Chokkappan Kabilan, Srinivasan Sivasubramanian, Subramanian Manickam, Kannivelu Anbalagan
Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore.
World J Nucl Med. 2015 Sep-Dec;14(3):205-8. doi: 10.4103/1450-1147.163257.
Accessory ossicles are widely prevalent in the ankle and foot. Although they are often asymptomatic, they can present clinically with symptoms at times. When they occur bilaterally in a patient who presents with unilateral complaints, it is clinically difficult to attribute the symptoms to the presence of these common anatomic variants. One needs specific imaging to assess the clinical relevance of the accessory ossicles, in order to tailor the treatment plan. The case presented in this article is one such example, where the patient presented with chronic unilateral ankle pain and initial radiographs revealed bilateral os trigonum and os subtibiale. He underwent a technetium-99m methyl diphosphonate (Tc-99m MDP) bone scan and single photon emission computed tomography/computed tomography (SPECT/CT). The Tc-99m MDP scan showed a focal uptake in the ankle of concern. SPECT/CT complemented the finding by exactly localizing the uptake to the posterior subtalar joint and around the os trigonum, thereby pointing to the diagnosis of os trigonum syndrome.
副骨在踝关节和足部广泛存在。尽管它们通常无症状，但有时也会出现临床症状。当它们在出现单侧症状的患者中双侧出现时，临床上很难将症状归因于这些常见的解剖变异的存在。为了制定治疗方案，需要特定的影像学检查来评估副骨的临床相关性。本文介绍的病例就是这样一个例子，患者表现为慢性单侧踝关节疼痛，最初的X线片显示双侧距三角骨和胫下骨。他接受了锝-99m亚甲基二膦酸盐（Tc-99m MDP）骨扫描和单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）。Tc-99m MDP扫描显示踝关节有一处可疑的局部摄取。SPECT/CT通过将摄取精确地定位到距下后关节和距三角骨周围，补充了这一发现，从而指向距三角骨综合征的诊断。
