Utility of 99mTc-MDP SPECT-CT for the diagnosis of sesamoiditis as cause of metatarsalgia
A 37-year-old lady was sent for a 99mTc-MDP bone scintigraphy for evaluation of nonspecific pain in the right foot. She was nondiabetic. The pain was not localized; it was aggravated with walking. She gave a history of wearing high heels. There was no history of trauma. On clinical examination, no point tenderness was elicitable. Radiographs of the right leg and foot were unremarkable. Three-phase bone scintigraphy was done after intravenous injection of 740 MBq (20 mCi) of 99mTc-MDP. Flow [] and pool images [Figures and ] of the feet were unremarkable. Delayed planar imaging acquired three hours after radiotracer injection showed a faint focal area of tracer uptake in the region of the right great toe []. SPECT-CT images of bilateral feet were acquired on a dedicated SPECT-CT system (Symbia T6, Seimens Medical Solutions, USA). CT images were unremarkable []. SPECT [] and SPECT-CT [] images showed focally increased radiotracer uptake in the lateral right sesamoid bone. Volume-rendered SPECT-CT image [] showed the radiotracer uptake in the right lateral sesamoid bone. Based on SPECT-CT findings, a diagnosis of sesamoiditis was made. The patient underwent a change of footwear and used specifically advised shoes having insoles with sesamoid protective padding.[] Pain was much relieved at three months follow-up.