:

• SPECT bone scintigraphy is the most sensitive noninvasive method for assessing osteoarthritis severity in the knee.
• Bone scintigraphy is a highly sensitive indicator for torn menisci, offering potential as a pre-arthroscopic screening examination for chronic knee pain.
• Increased perfusion (hyperemia) in osteoarthritis may not reliably distinguish it from septic knee conditions.