E1276. Hybrid Bone SPECT-CT: Finding the Source of Undiagnosed Foot Pain
  1. Ragheed Al-Dulaimi; University of Utah
  2. Rebekah Aquino; University of Utah
  3. Gabriel Fine; University of Utah
  4. Richard Brown; University of Utah
  5. Kathryn Morton; University of Utah
Foot pain is common, and the etiology is often unclear based on physical examination and history alone. Diagnostic imaging plays an important role in determining the etiology of pain in these cases. However, proper imaging management requires knowledge of the pathologic entities that can cause the pain as well as appropriate utilization of the modalities that can be deployed in the work-up. Bone SPECT–CT (single-photon emission tomography with computerized tomography) is a hybrid imaging modality that combines functional and anatomical imaging together to help solve clinical challenges that can be difficult to solve by either technique alone. We present a collection of challenging cases with foot pain that were not diagnostically resolved with the usual combination of history, examination, and conventional imaging, and therefore underwent bone SPECT–CT.

Educational Goals / Teaching Points
This presentation is directed toward radiology residents, nuclear medicine practitioners, and musculoskeletal radiologists. The goals of this review are: to summarize current evidence supporting the use of SPECT-CT for diagnosing obscure foot pain, to briefly review foot anatomy, correlation with other imaging modalities, to learn how to optimally perform SPECT/CT studies to best delineate pathology to discuss common and rare entities that can cause foot pain through a range of cases and to understand the role of SPECT-CT in identifying the etiology of the pain in these cases as well as the limitations of SPECT/CT and when and how MRI can add value in the work-up.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This review will highlight why SPECT-CT can be of added value. We will review the relevant foot anatomy and discuss differential diagnosis of foot pain generators through a range of cases.

SPECT-CT can be a valuable tool in the assessment of obscure foot pain.