The Utility of Tc-99m Hydroxymethylene Diphosphonate Single-photon Emission Computed Tomography/Computed Tomography in Symptomatic Os Trigonum

Sharjeel Usmani 1, Noora Bin Essa 1, Fahad Marafi 2, Rashid Rasheed 1, Fareeda Al Kandari 1

Affiliations

01 April 2018

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doi: 10.4103/ijnm.IJNM_165_17

Abstract

Os trigonum is a congenital condition in which a bone ossicle fails to fuse to a secondary ossification center in the posterior aspect of the talar bone. Repetitive plantar flexion of the foot may elicit inflammation of the ossicles fibrous connective band, subsequently causing pain. It is common to misdiagnose os trigonum as an avulsion fracture. We report a case of a 23-year-old male with symptomatic os trigonum diagnosed on Tc-99m hydroxymethylene diphosphonate single-photon emission computed tomography-computed tomography (SPECT-CT). We also wish to emphasize on the use of SPECT/CT in not only allocating the ossicle anatomically but also for the purpose of evaluation an active source of pain in a region of multiple complex small bones.

Keywords: Ankle pain; Os trigonum; Tc-99m hydroxymethylene diphosphonate single-photon emission computed tomography-computed tomography.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1 A 23-year-old male patient presented with right posterior ankle pain for 1 month. Three phase bone scintigraphy is performed by injecting 24 mCi of Tc-99m hydroxymethylene diphosphonate intravenously. (a) Dynamic flow over the feet and whole-body blood pool images are unremarkable. (b) Delayed whole-body images show focal increase tracer uptake at right ankle region (arrow)

Figure 1 A 23-year-old male patient presented with right posterior ankle pain for 1 month. Three phase bone scintigraphy is performed by injecting 24 mCi of Tc-99m hydroxymethylene diphosphonate intravenously. (a) Dynamic flow over the feet and whole-body blood pool images are unremarkable. (b) Delayed whole-body images show focal increase tracer uptake at right ankle region (arrow)

Figure 2 (a) Coronal, sagittal, and transaxial single-photon emission computed tomography images show focal area of increase tracer uptake at the posterior aspect of right talus. (b) Noncontrast computed tomography coronal, sagittal, and transaxial images show small accessory/sesamoid bone (os trigonum) with corresponding increased uptake on fused images. (c and d) Volume rendered images better delineate the uptake at bony ossicle which may present a source of pain, suggestive of os trigonum syndrome

Figure 2 (a) Coronal, sagittal, and transaxial single-photon emission computed tomography images show focal area of increase tracer uptake at the posterior aspect of right talus. (b) Noncontrast computed tomography coronal, sagittal, and transaxial images show small accessory/sesamoid bone (os trigonum) with corresponding increased uptake on fused images. (c and d) Volume rendered images better delineate the uptake at bony ossicle which may present a source of pain, suggestive of os trigonum syndrome

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