Imaging Non-Specific Wrist Pain: Interobserver Agreement and Diagnostic Accuracy of SPECT/CT, MRI, CT, Bone Scan and Plain Radiographs

PURPOSE: Chronic hand and wrist pain is a common clinical issue for orthopaedic surgeons and rheumatologists. The purpose of this study was 1. To analyze the interobserver agreement of SPECT/CT, MRI, CT, bone scan and plain radiographs in patients with non-specific pain of the hand and wrist, and 2. to assess the diagnostic accuracy of these imaging methods in this selected patient population. MATERIALS AND METHODS: Thirty-two consecutive patients with non-specific pain of the hand or wrist were evaluated retrospectively. All patients had been imaged by plain radiographs, planar early-phase imaging (bone scan), late-phase imaging (SPECT/CT including bone scan and CT), and MRI. Two experienced and two inexperienced readers analyzed the images with a standardized read-out protocol. Reading criteria were lesion detection and localisation, type and etiology of the underlying pathology. Diagnostic accuracy and interobserver agreement were determined for all readers and imaging modalities. RESULTS: The most accurate modality for experienced readers was SPECT/CT (accuracy 77%), followed by MRI (56%). The best performing, though little accurate modality for inexperienced readers was also SPECT/CT (44%), followed by MRI and bone scan (38% each). The interobserver agreement of experienced readers was generally high in SPECT/CT concerning lesion detection (kappa 0.93, MRI 0.72), localisation (kappa 0.91, MRI 0.75) and etiology (kappa 0.85, MRI 0.74), while MRI yielded better results on typification of lesions (kappa 0.75, SPECT/CT 0.69). There was poor agreement between experienced and inexperienced readers in SPECT/CT and MRI. CONCLUSIONS: SPECT/CT proved to be the most helpful imaging modality in patients with non-specific wrist pain. The method was found reliable, providing high interobserver agreement, being outperformed by MRI only concerning the typification of lesions. We believe it is beneficial to integrate SPECT/CT into the diagnostic imaging algorithm of chronic wrist pain

Auf den Spuren der Konkurrenz. Kultur- und sozialwissenschaftliche Perspektiven

Bürkert K, Engel A, Heimerdinger T, Tauschek M, Werron T, eds. Auf den Spuren der Konkurrenz. Kultur- und sozialwissenschaftliche Perspektiven. Freiburger Studien zur Kulturanthropologie . Vol 2. Münster; New York: Waxmann; 2019

Form und Typen der Konkurrenz

Werron T. Form und Typen der Konkurrenz. In: Bürkert K, Engel A, Heimerdinger T, Tauschek M, Werron T, eds. Auf den Spuren der Konkurrenz. Kultur- und sozialwissenschaftliche Perspektiven. Freiburger Studien zur Kulturanthropologie. Vol 2. Münster; New York: Waxmann; 2019: 17-44

Form und Typen der Konkurrenz

Werron T. Form und Typen der Konkurrenz. In: Bürkert K, Engel A, Heimerdinger T, Tauschek M, Werron T, eds. Auf den Spuren der Konkurrenz. Kultur- und sozialwissenschaftliche Perspektiven. Freiburger Studien zur Kulturanthropologie. Vol 2. Münster; New York: Waxmann; 2019: 17-44

Kappa of interobserver agreement in detection of the relevant lesion.

<p>The error bars delineate the 95% confidence interval. </p

50-year-old female with ulnocarpal impaction syndrome.

<p>Relative overlength of the distal articular surface of the ulna on plain radiograph with localized geographic cystic-sclerotic changes in the medial proximal pole of the lunate and overprojection of TFCC calcification (a), focally increased radiotracer uptake in the carpal region on bone scan (b, arrow), subcortical cyst with rim sclerosis at the proximal ulnar pol of the lunate bone on CT (c, arrow), subcortical cyst displaying tracer accumulation on SPECT/CT fusion image (d, arrow), several subchondral cysts with adjacent alterations of bone marrow signal in the proximal ulnar pol of the lunate bone in PDw SPIR (e, arrow) and T1w image (f, arrow) on MRI. </p

44-year-old female with osteomalacia of the lunate bone.

<p>Relative shortness of the distal articular surface of the ulna on plain radiograph (a), focally increased radiotracer uptake in the carpal region on bone scan (b), slightly hyperdense and coarse trabecular structure of the lunate bone on CT (c), tracer accumulation throughout the lunate bone on SPECT/CT fusion image (d), altered signal of lunate bone marrow in PDw SPIR (e) and T1w image (f) on MRI. Besides, there is also focal tracer accumulation in the ulnar-sided base of the 2^nd metacarpal (d) indicating a “carpal boss”, which was not in the main clinical focus at that time. </p