CME 6 Session – EANM’13

The Limping Patient - Multimodality Imaging

Educational objectives:
  1. To gain an overview of the main conditions involving the lower limb joints responsible for limping
  2. To understand the technical requirements of SPECT/CT protocols adapted to rheumatological or orthopaedic indications
  3. To recognise the most important semiological SPECT/CT patterns and their causes
  4. To illustrate how to avoid common diagnostic pitfalls (e.g. referred pain) and review recent insights
This continuing medical education session is directed towards a broad audience of nuclear medicine practitioners and will be of special interest for skeletal imaging-oriented colleagues.
A vast spectrum of lower limb bone and joint disorders (hip, knee, ankle, foot) present with a common clinical presentation (limping) and too often generates a cascade of less than efficient imaging studies, 99mTc-bisphosphonates bone scintigraphy included.
Emphasis will be placed on optimising the diagnostic effectiveness of bone scintigraphy, such as correct clinical indication, optimal scintigraphy procedure and updated image pattern-oriented reporting.
Beyond frustrating, and often misleading, dichotomous diagnosis of fatigue fractures and CRPS type I (formerly reflex sympathetic dystrophy), frequent lower limb conditions never suggested on a planar bone scan report but evidenced or suspected on SPECT/CT bone scan will be sketched out.
Clinical and imaging pitfalls, such as referred pain (e.g. originating from spine lesion), incipient chronic rheumatic diseases (e.g. spondyloarthropathies) and malignant conditions, will be reviewed. Clinical and paraclinical red flags for such instances will be recalled.
Lyon EANM bone and joint CME is an updated and focused seminar in keeping with the 2010 EANM Vienna congress session which was dedicated to musculo-skeletal pain:

Key Words:
Bone and Joint Disorders, Lower Limb, Bone Scintigraphy, SPECT/CT, Imaging Patterns, Pitfalls

Extended Abstract Book for download (5 MB)

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