Bone scintigraphy in trauma and sport injuries

Abstract

Bone scintigraphy has a long and useful track record in the early detection of trauma, both acute and chronic, since its introduction in the 1970s as a new imaging modality. It has been widely used in the early detection of occult bone injury that is not evident on plain x-ray, with a significant increase in sensitivity with the adoption of SPECT. Adoption of scintigraphy into the investigation of sporting injuries was a more successful enterprise in the last 1970s and 1980s and, in many instances of stress fracture and the medial tibial stress syndrome, became the reference standard. MRI has diminished the role of scintigraphy with its exquisite contrast resolution and excellent spatial resolution, especially for soft-tissue injury. It reflects the cyclical nature of technological advances in imaging. We are now at another exciting crossroad, where SPECT has been combined with CT, allowing the marriage of the superb contrast resolution of SPECT with the high spatial resolution of CT. Early experience suggests that there is an incremental value of 25-30 % over SPECT or CT alone, opening up exciting possibilities for imaging trauma. Evidence for its utility in sporting and non-sporting trauma will be evaluated.