CASE REPORT Clinical benefit of SPECT/CT for follow-up of surgical treatment of osteochondritis dissecans Praveen Konala • Farhad Iranpour • Anna Kerner • Helmut Rasch • Niklaus F. Friederich • Michael T. Hirschmann Received: 3 February 2010 / Accepted: 11 May 2010 Ó The Japanese Society of Nuclear Medicine 2010 Abstract We present the case of a 17-year-old ice- hockey player, who complained about persistent left medial knee pain having undergone a refixation of a grade III osteochondritis dissecans with biodegradable pins, a reconstruction of the anterior cruciate ligament (ACL) and a medial meniscal repair 1 year previously. Sequential MRIs performed 8 and 12 months after surgery were inconclusive, and failed to show the insufficient integration of the osteochondral fragment. Combined single photon emission and conventional computerized tomography (SPECT/CT) clearly revealed the cause of the patient’s persistent knee problems—the osteochondral fragment had not integrated. SPECT/CT may hold great clinical value for symptomatic patients who have previously undergone treatment for osteochondral lesions, and it should be con- sidered as alternative diagnostic imaging modality. Keywords SPECT/CT Á Knee Á Osteochondritis dissecans Á Clinical value Introduction Osteochondritis dissecans (OCD) is a common condition in children, adolescents and young adults [1]. Due to its high sensitivity and specificity for detection of cartilage lesions, the follow-up of patients after treatment of OCD today is the domain of MRI [2–5]. However, particularly in patients having undergone surgical treatment, the MRI findings may be less specific and difficult to interpret. Frequently the question whether the zone of bone oedema represents a clinically relevant finding remains unanswered [3]. In contrast to MRI, which provides only anatomical data, combined single photon emission computerized tomogra- phy and conventional CT (SPECT/CT) additionally pro- vides information about the metabolic state regarding bone healing and integration of the osteochondral fragment [6, 7]. The SPECT/CT is increasingly recognized by ortho- paedic surgeons [6–9]. With the case presented, we endeavour to highlight the clinical value of SPECT/CT in patients who have previously undergone treatment for osteochondral lesions, e.g. refixation of osteochondral fragments, microfracturing, mosaicplasty or autologous chondrocyte transplantation. Case report A 17-year-old male semi-professional (national level) ice- hockey player presented with activity-related persistent left knee pain, localizing mainly to the medial compartment. One year ago, he sustained a severe twisting injury while playing soccer. At that time, he had an anterior cruciate ligament (ACL) tear, a medial meniscal tear and a 15 9 20 mm osteochondral lesion of the medial femoral P. Konala Á F. Iranpour Á M. T. Hirschmann Musculoskeletal Surgery Department, Imperial College, London, UK A. Kerner Á H. Rasch Institute for Radiology and Nuclear Medicine, Kantonsspital Bruderholz, 4101 Bruderholz, Switzerland N. F. Friederich Á M. T. Hirschmann (&) Department of Orthopaedic Surgery and Traumatology, Kantonsspital Bruderholz, 4101 Bruderholz, Switzerland e-mail: michael.hirschmann@ksbh.ch 123 Ann Nucl Med DOI 10.1007/s12149-010-0391-9