Prevalence and prognostic value of increased uptake in bone SPECT/CT in asymptomatic wrists

Abstract

Purpose: To evaluate the prevalence and prognostic value of increased uptake in SPECT/CT in asymptomatic wrists. Methods: Forty-four patients (18 women, 26 men, median age 42.5 years, range 18–62 years) referred for bone SPECT/CT for painful symptomatic wrist (SW) were additionally imaged on their asymptomatic contralateral wrist (AW). Planar and SPECT/CT images of the SW and AW were performed between July 2014 and September 2016 and retrospectively evaluated for presence, localization, intensity and origin of uptake using a 4-point grading scale (0 = no uptake, 1 = low uptake, 2 = moderate uptake, 3 = high uptake). Fourteen patients with increased uptake in the AW were available for clinical follow-up (median follow-up: 11 months, range 3–15 months). Results: Thirty-one (70.5%, 95% confidence interval (CI): [54.8%, 83.2%]) patients showed increased uptake in the SW and 14 (31.8%, 95% CI: [18.6%, 47.6%]) in the contralateral AW. Mean maximum uptake grade in the SW was 1.48 (range 0–3) and 0.48 (range 0–2) in the AW, respectively. The SW showed significantly more locations with increased uptake (p < 0.001) and significantly higher maximum uptake grades compared to the AW (p < 0.001). Abnormal uptake in AW was due to osteoarthritis (n = 7), mechanical overload (n = 5), trauma (n = 1) and a normal variation of an ankylosis (n = 1). No patient of the follow-up group developed spontaneous pain in the primarily AW with the exception of 5 patients where wrist examination triggered local pain in the anatomical region of increased SPECT/CT uptake. Conclusions: One third of the contralateral asymptomatic wrists demonstrate low to intermediate grade uptake in bone SPECT/CT. The majority of uptake in the contralateral asymptomatic wrist remained clinically silent in the short time follow-up.