3rd Annual SPECT/CT symposium: current status and future directions of SPECT/CT imaging

Registered Charity No: 215869

3rd Annual SPECT/CT symposium: current status and future directions of SPECT/CT imaging 24 February 2014 Venue: Royal Society of Medicine 7 CPD credits

Kindly supported by:

BIR Annual Congress 2014 - 22-23 October, London

Welcome and thank you for coming to the ‘3rd Annual SPECT/CT symposium’ organised jointly by the British Institute of Radiology and the British Nuclear Medicine Society.

This booklet contains the abstracts and biographies for each speaker (where supplied).

This meeting has been awarded 7 RCR category I CPD credits.

CPD certificates will be distributed by email within two weeks of the meeting once the online delegate survey has been completed.

Please complete the online delegate survey using the below link. We will use your valuable feedback to improve future conferences. https://www.surveymonkey.com/s/3RD_SPECT We hope you find the day interesting and enjoyable.

Dr Gopinath Gnanasegaran, Meeting organiser, Consultant Nuclear Medicine Physician, Guy’s and St Thomas’ NHS Foundation Trust

We are most grateful to

for supporting this event

PROGRAMME

08:45 Registration and refreshments 09:15 Faculty introduction Chair: Dr Gopinath Gnanasegaran, Consultant Nuclear Medicine Physician,

Guy’s and St Thomas’ NHS Foundation Trust 09:30 SPECT/CT: technical aspects

Dr Lefteris Livieratos, Principal Medical Physicist,

Guy’s and St Thomas’ Hospital 10:00 Musculoskeletal CT: tips for the SPECT/CT practitioner

Dr Marko Berovic, Consultant Radiologist, Whittington Hospital NHS Trust 10:30 Musculoskeletal MRI: tips for SPECT/CT users

Dr Priya Suresh, Consultant Radiologist, Plymouth Hospitals NHS Trust 11:00 Refreshments Chair: Dr Syed Rizwan, Consultant Radiologist and Nuclear Physician,

Institute of Nuclear Medicine UCLH 11:30 SPECT/CT in malignant bone disease

Dr Gopinath Gnanasegaran, Consultant Nuclear Medicine Physician,

Guy’s and St Thomas’ NHS Foundation Trust 12:00 SPECT/CT in sentinel lymph node localisation

Dr Renato Valdés Olmos, Senior Consultant in Nuclear Medicine,

Netherlands Cancer Institute 12:30 Lunch Chair: Dr Sanjay Vijayanathan, Consultant MSK Radiologist, Guy’s and St Thomas’

NHS Foundation Trust 13:30 SPECT/CT imaging protocols and reconstruction

Dr Malavika Nathan, Consultant in Nuclear Medicine and Radiology,

Royal Free London NHS Foundation Trust 14:00 Bone SPECT/CT in spinal imaging

Dr Ranju Dhawan, Consultant Radiologist, Imperial College Healthcare

NHS Trust

14:30 SPECT/CT reporting: systematic approach

Dr Sanjay Vijayanathan, Consultant MSK Radiologist,

Guy’s and St Thomas’ NHS Foundation Trust 14:50 Refreshments Chair: Dr Gopinath Gnanasegaran, Consultant Nuclear Medicine Physician,

Guy’s and St Thomas’ NHS Foundation Trust 15:20

SPECT/CT for evaluation of patients with painful knees after total knee arthroplasty Dr Michael T Hirschman, Consultant Orthopaedic Surgeon, Department of Orthopaedic Surgery and Traumatology, Switzerland

16:00 SPECT/CT in foot and ankle pathology

Dr Malavika Nathan, Consultant Radiologist,

Royal Free Hampstead NHS Trust 16:30 Bone SPECT/CT in hand and wrist surgical practice

Dr Ranju Dhawan, Consultant Radiologist, Imperial College Healthcare

NHS Trust 17:00 SPECT/CT in oncology: when and why

Professor Val Lewington, Professor of Clinical Therapeutic Nuclear

Medicine, King’s College London 17:30 SPECT/CT in infection

Dr Shaunak Navalkissoor, Consultant Nuclear Medicine Physician,

Royal Free Hampstead NHS Trust 18:00 Close of meeting ________________________________________________________________

Please remember to complete the online delegate survey using the below link: https://www.surveymonkey.com/s/3RD_SPECT Your certificate of attendance will be emailed to you within the next two weeks once these have been completed.

BIR Annual Congress 2014 - 22-23 October, London

Speaker profiles (where supplied) Dr Marko Berovic Consultant Radiologist, Whittington Hospital NHS Trust After completing core physicians training I chose radiology as a career and enrolled on the UCLH training scheme. My final year was a fellowship in nuclear medicine at UCLH and I joined the specialist register with a subspecialty interest in radionuclide radiology in 1998. Since then I have been the clinical lead of the nuclear medicine service at the Whittington Hospital and have developed further interests in musculoskeletal and chest imaging within my radiology and nuclear medicine practices.

Dr Ranju Dhawan Consultant Radiologist, Imperial College Healthcare NHS Trust Dr Ranju T Dhawan is a dual specialty accredited Consultant cross-sectional Radiologist and Nuclear Medicine Physician based at St Mary’s Hospital Campus, Imperial College Healthcare NHS Trust, London.

Her sub-specialty interests are chest radiology and hybrid imaging (SPECT/CT and PET/CT). Within SPECT-CT, she has a niche interest in spinal, orthopaedic and infection imaging collaborating closely with spinal units, orthopaedic and sports medicine specialists. Having worked extensively with the modality for the last 7 years or so, she has a large body of experience to share in the field.

Dr Gopinath Gnanasegaran Consultant Nuclear Medicine Physician, Guy’s and St Thomas’ NHS Foundation Trust Dr Gopinath Gnanasegaran MBBS, MSc, MD, FRCP is a Consultant Physician in the Department of Nuclear Medicine at Guy’s and St Thomas’ NHS Foundation Trust, London, UK. He is currently; 1. Chair-Nuclear Medicine and Molecular Imaging Committee for the British Institute of Radiology (BIR). 2. Member of EANM Bone Committee and 3. Chair-Education Committee for the British Nuclear Medicine Society.

Dr Michael T Hirschman Consultant Orthopaedic Surgeon, Department of Orthopaedic Surgery and Traumatology, Switzerland PD Dr Michael T Hirschmann finished his medical school from the Johannes Gutenberg University in Mainz, Germany in 2003.

As a former athlete it was his wish to become an orthopaedic surgeon.

After his common trunk residency in surgery at the University Hospital of Basel, Switzerland he started his orthopaedic residency at Kantonsspital Bruderholz, Switzerland, under the leadership of Prof Niklaus Friederich.

During his residency he specialised in knee surgery (reconstructive and arthroplasty) and achieved his board certification as an orthopaedic surgeon. Mr Hirschmann went on numerous fellowships such as a clinical and research fellowship at Imperial College in London, UK with Prof Justin Cobb and Prof Andrew Amis and a clinical sports medicine fellowship (AOA) with Dr John Bartlett in Melbourne, Australia. Other clinical fellowships took him to Tampere, Finland and Auckland, New Zealand. Since August 2013 he has served as the head of knee surgery at Kantonsspital Baselland (Bruderholz, Laufen, Liestal). This unit offers the entire variety of knee surgery from reconstructive to arthroplasty and revision surgery.

From the beginning of his career he has been interested in clinical and experimental research, in particular imaging related research. In his residency he founded a research unit at Kantonsspital Bruderholz, which focuses on the improvement of orthopaedic related imaging and imaging analysis as well as clinical outcome studies.

Mr Hirschmann is an internationally renowned orthopaedic surgeon and researcher having published over 90 peer-reviewed publications in international journals.

He is active board member of numerous societies as well as editorial boards. His research is supported by national and international grant authorities. One major research focus lies in the investigation of the clinical applicability and value of SPECT/ CT for orthopaedic imaging. For this work his research group was awarded the Swiss Quality Award 2013 and the EANM Young Investigator Award 2013 for their contribution in SPECT/CT imaging in unhappy knee arthroplasty.

Dr Lefteris Livieratos Principal Medical Physicist, Guy’s and St Thomas’ Hospital Dr Livieratos is a Medical Physicist in Nuclear Medicine at Guy’s & St Thomas’ Hospitals and Senior Clinical Lecturer in Imaging Sciences at King’s College, London.

He has worked in PET methodology at Hammersmith Hospital alongside the MRC PET Oncology and PET Cardiology research groups on radiotracer image-based quantification and novel schemes for patient motion correction such as respiratory motion correction of PET projection data. He subsequently worked as a Clinical Scientist at Guy’s & St Thomas’ involved with diagnostic and therapeutic applications, including the clinical implementation of the first SPECT/CT in Europe with diagnostic 16-slice CT. He is involved with teaching of radionuclide imaging physics at King’s College and the supervision of students and trainee clinical scientists. His research interests include multi-modality imaging, image quantification and tracer kinetics methodology for translational applications and patient-specific dosimetry in targeted radionuclide therapy.

Professor Val Lewington Professor of Clinical Therapeutic Nuclear Medicine, King’s College London Val Lewington trained in internal medicine before specialising in nuclear medicine and was appointed Professor of Clinical Therapeutic Nuclear Medicine at King’s College London in 2011.

Her special interest is nuclear oncology, particularly molecular radiotherapy.

She has extensive experience in targeted therapy using radiopeptides for neuroendocrine tumours, radiolabelled antibodies in haematological malignancies and bone seeking pharmaceuticals for skeletal metastases. Her research focus is the development of multimodality cancer treatment linked to molecular imaging, exploring applications of conventional and novel radiolabelled imaging biomarkers.

Dr Malavika Nathan Consultant in Nuclear Medicine and Radiology, Royal Free London NHS Foundation Trust Malavika Nathan is a dual accredited Radiologist and Nuclear Medicine Physician.

Her clinical radiology training was undertaken through the Royal Free Hospital training programme. During this period, she developed an interest in nuclear medicine and pursued further training in nuclear medicine both at the Royal Free Hospital and at Guy’s and St Thomas’ NHS Foundation Trust. She completed a MSc in the science and practice of nuclear medicine from King’s College London, with distinction, during this time.

She has an interest in many aspects of hybrid imaging, both PET/CT and SPECT/CT, but has a particular interest in musculoskeletal SPECT/CT which germinated during her training period at Guy’s and St Thomas’ Hospitals and which she enthusiastically continues to develop at the Royal Free Hospital.

Dr Shaunak Navalkissoor Consultant Nuclear Medicine Physician, Royal Free Hampstead NHS Trust I am a Consultant Nuclear Medicine Physician, working at the Royal Free London NHS Foundation Trust. I was appointed in 2010. My special interests include radionuclide therapy and oncological imaging (with a particular interest in neuroendocrine tumours).

Dr Priya Suresh Consultant Radiologist, Plymouth Hospitals NHS Trust Consultant Radiologist with special interest in musculoskeletal radiology at Plymouth Hospitals NHS Trust for 7 years.

Fellowship at Royal National Orthopaedic Hospital Stanmore.

Dr Renato ValdĂŠs Olmos Senior Consultant in Nuclear Medicine, Netherlands Cancer Institute Dr Renato ValdĂŠs Olmos is currently a Senior Consultant in Nuclear Medicine at the Netherlands Cancer Institute. Since 1993, he has been actively involved in the field of lymphatic mapping, radioguided surgery and the sentinel node procedure with numerous projects and publications as well as the supervision of various PhD theses. Since October 2012, he has been a senior researcher at the Leiden University Medical Centre concerning interventional molecular imaging applications and nuclear medicine activities. ______________________________________________________________________ Abstracts (where suppiled) SPECT/CT: technical aspects Dr Lefteris Livieratos The most influential recent development in radionuclide imaging was by far the introduction of multi-modality systems combining functional PET or SPECT imaging with CT. While initially the incentive for this was acceleration of transmission scanning for attenuation correction in PET, leading to improved patient throughput and cost effectiveness, soon the diagnostic enhancement of functional imaging by the addition of anatomical localisation was acknowledged and rapidly established in clinical practice. It was not until later around the mid-2000s when the impact of hybrid SPECT/CT became clearer with the introduction of multi-detector CT components allowing structural imaging at improved versatility and image quality.

This was a paradigm shift for SPECT/CT which until then operated CT components attached to a single gantry with the gamma camera thus of fixed limited CT image quality especially in terms of axial slice thickness. The rapid growth of high-end SPECT/CT has brought up capabilities of varying CT acquisition parameters reflecting the diverse needs of different clinical applications in terms of image quality such as voxel resolution and signal-to-noise levels. An assessment of this relationship between adequate image quality and radiation dose is critical in the context of defined disease pathways. An introduction to SPECT/CT and the current state of instrumentation and methodology will be presented with the aim to set the scene of technical background that may underpin clinical applications discussed at the meeting.

Musculoskeletal CT: tips for the SPECT/CT practitioner Dr Marko Berovic The high intrinsic contrast on CT of bone tissue allows reconstruction of diagnostic images even at low CT doses. Obtaining the maximum value from the anatomical information of a bone SPECT/CT study requires CT scanning and reconstruction parameters that are optimised for imaging the skeleton. The ROC of the study significantly improves when both the SPECT and the CT images are utilised for diagnostic assessment.

A structured approach using the ABC method helps the reporter to optimise the diagnostic value from the anatomy for correlation with the physiological study component. Abnormalities in skeletal alignment, bone tissue and joint cartilage can be used to explain the tracer distribution on the SPECT study. Joints have CT appearances that can differentiate between degenerate, inflammatory and crystal arthropathies.

The CT can also classify the severity of joint degeneration and cartilaginous damage in a “hot� joint for correlation with the intensity of tracer activity. In post-operative patients there are CT features associated with pseudoarthrosis formation that increase the reporters confidence in diagnosing a failed fusion on SPECT/CT. The entire scan volume should be reviewed for significant incidental abnormalities on the CT component. The American College of Radiologists white paper on managing incidental findings on abdominal CT and the Fleischner society guidelines on management of lung nodules are both helpful in advising how to handle these additional scan findings.

Musculoskeletal MRI: tips for SPECT/CT users Dr Priya Suresh I would like to share my thoughts on tips about use of MRI in different musculoskeletal pathologies.

I will discuss its limitations.

I will also discuss how SPECT imaging and MR imaging can compliment each other in guiding the clinician in management of the varied spectrum of musculoskeletal pathology.

SPECT/CT in malignant bone disease Dr Gopinath Gnanasegaran Early detection or exclusion of bone metastases is important in management of patients with cancer. The skeletal system is the third most common site for metastases following lung and liver and radionuclide bone imaging with 99mTc-MDP as the standard imaging modality. Several reports emphasise the high sensitivity of 99mTc-MDP bone scan in the diagnosis of bone metastases.

However, the specificity of radionuclide bone scan is quite variable or low. In general, the accuracy in characterising and localising benign and malignant lesions is limited and often will initiate the need for further radiological imaging such as CT or MRI for a definitive diagnosis.

SPECT/CT may be useful in classifying equivocal or indeterminate lesions on a 99mTc-MDP bone scan. Hoger et al have reported improved accuracy of bone scintigraphy by correctly classifying equivocal lesions. Romer et al reported, SPECT-guided CT was able to clarify more than 90% of SPECT findings classified as indeterminate. Furthermore, Utsunomiya et al have reported increased diagnostic confidence with fused SPECT/CT images compared with separate sets of scintigraphic and CT images in differentiating malignant from benign bone lesions. Recently Zhao and co-workers, assessed 141 lesions in 125 cancer patients with non-specific findings on planar imaging, and compared the efficacy of multislice SPECT/CT to SPECT alone and SPECT + CT. The sensitivity, specificity and accuracy of SPECT/CT were significantly higher than SPECT alone. Thus, available data suggests the addition of localised SPECT/CT in the assessment of indeterminate lesions on planar imaging improves diagnostic performance, diagnostic confidence and inter-observer agreement in most cases.

In general, a definitive diagnosis is made in the majority of cases, which may reduce the use additional imaging, such as MRI. There is convincing evidence to suggest a role for SPECT/CT in the assessment of equivocal lesions on planar imaging. SPECT/CT may provide a one-stop diagnostic service in cancer patients and may shorten the diagnostic process. Overall SPECT/CT is spectacular.

References: Romer W, Nomayr A, Uder M et al (2006) SPECT-guided CT for evaluating foci of increased bone metabolism classified as indeterminate on SPECT in cancer patients. J Nucl Med 47:1102-6 Strobel K, Burger C, Seifert B et al (2007) Characterization of focal bone lesions in the axial skeleton: performance of planar bone scintigraphy compared with SPECT and SPECT fused with CT. AJR Am J Roentgenol 188:467 -74 Utsunomiya D, Shiraishi S, Imuta M et al (2006) Added value of SPECT/CT fusion in assessing suspected bone metastasis: comparison with scintigraphy alone and nonfused scintigraphy and CT. Radiology 238:264-71

Zhao Z, Li L, Li F, Zhao L (2010) Single photon emission computed tomography/ spiral computed tomography fusion imaging for the diagnosis of bone metastasis in patients with known cancer. Skeletal Radiol 39:147-53 Gnanasegaran G, Barwick T, Adamson K et al (2009) Multislice SPECT/CT in benign and malignant bone disease: when the ordinary turns into the extraordinary.

Semin Nucl Med 39:431-42 Helyar V, Mohan HK, Barwick T et al (2010) The added value of multislice SPECT/ CT in patients with equivocal bony metastasis from carcinoma of the prostate.

Eur J Nucl Med Mol Imaging 37:706-13 Horger M, Eschmann SM, Pfannenberg C et al (2004) Evaluation of combined transmission and emission tomography for classification of skeletal lesions. AJR Am J Roentgenol 183:655-61 SPECT/CT in sentinel lymph node localisation Dr Renato ValdĂŠs Olmos Educational objectives: 1. To emphasise the value of preoperative nuclear medicine imaging in the sentinel lymph node procedure in oncology 2. To recognise the patterns of lymphatic drainage and the criteria for sentinel lymph node identification by means of the comprehensive use of lymphoscintigraphy and SPECT/CT 3. To describe SPECT/CT indications for sentinel lymph node in breast cancer, melanoma, head and neck cancer, and other malignancies.

Summary: SPECT/CT has been used in breast cancer and melanoma for anatomical sentinel lymph node (SLN) localisation, detection of additional SNs in aberrant basins, and depiction of SLNs in cases with no visualisation on planar images. Recently, in a large series of melanoma patients, the use of SPECT/CT was associated with the detection of more metastatic SLNs and a higher rate of disease-free survival.

SPECT/CT has also been applied in oral cavity cancer as well as in urological and gynaecological malignancies. In the areas of lymphatic drainage of these malignancies (head and neck, pelvis, and upper abdomen) SPECT/CT appears to be essential to localise SLNs, providing helpful anatomical landmarks to plan SLN biopsies. With the improvement of the CT component in the last generation of SPECT/CT cameras, nuclear physicians today can individualise lymph nodes corresponding with the radioactive SLNs. This is made possible using a display of SPECT/CT similar to that of conventional tomography.

Multiplanar reconstruction enables correlating radioactive SLNs seen on fused SPECT/CT with lymph nodes seen on CT, and the use of cross-reference lines allows the navigation between axial, coronal and sagittal views. Fused SPECT/CT images may also be three-dimensionally displayed, improving anatomical SN localisation and recognition. However, a comprehensive interpretation of SPECT/CT together with lymphoscintigraphy is necessary to identify radioactive lymph nodes as SLNs. SPECT/CT imaging protocols and reconstruction Dr Malavika Nathan High quality SPECT/CT imaging relies on robust imaging and reconstruction protocols that aim to optimise both the SPECT and CT components of the study. The focus of this lecture will be on bone SPECT/CT; discussing the variety of protocols in the published literature and highlighting the processes behind protocol derivation and supporting rationale.

Bone SPECT/CT in spinal imaging Dr Ranju Dhawan MRI is the cornerstone of spinal imaging, whilst CT has a vital role in the setting of spinal trauma; the combination of these modalities, are by and large considered adequate for most clinical scenarios, certainly in the context of the native spine. As experience however accumulates, it is becoming more apparent that Tc99m HDP Bone SPECT/CT has a selective role to play in refining diagnosis and directing therapy in neck and back pain from underlying bone and joint-based pain generators. The choice of cases for spinal SPECT/CT however needs to be judicious and used as second-line imaging, to keep the radiation burden justifiable and acceptable. The use of Bone SPECT/CT in the preoperative and most pertinently post-operative context is less controversial. The intention with spinal fusion is to remove a potential pain generator from failure of the normal joint structure that result in pathological movements that result in pain.

Evidence for the pre-operative accuracy of disc/end plate levels for spinal fusion is limited. Following surgical intervention when patients have persistent pain, a combination of plain films, CT and MRI has conventionally been used to assess the metalwork, fusion and potential nerve impingement. It is by large a difficult clinical and imaging field due to inherent technical limitations imposed by metalwork. The use of Tc99m HDP Bone SPECT/CT in these contexts is under investigation, and growing experience suggests it may be a powerful tool. The lecture presents my experience with the modality in the context of native and post-operative spinal imaging, collaborating with specialist spinal units and clinics to explore the value-added potential of the test.

SPECT/CT for evaluation of patients with painful knees after total knee arthroplasty Dr Michael T Hirschman Knee arthroplasty is a very successful treatment for osteoarthritis of the knee joint, however, careful scrutiny of the orthopaedic and radiological literature reveals that up to 20– 40 % of patients are not fully satisfied and symptom free following joint replacement, and complain of pain, stiffness, and loss of range of motion. The most common explanations for these are infection, aseptic loosening, instability, malposition of the prosthetic components, arthrofibrosis, and patellofemoral problems. To date, the clinical and radiological diagnostics tools (radiographs, CT, MRI, scintigraphy, SPECT, PET) are limited and do not clearly identify the site and cause of the patient’s symptoms.

In patients with unexplained symptoms following arthroplasty, SPECT/CT offers both radiologists and surgeons a rich source of information, combining mechanical, structural, and metabolic data on the patient’s knee joint.

The combination of the use of three-dimensional (3D) reconstructed CT-based analysis of component position, orientation, mechanical and anatomical leg axes, as well as both the distribution and intensity of SPECT tracer uptake values has introduced a new dimension on diagnostics. Biomechanics and biology are brought together.

This presentation gives an overview on the clinical value, and current and future applications of SPECT/CT in patients after knee arthroplasty. In addition, clinical cases are shown and the clinical benefit in the treatment of these patients is highlighted.

SPECT/CT in foot and ankle pathology Dr Malavika Nathan In certain clinical settings, the evaluation of ankle and foot pathology can be challenging for the clinician. Pinpointing the location of pathology in an anatomically complex area such as the ankle and foot or assessing the likely pain generator where there is multifocal pathology can be very difficult with conventional imaging modalities utilised in isolation.

SPECT/CT has the potential to overcome these challenges as it integrates high sensitivity (SPECT) with high specificity (CT) imaging. In this lecture, the role of bone SPECT/CT in the ankle and foot will be explored through discussion of the published evidence to date and depiction of cases where SPECT/CT was influential in the diagnosis and subsequent patient management.

Bone SPECT/CT in hand and wrist surgical practice Dr Ranju Dhawan Wrist pain can prove challenging to diagnose, even with experienced clinical examination and conventional imaging modalities (plain film, ultrasound, CT and MRI). In unresolved cases, arthroscopy is often employed as a further diagnostic tool; however it has limited sensitivity and, as an invasive procedure, it presents little benefit if an arthroscopic correction is not possible. This talk presents my collaborative experience with an eminent wrist surgeon and his team (Mr David Evans) using Tc99m HDP bone SPECT/CT as an additional line of investigation in patients with wrist pain that could not be diagnostically resolved with the usual combination of history, examination and conventional imaging. Clinical and imaging findings, management outcomes of selected cases are discussed to explore the potential role of Bone SPECT/CT in hand and wrist surgical practice.

SPECT/CT in oncology: when and why Professor Val Lewington The fusion of functional and anatomical data significantly improves both the sensitivity and specificity of diagnostic imaging and has had a major positive impact at key decision points in cancer diagnosis and management. While SPECT alone improves lesion conspicuity by comparison with planar imaging, precise anatomical localisation of functional abnormalities is essential for treatment planning. Accurate co-registration of anatomical and functional data may also provide complementary diagnostic information.

At present, SPECT/CT is used routinely to locate, characterise and stage tumours.

Image fusion reduces the number of false positive results and improves the characterisation of indeterminate abnormalities. Data from fused, hybrid imaging can also be applied to optimise CT guided tissue sampling in heterogeneous tumour masses and offer the possibility of early metabolic treatment response. The latter often precedes measurable changes in tumour volume and can, therefore, guide subsequent therapy.

In the future, SPECT/CT is likely to play an increasingly important role in individualised treatment planning by, for example, improving the selection of patients for targeted therapies and facilitating patient specific dosimetry prior to molecular radiotherapy.

SPECT/CT in infection Dr Shaunak Navalkissoor This talk describes the advantages of SPECT/CT in imaging of patients with suspected infection. The talk demonstrates the value of SPECT/CT in the following sections: osteomyelitis and prosthetic joint infections (PJI), diabetic foot, pyrexia of unknown origin (PUO), soft tissue infection, vascular graft infection, endocarditis/ implantable device infection.

In osteomyelitis and PJI, the various SPECT/CT based radionuclides are discussed.

The advantages of SPECT/CT over conventional scintigraphy are demonstrated.

These advantages include discriminating soft tissue infection from osteomyelitis, increased specificity and increased diagnostic reporting confidence.

The next section is on the value of SPECT/CT in the diabetic foot. It is important to define the extent of infection in the feet of diabetic patients to determine the optimal management. The advantages of leucocyte imaging with SPECT/CT over conventional scintigraphy and other cross-sectional imaging modalities are discussed.

SPECT/CT in PUO and soft tissue infection is discussed next. Although FDG PET/CT has an emerging role for PUO, there may still be a role for leucocyte/ Ga-67 citrate imaging in certain situations and when FDG PET/CT is not available.

SPECT/CT helps to differentiate physiological from pathological uptake, thus increasing the specificity of the test. It also helps to define the extent of infection.

In the final short section I will discuss miscellaneous use of SPECT/CT leucocyte imaging e.g. in suspected vascular graft infections or implantable device infection. ________________________________________________________________

Please remember to complete the online delegate survey using the below link: https://www.surveymonkey.com/s/3RD_SPECT Your certificate of attendance will be emailed to you within the next two weeks once these have been completed.

BIR Annual Congress 2014 - 22-23 October, London

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