The diagnostic utility of single-photon emission computed tomography combined with computed tomography (SPECT/CT) in hand and wrist disorders: a systematic review

Abstract

Introduction:

This systematic review aimed to investigate the use of single-photon emission computed tomography/computed tomography (SPECT/CT) in diagnosing and managing hand and wrist disorders, especially hand and wrist pain of unknown aetiology.

Methods:

A systematic review of the Embase, MEDLINE and Cochrane databases was performed in accordance with Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Author experiences with SPECT/CT and, where available, sensitivity and specificity data were analysed.

Results:

The search yielded 3546 records, of which 3477 were excluded, leaving 69 for full-text analysis. Fourteen studies were eligible for inclusion. Overall, SPECT/CT demonstrated sensitivities and specificities in the ranges 0.6–0.83 and 0.9–0.1 for non-specific hand and wrist pain (n = 6), 0.75–1.0 and 0.82–0.93 for osseous disorders (n = 5) and 0.72–1.0 and 0.65–0.82 for rheumatic disorders (n = 3). For hand and wrist disorders, SPECT/CT demonstrated comparable sensitivity and specificity to magnetic resonance imaging (MRI), but greater diagnostic accuracy than routine imaging modalities. In cases where the pathology was subtle or ambiguous, SPECT/CT could help confirm the diagnosis, estimate the severity of the condition and identify clinically relevant anatomy.

Conclusion:

Although SPECT/CT has comparable diagnostic accuracy to other cross-sectional imaging modalities, such as MRI, the additional information it provides influences surgical management in only a minority of cases. Its substantial radiation exposure may prevent SPECT/CT from being used routinely, but it can be an effective problem-solving tool in cases where the diagnosis remains unclear despite prior imaging.

Keywords

SPECT CT MRI diagnostic imaging nuclear medicine sensitivity and specificity hand wrist

Introduction

Hand and wrist pain of unknown aetiology is a challenging, yet common, presentation for hand surgeons (Bay et al., 2020; Walker-Bone et al., 2004). Clinical assessment may be inconclusive, given the overlap in symptoms and pain location amongst differential diagnoses (Krastman et al., 2020), and many patients are unable to localize their pain. Although imaging plays a critical role in diagnosis, there is a group of patients for whom standard imaging does not correlate with clinical findings, meaning the underlying pathology remains unclear.

Diagnostic imaging for hand and wrist conditions typically follows a stepwise approach. Conventional radiography is the first-line investigation owing to its accessibility and ability to detect gross osseous abnormalities. (Forman et al., 2005; Van Vugt et al., 1999). However, its low sensitivity and specificity in detecting early rheumatological and soft tissue abnormalities are well recognized (Copeland and Byerly, 2025). Consequently, ultrasound and cross-sectional imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) are often used as second-line diagnostic tools. Ultrasound provides the ability to perform a dynamic assessment, while CT offers high-resolution visualization of bony structures. Magnetic resonance imaging is optimal for assessing soft tissue, cartilage and ligamentous pathology. However, both modalities are limited in their ability to provide dynamic insights into bone metabolism and physiological activity (Deveza et al., 2017; Fogelman and Carr, 1980).

Single-photon emission computed tomography combined with computed tomography (SPECT/CT) is a hybrid imaging technique that combines functional nuclear imaging with high-resolution cross-sectional imaging (Buck et al., 2008). By combining the metabolic insights of SPECT with the anatomical resolution of CT, SPECT/CT may overcome the key limitations of conventional imaging modalities. Despite this potential, SPECT/CT is not routinely used in the diagnostic work-up of hand and wrist disorders as its clinical utility in this context remains unknown.

This systematic review evaluated the diagnostic usefulness of SPECT/CT for disorders of the hand and wrist. Furthermore, we aimed to establish its potential as an adjunctive imaging modality for patients with persistent or unexplained symptoms where the primary diagnosis remains unclear despite standard assessments and imaging.

Methods

This systematic review followed Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) reporting guidelines (Page et al., 2021) and was registered with the international prospective systematic review registry, PROSPERO (ID: CRD42024621940).

Eligibility criteria

Studies were included if they reported on the use of SPECT/CT, with or without a comparator, for the diagnosis or prognosis of any disorder affecting the hand and/or wrist. A hand and/or wrist disorder was defined as any primary or secondary pathology that occurred in the area from the radiocarpal joint distally.

Search strategy and study selection

A systematic search of the Embase, MEDLINE and Cochrane databases was performed from inception to 1 November 2024. Studies were limited to those published in English. The references of the included studies were manually checked to identify any further eligible articles. A comprehensive search strategy was designed in collaboration with a clinical librarian, consisting of index, free-text and Medical Subject Headings terms relevant to the following key concepts: hand, wrist, SPECT, CT and relevant pathologies, see Online Table S1.

All duplicates were removed, after which the remaining records underwent title and abstract screening using the Rayyan systematic review management platform (Ouzzani et al., 2016), with two independent, blinded reviewers (S.S.S., S.Y.). Any conflicts were resolved by a third reviewer (O.M.). A list of potentially eligible articles was then reviewed in full.

Data collection

Two independent reviewers (O.M., S.Y.) collected the data from the included studies using a pre-designed proforma. The following data variables were extracted: first author, year of publication, country, study design, sample size, comparator modality (if applicable), pathology of interest and sensitivity/specificity (if applicable). Further technical details were collected from included articles where applicable, including the type and dose of radioisotope, the timing of scans, and the standardized uptake value (SUV)/details of qualitative assessment of scans.

Risk of bias assessment and statistical analysis

The revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to evaluate the risk of bias and the applicability of the included studies. Owing to the small number of studies and clinical heterogeneity between the included studies, data pooling was not performed. This differed from our PROSPERO protocol owing to the type and number of studies included in our review.

The search yielded 3546 records, of which 3477 were excluded. A full-text review was conducted on the remaining 69 articles. Of these, 55 were excluded. See the PRISMA flow chart for further details (Figure 1). No further eligible studies were identified through hand searching the reference lists of the included articles. Fourteen articles were included. (Abdelhafez et al., 2021; Bhure et al., 2015, 2020; Evbuomwan et al., 2023; Huellner et al., 2012, 2013; Kim et al., 2021; Le Corre et al., 2016; Lee et al., 2020; Lim et al., 2022; Querellou et al., 2014; Schleich et al., 2012; Shirley et al., 2016; Strobel et al., 2014).

Figure 1.

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart depicting identification, screening, and inclusion of eligible studies. SPECT: single-photon emission computed tomography; PET/CT: positron emission tomography/computed tomography; PET/MRI: positron emission tomography/magnetic resonance imaging.

Study characteristics

The 14 included studies reported data on 464 patients with hand and/or wrist conditions undergoing SPECT/CT in Switzerland (n = 6), South Korea (n = 3), the UK, the USA, Australia, France and South Africa (n = 1, respectively) from 2012 to 2023. The detailed characteristics of the studies are reported in Table 1, and the imaging procedures in Table 2.

Table 1.

Demographic breakdown of included studies.

Authors	Year	No. of participants	Country	Pathology	Study design
Abdelhafez et al.	2021	4	USA	Rheumatoid arthritis	Prospective
Bhure et al.	2015	21	Switzerland	Carpal boss	Retrospective
Bhure et al.	2020	48	Switzerland	Non-specific pain of hand/wrist	Retrospective
Evbuomwan et al.	2023	22	South Africa	Rheumatoid arthritis	Retrospective
Huellner et al.	2012	21	Switzerland	Non-specific pain of hand/wrist	Retrospective
Huellner et al.	2013	32	Switzerland	Non-specific pain of hand/wrist	Retrospective
Kim et al.	2021	30	South Korea	Basal joint arthritis	Retrospective
Le Corre et al.	2016	20	Australia	Non-specific pain of hand/wrist (osseous-only)	Retrospective
Lee et al.	2020	26	South Korea	TFCC tear with UIS	Retrospective
Lim et al.	2022	84	South Korea	Rheumatic diseases	Retrospective
Querellou et al.	2014	57	France	Occult wrist fracture	Prospective
Schleich et al.	2012	51	Switzerland	Non-specific pain of hand/wrist	Retrospective
Shirley et al.	2016	21	UK	Non-specific pain of hand/wrist	Retrospective
Strobel et al.	2014	27	Switzerland	UIS	Prospective

TFCC: Triangular fibrocartilage complex; UIS: ulnar impaction syndrome.

Table 2.

SPECT/CT imaging procedures and interpretation.

Study	Radiotracer	Radioisotope dose (MBq) (range)	Diagnostic threshold	Timing of scans post-injection
Abdelhafez et al. (2021)	^99mTc-MDP	963 (SD 36)	Quantitative assessment with MCCR	5 min (soft tissue phase) 3 h (osseous phase)
Bhure et al. (2015)	^99mTc-DPD	649 (599–728)	Standard radiological qualitative assessment	5 min (early-phase) 3 h (late-phase)
Bhure et al. (2020)	^99mTc-DPD	657 (580–730)	Semi-quantitative 4-point scale	3–8 min (early-phase) 3 h (late-phase)
Evbuomwan et al. (2023)	^99mTc-glucosamine (ECDG)	(740–925)	Standard radiological qualitative assessment	3 h
Huellner et al. (2012)	^99mTc-DPD	650	Standard radiological qualitative assessment	Late-phase (timing unspecified)
Huellner et al. (2013)	^99mTc-DPD	650	Standard radiological qualitative assessment	3 h
Kim et al. (2021)	^99mTc-HDP	740	Cutoff SUVmax of 7.90 (3.65–12.94)	3 h
Le Corre et al. (2016)	^99mTc-HDP	(800–900)	Standard radiological qualitative assessment	2–4 h
Lee et al. (2020)	^99mTc-HDP	740	Cutoff SUVmax of 4.09	2–3 h
Lim et al. (2022)	^99mTc-MDP	740	Cutoff SUVmax of 3.5 (MCP), 3.0 (PIP), 3.3 (wrist)	3 h
Querellou et al. (2014)	^99mTc-DPD	9 (per kg)	Standard radiological qualitative assessment	Immediate (early-phase) 3 h (late-phase)
Schleich et al. (2012)	^99mTc-DPD	670	Standard radiological qualitative assessment	Immediate (early-phase) Immediate (early-phase)
Shirley et al. (2016)	^99mTc-HDP	600 ± 60	Standard radiological qualitative assessment	3–3.5 h
Strobel et al. (2014)	^99mTc-DPD	650 (623–673)	Standard radiological qualitative assessment	3.5 h

SPECT/CT: single-photon emission computed tomography/computed tomography; ^99mTc: Technetium-99m; MDP: methylene diphosphonate; DPD: 3,3-diphosphono-1,2-propanodicarboxylic acid; ECDG: ethylenedicysteine-deoxyglucose; HDP: hydroxy-diphosphonate; MBq: megabecquerel; mCi: millicurie; MCCR: maximum corrected count ratio; SUVmax: maximum standardized uptake value; MCP: metacarpophalangeal; PIP: proximal interphalangeal.

Risk of bias

The studies showed a moderate risk of bias (domains 1–4), however with overall strong applicability (domains 5–7). A full breakdown of our risk of bias assessment is shown in Figure 2.

Figure 2.

The revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) assessment of included studies. D(n): Domain number.

Results

Non-specific hand and wrist pain

Six of the 14 studies examined the diagnostic value of SPECT/CT for new presentations of non-specific hand and wrist pain (Table 1). All studies found that SPECT/CT had a comparable diagnostic accuracy to MRI, with a sensitivities and specificities ranging from 0.6 to 0.83 and from 0.9 to 0.1 respectively. In general, SPECT/CT had a lower sensitivity but greater specificity than MRI. All studies that measured interobserver agreement between radiologists also found that SPECT/CT demonstrated greater agreement than MRI. Several studies found that SPECT/CT changed the diagnosis or management despite prior use of conventional imaging (Bhure et al., 2015; Le Corre et al., 2016; Schleich et al., 2012; Shirley et al., 2016) – see Online Table S2. Two studies used SPECT/CT arthrography with intraarticular contrast to enhance ligament and cartilage visualisation (Bhure et al., 2020; Strobel et al., 2014), finding high concordance between the two modalities but greater overall sensitivity with SPECT/CT (Online Table S2).

Osseous disorders

Five studies examined ulnar impaction syndrome (n = 2), occult wrist fractures (n = 1), basal joint arthritis (n = 1) and carpal boss (n = 1). The sensitivity of SPECT/CT ranged from 0.75 to 1.0, with a specificity ranging from 0.82 to 0.93 (Online Table S2). Three studies demonstrated that SPECT/CT showed uptake in areas that were previously negative on CT/MRI. Overall, SPECT/CT findings influenced surgical management in four out of 11 eligible studies (Bhure et al., 2015; Le Corre et al., 2016; Schleich et al., 2012; Shirley et al., 2016), demonstrating an overall positive concordance between wrists showing additional uptake on SPECT/CT and those responding to surgery (Online Table S2). However, a change in the management plan occurred for only a minority of patients scanned.

Rheumatic disorders

Two studies evaluated the prognostic value of SPECT/CT in rheumatoid arthritis (RA), while a third study assessed its use in diagnosing rheumatic diseases in general. In all studies, SPECT/CT uptake reliably correlated with active synovitis and the clinical severity of RA. The sensitivity for active synovitis ranged from 0.72 to 1.0, and the specificity ranged from 0.65 to 0.82. Ultrasound was more specific than SPECT/CT; however, SPECT/CT could differentiate between rheumatic conditions by utilizing SUVs to determine cutoff points for each condition (Lim et al., 2022).

Discussion

This systematic review found that SPECT/CT has comparable sensitivity and specificity to established cross-sectional imaging modalities and can outperform these modalities in equivocal or borderline cases, providing information to inform management decisions. However, there is little evidence to support its routine use in diagnosing hand and wrist conditions. SPECT/CT only changed surgical management in a minority of cases and thus may not be cost-effective or justify the risks associated with additional radiation exposure or adverse reactions to radiopharmaceuticals. Further evidence, however, is needed to determine this.

This study had several limitations. Firstly, high clinical heterogeneity made statistical pooling of sensitivities and specificities unreliable and prevented its implementation. Most studies did not report their true positive, true negative, false positive, and false negative rates, making it impossible to verify their calculations with a contingency table. Differences in the pathology being assessed, the study protocol, the timing of scans after injury, and the time between the reference test and the SPECT/CT scan could also limit the reliability of the conclusions (Table 2). However, considering the chronic nature of the conditions, it is unlikely that they would have resolved between reference and index testing. Since no treatment was given, differences in protocol would have less impact. Secondly, the studies included in this review had small sample sizes. It is known that small studies have lower statistical power and tend to overestimate effect sizes in diagnostic studies (Song et al., 2002). We may have limited our evidence pool by only including studies written in English. Thirdly, several retrospective studies interpreted the index test (SPECT/CT) while knowing the results of the reference test (Abdelhafez et al., 2021; Bhure et al., 2015; Le Corre et al., 2016; Huellner et al., 2012; Shirley et al., 2016) (Figure 2). This could bias the interpreter; however, it is difficult to determine whether this has a noteworthy impact on the diagnostic accuracy of the index test. Well-designed retrospective studies can allow for reliable conclusions, and most of our clinical knowledge comes from retrospective reviews (Brand, 2008). Future studies should aim to use robust blinding measures as some of the higher-quality studies included in this review have done. Finally, evidence of SPECT/CT’s performance in non-autoimmune cases of soft tissue pathology was sparse. Ligament and cartilage injuries were underrepresented in the pathologies across all studies, probably owing to the presumed superior performance of MR in soft tissue pathology compared with SPECT/CT.

In cases of non-specific pain, SPECT/CT scans were found to be more accurate than radiographs, CT scans and bone scintigraphy. This is to be expected given the hybrid anatomical-functional nature of the scan, which provides information that other modalities cannot (Buck et al., 2008). Although SPECT/CT was generally less sensitive than MRI, it was more specific (Huellner et al., 2013), yielding comparable diagnostic accuracy. The diagnostic performance of SPECT/CT vs. MRI is consistent across other non-hand musculoskeletal conditions, including ankle, foot and complex spine conditions (Ha et al., 2015; Thurston et al., 2024). In several studies, SPECT/CT diagnosis directly changed management plans for non-specific pain (Online Table S2), and one study reported positive outcomes as a result (Shirley et al., 2016). Our findings suggest that SPECT/CT may be valuable in confirming diagnoses and aiding surgical planning. However, concordance across modalities was generally high, and surgical cases in which SPECT/CT findings directly altered management plans were in the minority. This suggests that SPECT/CT may not provide a major benefit if used routinely in diagnostic workups.

The clinical use of SPECT/CT has predominantly focused on osseous and non-osseous malignant lesions (Alqahtani et al., 2020). Where a diagnosis had already been made using prior imaging, the main benefit of SPECT/CT was to differentiate clinically noteworthy areas and detect concomitant pathology that had not been seen in the initial imaging. For instance, this has been used to detect concomitant ulnar impaction syndrome and triangular fibrocartilage tears (Lee et al., 2020; Strobel et al., 2014) and to differentiate rheumatic joint diseases (Lim et al., 2022). This is possible due to the quantitative measurements that scintigraphy can provide, specifically localising areas of high SUV, which allows for better radiological correlation with clinical symptoms. This allows for the specific targeting of the most clinically relevant anatomy and can theoretically create diagnostic cutoffs for certain conditions (e.g. RA vs. fibromyalgia; Lim et al., 2022). SPECT/CT showed higher interobserver agreement among both experienced and inexperienced readers than MRI or radiography (Huellner et al., 2013). In a diagnostic workup, this may be beneficial if rapid interpretation is required; however, this scenario is unlikely to arise in the context of hand and wrist conditions.

Prognostic studies have demonstrated that SPECT/CT uptake, as measured by SUVmax or qualitative interpretation, reliably correlates with disease activity. The SUVmax has also been found to stratify risk in amyloid transthyretin-related cardiomyopathy (Caobelli et al., 2024) and to monitor treatment response and predict survival in prostate cancer (Dittmann et al., 2021; Neubauer et al., 2024). However, multiple studies in our review noted that SPECT/CT can overestimate the clinical importance of some areas of uptake. This can make correlating these to clinical symptoms more challenging and may lead to overtreatment. The same has been found to be the case in sentinel lymph node biopsies of head and neck malignancies (Remenschneider et al., 2015). In the case of hand and wrist disorders, this phenomenon could cause more harm than good. Given the widespread availability and low cost and absence of radiation exposure of ultrasound, SPECT/CT may have no role in the routine determination of prognosis of autoimmune hand and wrist conditions.

The included studies provided no details or discussion surrounding the economic burden or cost-effectiveness of SPECT/CT. In non-hand literature, however, there is some evidence that SPECT/CT can save costs as a strategy to avoid surgery in cases of persistent knee pain after total knee arthroplasty and in small renal masses (Su et al., 2021; Van den Wyngaert et al., 2018). However, SPECT/CT was applied in specific and uncommon situations in these studies, so there is little evidence of its broad cost-effectiveness as a routine modality.

While the included studies reported no adverse reactions, technetium-99m (^99mTc)-based radiopharmaceuticals commonly cause nausea, vomiting and erythematous skin reactions (Meher et al., 2021). In addition, an intravenous dose carries substantial radiation exposure. The most commonly used radiopharmaceutical was ^99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (^99mTc-DPD), which was used in seven of the 14 included studies (Table 2). A SPECT/CT scan using 700 MBq of ^99mTc-DPD results in radiation exposure equivalent to 6.7 mSv (Quarta et al., 2021), which translates to an additional fatal cancer case for every 3000 patients scanned (Lin, 2010). Considering that the radiation exposure for a standard CT wrist scan is 0.15 mSv (Iordache et al., 2017) and is negligible for an MRI scan, both surgeons and patients need to give serious consideration to these risks for informed decision-making.

Overall, despite having comparable sensitivity and specificity to other cross-sectional imaging modalities, such as MRI, the evidence suggests that it cannot replace them. This is demonstrated by the fact that it only influences surgical management in a minority of cases. While its dual anatomical and functional nature is advantageous in specific scenarios, it can also lead to the overestimation of the clinical relevance of areas of uptake in others. Furthermore, SPECT/CT may carry a financial and radiation burden that is not justified by its demonstrated benefits. This is particularly the case when it comes to predicting autoimmune conditions, where ultrasound carries zero radiation and radiopharmaceutical risks and costs a fraction of the price. Based on the current evidence, SPECT/CT should not be used routinely in diagnostic procedures and offers little benefit in cases of obvious pathology. However, in select circumstances where the pathology is subtle or the prior imaging is inconclusive, SPECT/CT can be an effective problem-solving tool.

Supplemental Material

sj-docx-1-jhs-10.1177_17531934251404743 – Supplemental material for The diagnostic utility of single-photon emission computed tomography combined with computed tomography (SPECT/CT) in hand and wrist disorders: a systematic review

Supplemental material, sj-docx-1-jhs-10.1177_17531934251404743 for The diagnostic utility of single-photon emission computed tomography combined with computed tomography (SPECT/CT) in hand and wrist disorders: a systematic review by Onyedi Moses, Sharon Yohannes, Shaikh S Seraj, Luke Geoghegan and Maxim D Horwitz in Journal of Hand Surgery (European Volume)

Supplemental Material

sj-docx-2-jhs-10.1177_17531934251404743 – Supplemental material for The diagnostic utility of single-photon emission computed tomography combined with computed tomography (SPECT/CT) in hand and wrist disorders: a systematic review

Supplemental material, sj-docx-2-jhs-10.1177_17531934251404743 for The diagnostic utility of single-photon emission computed tomography combined with computed tomography (SPECT/CT) in hand and wrist disorders: a systematic review by Onyedi Moses, Sharon Yohannes, Shaikh S Seraj, Luke Geoghegan and Maxim D Horwitz in Journal of Hand Surgery (European Volume)

Footnotes

Acknowledgements

Evidence search strategy: Ms Assad Lahlou, Barts Health Knowledge and Library Services.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Ethical approval

Not applicable.

Informed consent

Not applicable.

ORCID iDs

Onyedi Moses

Shaikh S Seraj

Luke Geoghegan

Supplementary material

Supplemental material for this article is available online.

References

Abdelhafez

Godinez

Sood

, et al. Feasibility of dual-phase ^99mTc-MDP SPECT/CT imaging in rheumatoid arthritis evaluation. Quant Imaging Med Surg. 2021, 11: 2333–43.

Alqahtani

Fulton

Constable

Willowson

Kench

PL.

Diagnostic performance of whole-body SPECT/CT in bone metastasis detection using 99mTc-labelled diphosphate: a systematic review and meta-analysis. Clin Radiol. 2020, 75: 961.e11–e24.

Bay

COA

Willacy

Moses

Coleman

Wilson

. Nonspecific wrist pain in pediatric patients: a systematic review. J Orthop. 2020, 22: 308–15.

Bhure

Hug

Huellner

, et al. The value of SPECT/CT in carpal boss. Eur J Nucl Med Mol Imag. 2015, 42: 1883–90.

Bhure

Roos

Perez-Lago

MDS

Strobel

Single-photon emission computed tomography/computed tomography arthrography of wrist, ankle, and knee joints. Nucl Med Commun. 2020, 41: 182–8.

Brand

RA.

Writing for clinical orthopaedics and related research. Clin Orthop Relat Res. 2008, 466: 239–47.

Buck

Nekolla

Ziegler

, et al. SPECT/CT. J Nucl Med. 2008, 49: 1305–19.

Caobelli

Gözlügöl

Bakula

, et al. Prognostic value of [^99mTc]Tc-DPD quantitative SPECT/CT in patients with suspected and confirmed amyloid transthyretin-related cardiomyopathy and preserved left ventricular function. J Nucl Med. 2024, 65: 944–51.

Copeland

Byerly

DW.

Wrist imaging. Treasure Island, FL, StatPearls Publishing, 2025.

10.

Deveza

Kraus

Collins

, et al. Association between biochemical markers of bone turnover and bone changes on imaging: data from the osteoarthritis initiative. Arthritis Care Res (Hoboken). 2017, 69: 1179–91.

11.

Dittmann

Kaltenbach

Weissinger

, et al. The prognostic value of quantitative bone SPECT/CT before ²²³Ra treatment in metastatic castration-resistant prostate cancer. J Nucl Med. 2021, 62: 48–54.

12.

Evbuomwan

Engelbrecht

Driver

, et al. Head-to-head comparison of ultrasound and ^99mTc-glucosamine SPECT/CT imaging of patients with rheumatoid arthritis: a single center prospective study. Egypt J Radiol Nucl Med. 2023, 54: 223.

13.

Fogelman

Carr

A comparison of bone scanning and radiology in the evaluation of patients with metabolic bone disease. Clin Radiol. 1980, 31: 321–6.

14.

Forman

Rose

NE.

A clinical approach to diagnosing wrist pain. Am Fam Physician. 2005, 72: 1753–8.

15.

Hong

Paeng

, et al. Comparison of SPECT/CT and MRI in diagnosing symptomatic lesions in ankle and foot pain patients: diagnostic performance and relation to lesion type. PLoS One. 2015, 10: e0117583.

16.

Huellner

Bürkert

Schleich

, et al. SPECT/CT versus MRI in patients with nonspecific pain of the hand and wrist – a pilot study. Eur J Nucl Med Mol Imaging. 2012, 39: 750–9.

17.

Huellner

Bürkert

Strobel

, et al. Imaging non-specific wrist pain: interobserver agreement and diagnostic accuracy of SPECT/CT, MRI, CT, bone scan and plain radiographs. PLoS One. 2013, 8: e85359.

18.

Iordache

Goldberg

Paz

Peylan

Hur

Steinmetz

Radiation exposure from computed tomography of the upper limbs. Acta Orthop Belg. 2017, 83: 581–8.

19.

Kim

Y-I

Ryu

J-S

Kim

Al-Dhafer

BAA

Shin

. Quantitative bone single-photon emission CT/CT parameters reflect pain and functional status of symptomatic basal joint arthritis of the thumb. Bone Joint J. 2021, 103-B: 1380–5.

20.

Krastman

Mathijssen

NMC

Bierma-Zeinstra

SMA

Kraan

Runhaar

Diagnostic accuracy of history taking, physical examination and imaging for non-chronic finger, hand and wrist ligament and tendon injuries: a systematic review update. BMJ Open. 2020, 10: e037810.

21.

Le Corre

Huynh

Dhaliwal

Bain

GI.

Development of a protocol for SPECT/CT in the assessment of wrist disorders. J Wrist Surg. 2016, 5: 297–305.

22.

Lee

Han

Gong

Lee

WW.

Semiquantitative single-photon-emission computed tomography /computed tomography study to evaluate concomitant ulnar impaction syndrome in patients presenting with triangular fibrocartilage complex tears. PLoS One. 2020, 15: e0244256.

23.

Lim

Kim

H-S

Lee

K-A

Kim

Park

SB.

Clinical significance of quantitative bone SPECT/CT in the evaluation of hand and wrist pain in patients with rheumatic disease. Sci Rep. 2022, 12: 327.

24.

Lin

EC.

Radiation risk from medical imaging. Mayo Clin Proc. 2010, 85: 1142–6; quiz 1146.

25.

Meher

Agrawal

Gnanasegaran

Review of adverse reactions associated with the use of common diagnostic radiopharmaceuticals. Indian J Nucl Med. 2021, 36: 163–7.

26.

Neubauer

Nicolas

Bauman

, et al. Early response monitoring during [¹⁷⁷Lu]Lu-PSMA I&T therapy with quantitated SPECT/CT predicts overall survival of mCRPC patients: subgroup analysis of a Swiss-wide prospective registry study. Eur J Nucl Med Mol Imaging. 2024, 51: 1185–93.

27.

Ouzzani

Hammady

Fedorowicz

Elmagarmid

Rayyan – a web and mobile app for systematic reviews. Syst Rev. 2016, 5: 210.

28.

Page

McKenzie

Bossuyt

, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021, 372: n71.

29.

Quarta

Zheng

Hutt

, et al. 99mTc-DPD scintigraphy in immunoglobulin light chain (AL) cardiac amyloidosis. Eur Heart J Cardiovasc Imaging. 2021, 22: 1304–11.

30.

Querellou

Arnaud

Williams

, et al. Role of SPECT/CT compared with MRI in the diagnosis and management of patients with wrist trauma occult fractures. Clin Nucl Med. 2014, 39: 8–13.

31.

Remenschneider

Dilger

Wang

Palmer

Scott

Emerick

KS.

The predictive value of single-photon emission computed tomography/computed tomography for sentinel lymph node localization in head and neck cutaneous malignancy. Laryngoscope. 2015, 125: 877–82.

32.

Schleich

Schürch

Huellner

, et al. Diagnostic and therapeutic impact of SPECT/CT in patients with unspecific pain of the hand and wrist. EJNMMI Res. 2012, 2: 53.

33.

Shirley

Dhawan

Rodrigues

Evans

DM.

Bone SPECT-CT: an additional diagnostic tool for undiagnosed wrist pain. J Plast Reconstr Aesthet Surg. 2016, 69: 1424–9.

34.

Song

Khan

Dinnes

Sutton

AJ.

Asymmetric funnel plots and publication bias in meta-analyses of diagnostic accuracy. Int J Epidemiol. 2002, 31: 88–95.

35.

Strobel

Steurer-Dober

Da Silva

, et al. Feasibility and preliminary results of SPECT/CT arthrography of the wrist in comparison with MR arthrography in patients with suspected ulnocarpal impaction. Eur J Nucl Med Mol Imaging. 2014, 41: 548–55.

36.

Patel

Huang

, et al. Cost-effectiveness analysis of ^99mTc-sestamibi SPECT/CT to guide management of small renal masses. Eur Urol Focus. 2021, 7: 827–34.

37.

Thurston

Hurley

Raheel

, et al. A comparison of magnetic resonance imaging and SPECT-CT imaging in complex spine pathology: does SPECT-CT provide additional diagnostic information over magnetic resonance imaging? Glob Spine J. 2024, 14: 1997–2003.

38.

Van den Wyngaert

Palli

Imhoff

Hirschmann

MT.

Cost-effectiveness of bone SPECT/CT in painful total knee arthroplasty. J Nucl Med. 2018, 59: 1742–50.

39.

van Vugt

Bijlsma

van Vugt

AC.

Chronic wrist pain: diagnosis and management. Development and use of a new algorithm. Ann Rheum Dis. 1999, 58: 665–74.

40.

Walker-Bone

Palmer

Reading

Coggon

Cooper

Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Arthritis Care Res (Hoboken). 2004, 51: 642–51.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.02 MB