Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Usefulness of Bone SPECT/CT for Predicting Avascular Necrosis of the Femoral Head in Children with Slipped Capital Femoral Epiphysis or Femoral Neck Fracture

  • Yoo Sung Song (Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Won Woo Lee (Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Moon Seok Park (Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Nak Tscheol Kim (Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Ki Hyuk Sung (Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital)
  • Received : 2021.07.07
  • Accepted : 2021.11.14
  • Published : 2022.02.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: This study aimed to investigate the usefulness of bone single-positron emission tomography/computed tomography (SPECT/CT) of the hip in predicting the later occurrence of avascular necrosis (AVN) after slipped capital femoral epiphysis (SCFE) or femoral neck fracture in pediatric patients. The quantitative parameters of SPECT/CT useful in predicting AVN were identified. Materials and Methods: Twenty-one (male:female, 10:11) consecutive patients aged < 18 years (mean age ± standard deviation [SD], 11.0 ± 2.7 years) who underwent surgery for SCFE or femoral neck fracture and postoperative bone SPECT/CT were included. The maximum standardized uptake value (SUV), mean SUV, and minimum SUV of the femoral head were measured. The ratios of the maximum SUV, mean SUV, and minimum SUV of the affected femoral head to the contralateral side were determined. Patients were followed up for > 1 year after the surgery. The SPECT/CT parameters were compared between patients who developed AVN and those who did not. The accuracy of SPECT/CT parameters for predicting AVN was assessed. Results: Six patients developed AVN. There was a significant difference in the ratio of the mean SUV among patients who developed AVN (mean ± SD, 0.8 ± 0.3) and those who did not (1.1 ± 0.2, p = 0.018). However, there were no significant differences in the ratios of the maximum and minimum SUV between the groups (all p = 0.205). For the maximum, mean, and minimum SUVs, no significant differences were observed between the groups (p = 0.519, 0.733, and 0.470, respectively). The cutoff mean SUV ratio of 0.87 yielded a 66.7% sensitivity and 93.2% specificity for predicting AVN. Conclusion: Quantitative bone SPECT/CT is useful for evaluating femoral head viability in pediatric patients with SCFE or femoral neck fractures. Clinicians should consider the high possibility of later AVN development in patients with a decreased mean SUV ratio.

Keywords

References

  1. Zaltz I, Baca G, Clohisy JC. Unstable SCFE: review of treatment modalities and prevalence of osteonecrosis. Clin Orthop Relat Res 2013;471:2192-2198
  2. Krahn TH, Canale ST, Beaty JH, Warner WC, Lourenco P. Long-term follow-up of patients with avascular necrosis after treatment of slipped capital femoral epiphysis. J Pediatr Orthop 1993;13:154-158
  3. Naseem H, Chatterji S, Tsang K, Hakimi M, Chytas A, Alshryda S. Treatment of stable slipped capital femoral epiphysis: systematic review and exploratory patient level analysis. J Orthop Traumatol 2017;18:379-394
  4. Spence D, DiMauro JP, Miller PE, Glotzbecker MP, Hedequist DJ, Shore BJ. Osteonecrosis after femoral neck fractures in children and adolescents: analysis of risk factors. J Pediatr Orthop 2016;36:111-116
  5. Bertrand T, Urbaniak JR, Lark RK. Vascularized fibular grafts for avascular necrosis after slipped capital femoral epiphysis: is hip preservation possible? Clin Orthop Relat Res 2013;471:2206-2211
  6. Mullins MM, Sood M, Hashemi-Nejad A, Catterall A. The management of avascular necrosis after slipped capital femoral epiphysis. J Bone Joint Surg Br 2005;87:1669-1674
  7. Pape HC, Krettek C, Friedrich A, Pohlemann T, Simon R, Tscherne H. Long-term outcome in children with fractures of the proximal femur after high-energy trauma. J Trauma 1999;46:58-64
  8. Agarwal A. Fractures of the femoral neck in children: long-term follow-up in 62 hip fractures. Injury 2006;37:90
  9. Togrul E, Bayram H, Gulsen M, Kalaci A, Ozbarlas S. Fractures of the femoral neck in children: long-term follow-up in 62 hip fractures. Injury 2005;36:123-130
  10. Bagatur AE, Zorer G. Complications associated with surgically treated hip fractures in children. J Pediatr Orthop B 2002;11:219-228
  11. Trueta J. The normal vascular anatomy of the human femoral head during growth. J Bone Joint Surg Br 1957;39-B:358-394
  12. Wang WT, Li YQ, Guo YM, Li M, Mei HB, Shao JF, et al. Risk factors for the development of avascular necrosis after femoral neck fractures in children: a review of 239 cases. Bone Joint J 2019;101-B:1160-1167
  13. Palocaren T. Femoral neck fractures in children: a review. Indian J Orthop 2018;52:501-506
  14. Ryoo HG, Lee WW, Kim JY, Kong E, Choi WH, Yoon JK; K-SPECT Group. Minimum standardized uptake value from quantitative bone single-photon emission computed tomography/ computed tomography for evaluation of femoral head viability in patients with femoral neck fracture. Nucl Med Mol Imaging 2019;53:287-295
  15. Han S, Oh M, Yoon S, Kim J, Kim JW, Chang JS, et al. Risk stratification for avascular necrosis of the femoral head after internal fixation of femoral neck fractures by post-operative bone SPECT/CT. Nucl Med Mol Imaging 2017;51:49-57
  16. Fan W, Zhu L, Chen J, Guo C, Yan Z. Identifying patients who will most benefit from single photon emission computerized tomography and computerized tomography after femoral neck fracture. Med Sci Monit 2017;23:5669-5674
  17. Yuan HF, Shen F, Zhang J, Shi HC, Gu YS, Yan ZQ. Predictive value of single photon emission computerized tomography and computerized tomography in osteonecrosis after femoral neck fracture: a prospective study. Int Orthop 2015;39:1417-1422
  18. Han YH, Jeong HJ, Sohn MH, Yoon SJ, Lim ST. Incidence and severity of femoral head avascularity after femoral neck or intertrochanteric fractures on preoperative bone single photon emission computed tomography/computed tomography: preliminary study. Nucl Med Commun 2019;40:199-205
  19. Park SJ, Ko BS, Moon KH, Lee M. Prediction value of SPECT/CT in avascular necrosis of femoral head after femur neck fracture. Geriatr Orthop Surg Rehabil 2019;10:2151459319872943
  20. Parikh AK, Washington ER 4th, Bobbey AJ, Spottswood SE. Evaluation of femoral head viability via bone scintigraphy in the postoperative pediatric patient. Pediatr Radiol 2018;48:350-358
  21. DosSantos A, Macalintal N, Bouchareb Y, Joel E, Jan H, Haroon A. Incremental value of SPECT/CT in the detection of femoral head viability in slipped capital femoral epiphysis. J Nucl Med Technol 2018;46:153-154
  22. Ramachandran M, Ward K, Brown RR, Munns CF, Cowell CT, Little DG. Intravenous bisphosphonate therapy for traumatic osteonecrosis of the femoral head in adolescents. J Bone Joint Surg Am 2007;89:1727-1734
  23. Gao F, Sun W, Guo W, Wang B, Cheng L, Li Z. Combined with bone marrow-derived cells and rhbmp-2 for osteonecrosis after femoral neck fractures in children and adolescents: a case series. Sci Rep 2016;6:30730
  24. Napora JK, Gilmore A, Son-Hing JP, Grimberg DC, Thompson GH, Liu RW. Early MRI detection and closed bone graft epiphysiodesis may alter the course of avascular necrosis following unstable slipped capital femoral epiphysis. J Pediatr Orthop 2018;38:202-207