The Role of 99mTc-HDP-SPECT/CT in the Evaluation of Heel Pain

초록

Purpose : The diagnosis of heel pain is sometimes difficult because the foot has complex anatomy and function and various diseases cause heel pain. Therefore, we hypothesized that SPECT/CT would be helpful in the diagnosis and management of heel pain. Methods: A total of 47 patients with heel pain were enrolled. Orthopedic clinicians made preliminary diagnoses according to physical examinations and patient's symptom. Provisionally, typical subcalcaneal pain was regarded as plantar fasciitis and superior-posterior heel pain was diagnosed as Achilles tendinitis. Patients with atypical pain were categorized into the inconclusive group. Plain radiographs and a SPECT/CT of the foot were acquired. Uptake in plantar surface of calcaneus in relation to the attachment point of long plantar tendon (plantar uptake) on SPECT/CT was diagnosed as plantar fasciitis and uptake in the posterior surface of the calcaneus in relation to the Achilles tendon (posterior uptake) on SPECT/CT was regarded as Achilles tendinitis. The diagnostic agreement between the clinician's impression and the SPECT/CT results was analyzed. The radiography findings were also compared to the SPECT/CT images, and additional findings on SPECT/CT were evaluated. Results: Twenty-six out of 47 (55.3%) patients presented well-localized pain, subcalcaneal heel pain (n = 18) and posterior-superior heel pain (n = 8). However, 21 out of 47 (44.7%) patients could not be conclusive diagnosed because of atypical heel pain. The preliminary diagnosis matched the SPECT/CT findings in 83.3% (15 out of 18) of patients with typical subcalcaneal pain with the exception of 3 patients: 1 patient was finally diagnosed with idiopathic neuropathy, 1 patient with a metatarsal base fracture, and 1 patient with osteoarthritis. The preliminary diagnosis matched the SPECT/CT findings in 100% (8 out of 8) of our patients presenting typical posterior-superior heel pain. Conclusive diagnosis could be made by SPECT/CT in all 21 patients wit