SPECT-CT: Applications of a novel imaging tool in foot & ankle surgery

Gregory Neal-Smith, Daniel Marsland, Robin Elliot

North Hampshire Hospitals

Diagnostic uncertainty is common when treating foot and ankle pathology, due to complex anatomy or previous surgery. Single Photon Emission Computed Tomography-CT (SPECT-CT) has emerged as a novel tool and combines gamma radiation with traditional CT to accurately identify sites of pathology and pain generation. A recent study showed that SPECT-CT led to a change of management in 48% of the patients when compared with diagnosis based on MRI. The aim of the current study was to demonstrate the diagnostic value of SPECT-CT in foot and ankle surgery.

Data was collected on all SPECT-CT imaging ordered by a single foot and ankle consultant between September 2020 and March 2022. 47 patients were included, and patient notes were reviewed to investigate the reasons for using this imaging modality.

Three broad categories were identified where SPECT-CT can be particularly useful: pre-operative surgical decision making in the complex degenerate foot; pain after total ankle replacement; and pain after fusion surgery. We present cases to highlight how SPECT-CT scans influence decision making in managing complex foot and ankle pathology.

We have found SPECT-CT to be a valuable tool when there is diagnostic uncertainty despite traditional imaging modalities. It can help guide further treatment and reduce the need for unnecessary or incorrect surgery. Large, prospective studies on the use of SPECT-CT are required to further define the role of SPECT-CT and its impact upon success rates of surgery.