To establish the added value of SPECT/CT in wrist trauma. Reflecting on a decade of practice, we compare and correlate the significance of SPECT/CT with routine cross-sectional, sonographic and conventional radiographic imaging.

We analysed consecutive SPECT/CT wrist studies performed in cases with a documented history of trauma between September 2007 and January 2017. Protocol 800MBq (22 mCi) of 99mTcMDP Early blood pool and 3hr delayed static views of wrists were acquired SPECT/CT of wrist were performed after review of delayed images. Patient Positioning Superman position Hand is covered by a mesh A 16-slice Philips Precedence® SPECT/CT camera and local protocol Technetium 99m doses were utilised. In addition, dose adjusted CT acquisition allowed us to produce diagnostic studies...

Of 333 consecutive SPECT/CT studies performed, 107studies followed a clear history of trauma. Hand/wrist specialists made all referrals: Orthopaedic or plastic surgeons. The mechanism of injuries included: road traffic accidents, fall onto outstretched hand, hyperextension, overuse injuries related to specific sports (golf wrists, martial arts, tennis), de-gloving injuries. Indications included: claustrophobia (precluding MRI imaging), occult fractures, partial union, non-union, osteonecrosis, mechanical response, loosening (periprosthetic), bone cysts, secondary arthropathy, complex regional pain syndrome, capsular injuries and periosteal avulsions, TFCC injuries, biomechanical stress around a prosthesis, bossing...

Hybrid SPECT/CT is an excellent problem-solving tool best used as an adjunct to conventional imaging modalities, offering supplementary diagnostic value. It has a role in traumatic injuries, specifically in complex joints such as the wrist, where physiological information and anatomical detail allow a better understanding of the causes of patients’ pain. It is important to remember other causes of pain in trauma patients, which are not always related to the acute injury/ presentation.

American College of Radiology. ACR Appropriateness Criteria. Radiology 2000;215(Suppl):333–338 Newberg A, Dalinka MK, Alazraki N, et al. Acute hand and wrist trauma. American College of Radiology. ACR Appropriateness Criteria. Radiology 2000;215(Suppl):375–378 Macfarlane DG, Buckland-Wright JC, Lynch J,Fogelman I. Br J Rheumatol 1993; A study of the early and late 99technetium scintigraphic images and their relationship to symptoms in osteoarthritis of the hands. Macfarlane DG, Buckland-Wright JC, Lynch J, Fogelman I. Br J Rheumatol 1993; Kundel HL, Polansky M (2003) Measurement of observer agreement. Radiology 228:...

Dr Danoob Dalili Specialist Registrar Clinical Radiology, Imperial College London, UK Research fellow, Guy's & St Thomas' NHS Foundation Trust, London, UK Ms Stacey Johnson Senior Nuclear Medicine Technician, Guy's & St Thomas' NHS Foundation Trust, London, UK Dr Hajirah Ilyas Specialist Registrar Nuclear Medicine,Guy's & St Thomas' NHS Foundation Trust, London, UK Ms Kathryn Adamson Senior Medical Physicist,Guy's & St Thomas' NHS Foundation Trust, London, UK Dr Fahim Ul-Hassan Consultant Nuclear MedicineRadiologist, Guy's & St Thomas' NHS Foundation Trust, London, UK Dr Amy Eccles...