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Research

EVALUATING THE UTILITY OF SPECT/CT FOR THE IDENTIFICATION OF CARTILAGE LESIONS: A SYSTEMATIC REVIEW

The British Orthopaedic Research Society (BORS) 2023 Meeting, Cambridge, England, 25–26 September 2023.



Abstract

Abstract

Objective

A common orthopaedic pain found in a wide spectrum of individuals, from young and active to the elderly is anterior knee pain (AKP). It is a multifactorial disorder which is thought to occur through muscular imbalance, overuse, trauma, and structural malalignment. Over time, this can result in cartilage damage and subsequent chondral lesions. Whilst the current gold standard for chondral lesion detection is MRI, it is not a highly sensitive tool, with around 20% of lesions thought to be mis-diagnosed by MRI. Single-photon emission computerised tomography with conventional computer tomography (SPECT/CT) is an emerging technology, which may hold clinical value for the detection of chondral lesions. SPECT/CT may provide valuable diagnostic information for AKP patients who demonstrate absence of structural change on other imaging modalities. This review systematically assessed the value of SPECT/CT as an imaging modality for knee pain, and its ability to diagnose chondral lesions for patients who present with knee pain.

Methods

Using PRISMA guidelines, a systematic search was carried out in PubMed, Science Direct, and Web of Knowledge, CINAHL, AMED, Ovid Emcare and Embase. Inclusion criteria consisted of any English language article focusing on the diagnostic value of SPECT/CT for knee chondral lesions and knee pain. Furthermore, animal or cadaver studies, comparator technique other than SPECT/CT or patients with a pathology other than knee chondral lesions were excluded from the study. Relevant articles underwent QUADAS-2 bias assessment.

Results

11,982 manuscripts were identified, and the titles were screened for relevance. Seven studies were selected as being appropriate and were subjected to QUADAS-2 assessment. All 7 articles scored low for bias. Two papers deemed that the ICRS score of chondral lesions at intraoperative assessment correlated with SPECT/CT tracer uptake. Two studies concluded that MRI significantly correlated with SPECT/CT tracer uptake, with some instances whereby SPECT/CT identified more chondral lesions than MRI. Two papers compared bone scintigraphy (BS) to SPECT/CT and concluded that SPECT/CT was not only able to identify more chondral lesions than BS, but also localise and characterise the lesions.

Conclusion

Evidence implies that SPECT/CT may be a useful imaging modality for the detection and localisation of cartilage lesions, particularly in discrepant cases whereby there is an absence of lesions on other imaging modalities, or a lack of correspondence with patients’ symptoms. More studies would be of value to confirm the conclusions of this review.

Declaration of Interest

(b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.