Role of computed tomography in chronic ankle and foot pain
A. Navas, MD
Nuclear imaging in orthopaedic decision making with focus on ankle and foot
M. van Dijk, MD, PhD
Nuclear medicine techniques to image infections and inflammation with special attention to osteomyelitis/spondylodiscitis and the diabetic foot
A.W.J.M. Glaudemans, MD
The role of nuclear medicine techniques in differentiation between septic and aseptic loosening of total hip and knee arthroplasty
J.A. Jansen, MD
Nuclear medicine techniques and protocols used for diagnosis of (a)septic loosening of total joint replacements; a survey performed among the members of the Dutch Society of Nuclear Medicine
M.S. Kartachova, MD, PhD
18F-FDG PET/CT, not only diagnostic tool in post-traumatic chronic osteomyelitis but also guidance for operative treatment
M.F. Termaat, MD, Phd
99mTc-sestamibi scintigraphy in perfusion disorders of lumbar spine muscles after lumbar spine fusion surgery
M.S. Kartachova, MD, PhD
COURSES & CONFERENCES
Editorial
From the editors
Since several decades, radionuclide bone scanning has been used to characterise various types of bone pathology; especially bone metastases are detected well before radiographic modalities show structural abnormalities. For a long period of time, in many nuclear medicine practices the use of bone scanning in orthopaedics was limited. This was due to several factors such as the evolvement of radiologic techniques over the past three decades especially of magnetic resonance imaging, lack of guidelines concerning imaging in musculoskeletal diseases, varying experience of orthopaedic surgeons with nuclear medicine techniques, and the dependence on local availability of modern hybrid devices as SPECT/CT. The increased availability of SPECT/CT, which allowed us to detect subtle, nonspecific abnormalities on bone scans and interpret them as specific focal areas of pathology, has brought about important changes in this field. In recent years, bone scintigraphy combined with SPECT/CT has proven its value in the diagnostic workup of articular and non-articular arthropathy (especially in the hip-spine dilemma and chronic ankle and foot pain), occult fractures, stress injuries and many other musculoskeletal pathologies: enough reason to dedicate a special issue of our Journal to this subject, we believe.
As with any disease entity, a close collaboration between nuclear medicine specialists, radiologists and clinicians is mandatory to be able to achieve an optimal diagnostic workup in orthopaedics. We are pleased that this issue contains contributions from nuclear medicine specialists as well as from clinicians and radiologists. The first contribution is from drs. Navas, radiologist at the Leiden University Medical Center; she discusses the role and limitations of CT in the evaluation of the most common injuries around the ankle and foot. Subsequently, dr. van Dijk and dr. Lavalaye, orthopaedic surgeon and nuclear medicine physician at the St. Antonius Hospital in Nieuwegein, underline the importance of the synergistic information obtained with SPECT/CT and its impact on orthopaedic decision making, especially in complex bony structures as the ankle and foot.
Since many years nuclear medicine has played an important role in the diagnostic workup of bone infection. A variety of tracers and techniques have been developed for evaluation of osteomyelitis, spondylodiscitis and prosthetic joint infection; each with its own benefits and limitations. Drs. Glaudemans (nuclear medicine physician at the University Medical Center Groningen) provides us an overview of available nuclear imaging techniques in the field of infection and inflammation, with a special focus on spondylodiscitis and diabetic foot infections. This is followed by a contribution of drs. Jansen, orthopaedic surgeon at the Rijnland Hospital in Leiderdorp, in conjunction with drs. Smit and dr. Pereira Arias–Bouda, nuclear medicine physicians at the same hospital, focusing on the role of nuclear medicine techniques including 18F-FDG PET/CT in diagnosis of prosthetic joint loosening and the ability of these techniques to differentiate between aseptic loosening and infection: a huge diagnostic challenge! The interesting results we (dr. Kartachova and dr. Pereira Arias–Bouda) obtained from our survey among 26 Dutch hospitals on the use of radionuclide techniques for this purpose underline the fact that there is no true consensus on the gold standard technique. Dr. Termaat, trauma surgeon at the Leiden University Medical Center and coworkers, who describe three interesting cases that highlight the diagnostic value of 18F-FDG PET/CT in patients with suspected osteomyelitis after osteosynthesis, close the subject on bone infections.
Last but not least, dr. Kartachova and coworkers describe an interesting observation from the field concerning the relation between findings on 99mTc-sestamibi scintigraphy and perfusion disorders of lumbar spine
muscles after lumbar spine fusion surgery.
As guest-editors we hope this special issue of the Journal will give you support in dealing with the common diagnostic dilemmas in orthopaedics in daily practice. Enjoy reading!
Lenka Pereira Arias-Bouda
Nuclear Medicine, Rijnland Hospital Leiderdorp
Marina Kartachova
Nuclear Medicine, Medical Center Alkmaar