Bloodpool and Late-Phase 3D-Ring CZT SPECT/CT in Freiberg Disease

A 24-year-old woman was referred for chronic right foot pain, with suspicion of stress fracture. 99m Tc-HDP bone scintigraphy using new 3D-ring CZT system (StarGuide) was performed. Bloodpool and late-phase SPECT/CT demonstrated intense increased uptake in the right second metatarsal head, while the CT part of SPECT/CT showed subchondral sclerosis, suggestive of Freiberg disease, which was confirmed by MRI. Our case highlights the importance of including Freiberg disease in the differential diagnosis of uptake in the metatarsal head, especially in its early stages. The CT part of SPECT/CT and/or MRI may be needed to distinguish Freiberg disease from a stress fracture, as both have different therapeutic approaches.