Ces radiol. 2011, 65(3):210-217

The contribution of SPECT/CT in the diagnosis of avascular necrosis of the femoral head of adultReview article

Ladislav Zadražil^1,2,3, Petr Libus¹

¹ Oddělení nukleární medicíny, Nemocnice Havlíčkův Brod, p.o.

² Radiodiagnostické oddělení, Nemocnice Havlíčkův Brod, p.o.

³ Radiologická klinika LF MU, Brno

Avascular necrosis of the femoral head of adults is one of the diseases whose early diagnosis and treatment with the aim to protect the joint substantially improves the prognosis of patients. The disadvantage of both conventional radiographs and the native CT is a low sensitivity to early stages of the disease. Functional image through the bone scintigraphy brings into the diagnostic process sensitivity for the initial stages of ischemia when the radiographic image is still normal. The combination of both methods enables to localize anatomically the altered metabolic activity of osteoblasts, to assess the morphological and metabolic image of the bone reparative changes at the same time, to diagnose secondary complications and to find out whether a persistent metabolic activity in residual changes after an AVN remains.
This article will present a survey of the basic pathogenetic events that occur during the development of the disease and detect the pathophysiological substance of scintigraphic and of radiological findings on CT and X-ray images. It describes the technique of the SPECT/CT examination following immediately the whole-body bone scintigraphy as well and tries to put an objective view of the possibilities, diagnostic contribution and limits of this method.
Although nowadays the nuclear magnetic resonance imaging (MRI) for the diagnosis of aseptic necrosis is more and more often used, bone scintigraphy, especially in a three-phase modification, remains a highly sensitive method of detecting early stages of the disease. The combination of the scintigraphy and CT in a hybrid apparatus ensures the anatomical precision into functional imaging and a CT scan is useful above all in later stages when the morphological changes in the subchondral bone appear.

Keywords: femur head necrosis, single-photon emission computed tomography, X-ray computed tomography

Accepted: September 1, 2011; Published: September 1, 2011  Show citation