Lorberboym M, Ami D Ben, Zin D, Nikolov G, Adar E
Department of Nuclear Medicine, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Nucl Med Commun. 2003 Apr;24(4):403-10. doi: 10.1097/00006231-200304000-00010.
Painful disorders of the patellofemoral joint are one of the most frequent complaints in orthopaedic and sports medicine. The purpose of this study was to assess the value of single photon emission computed tomography (SPECT) bone imaging compared with arthroscopy in the differential diagnosis of anterior knee pain. Twenty-seven patients with chronic anterior knee pain and 27 age matched control patients were examined prospectively. All patients underwent a detailed clinical history and a thorough physical examination of the knee. Planar and SPECT knee scintigraphy was performed using 99mTc methylene diphosphonate (99mTc-MDP). Subsequently, arthroscopic examination of all three compartments of the affected knee was performed. The association between the scintigraphic findings and arthroscopy was examined statistically. Planar and SPECT scintigrams were classified as follows: focal or diffuse uptake in the patella only (eight patients), uptake in the patella and a corresponding focus in the distal femur (12 patients), and uptake in the patella associated with linear increased activity along the distal femur (six patients). One patient had no patellofemoral SPECT abnormalities. Six of eight patients with isolated increased patellar activity were diagnosed with chondromalacia of the patella, while 2/8 patients had arthroscopic findings unrelated to patellofemoral abnormalities. Seven of 12 patients with corresponding uptake in the patella and distal femur were diagnosed with patellofemoral arthritis. Eleven other patients with corresponding patellar and femoral activity were diagnosed with increased lateral patellar compression syndrome. In these patients the patellar foci were always lateral, and they separated during flexion of the knee. Seven patients had further scintigraphic findings in addition to patellofemoral abnormalities, unsuspected clinically. Nine of 27 patients in the control group (33%) had either focal or diffuse increased patellar uptake. Compared to arthroscopy SPECT imaging had a sensitivity of 100% for patellofemoral abnormalities and a specificity of 64% (negative predictive value, 100%; and positive predictive value, 72%). The overall observed agreement between SPECT and arthroscopy was 81% (kappa=0.63). It is concluded that SPECT imaging of the knee is highly sensitive for the diagnosis of patellofemoral abnormalities. SPECT significantly improves the detection of maltracking of the patella and the ensuing increased lateral patellar compression syndrome. This information could be used to treat patellofemoral problems more effectively.
髌股关节疼痛性疾病是骨科和运动医学中最常见的病症之一。本研究的目的是评估单光子发射计算机断层扫描（SPECT）骨显像与关节镜检查在膝前疼痛鉴别诊断中的价值。对27例慢性膝前疼痛患者和27例年龄匹配的对照患者进行了前瞻性检查。所有患者均接受了详细的临床病史询问和膝关节的全面体格检查。使用99m锝亚甲基二膦酸盐（99mTc-MDP）进行平面及SPECT膝关节闪烁显像。随后，对患侧膝关节的所有三个腔室进行关节镜检查。对闪烁显像结果与关节镜检查结果之间的关联进行了统计学分析。平面及SPECT闪烁图分类如下：仅髌骨局灶性或弥漫性摄取（8例患者）、髌骨摄取且股骨远端有相应病灶（12例患者）、髌骨摄取伴股骨远端线性活性增加（6例患者）。1例患者髌股关节SPECT无异常。8例孤立性髌骨活性增加的患者中，6例被诊断为髌骨软骨软化症，而2/8患者的关节镜检查结果与髌股关节异常无关。12例髌骨和股骨远端有相应摄取的患者中，7例被诊断为髌股关节炎。其他11例有相应髌骨和股骨活性的患者被诊断为外侧髌股挤压综合征增加。在这些患者中，髌骨病灶总是位于外侧，且在膝关节屈曲时分离。7例患者除髌股关节异常外，还有其他闪烁显像结果，临床上未被怀疑。对照组27例患者中有9例（33%）有局灶性或弥漫性髌骨摄取增加。与关节镜检查相比，SPECT成像对髌股关节异常的敏感性为100%，特异性为64%（阴性预测值为100%；阳性预测值为72%）。SPECT与关节镜检查的总体观察一致性为81%（kappa=0.63）。结论是膝关节SPECT成像对髌股关节异常的诊断高度敏感。SPECT显著提高了髌骨轨迹异常及随之而来的外侧髌股挤压综合征增加的检测率。这些信息可用于更有效地治疗髌股关节问题。
