Bone Scan with SPECT or SPECT/CT Knee Tc-99m bone scan with SPECT/CT knee is not routinely used as the initial imaging study for the evaluation of acute trauma to the knee. US Knee US is not routinely used as the initial imaging study for the evaluation of acute trauma to the knee. Acute Trauma to the Knee Variant 3: Adult or skeletally mature child. Fall or acute twisting trauma to the knee. No fracture seen on radiographs. Suspect occult fracture or internal derangement. Next study. CT Knee CT may be performed as the next imaging study for the evaluation of suspected radiographically occult knee fractures. Several studies reported CT to be superior to knee radiographs in detection and classification of fractures. In a study by Mustonen et al [12], CT showed 100% and radiographs 83% sensitivity in detection of tibial plateau fractures, and CT was superior in further characterization of fracture severity. In the setting of acute knee trauma, Mui et al [13] reported 80% sensitivity and 98% specificity of the CT examination in detecting bony avulsion fractures and a high negative predictive value for excluding ligamentous injuries, but MRI remained necessary for the preoperative detection of meniscal injury. Peltola et al [14] compared dual-energy CT examinations with MRI studies as a reference standard in 18 patients with acute knee trauma and reported dual-energy CT had 79% sensitivity and 100% specificity in detecting anterior cruciate ligament (ACL) ruptures [14]. In a study by Heffernan et al [15], 64-channel multidetector CT showed 87.5% to 100% sensitivity and 100% specificity for detection of the ACL tears. As on MRI, secondary signs, such as buckling of the posterior cruciate ligament, were also useful in their diagnosis.
Acute Trauma to the Knee. Bone Scan with SPECT or SPECT/CT Knee Tc-99m bone scan with SPECT/CT knee is not routinely used as the initial imaging study for the evaluation of acute trauma to the knee. US Knee US is not routinely used as the initial imaging study for the evaluation of acute trauma to the knee. Acute Trauma to the Knee Variant 3: Adult or skeletally mature child. Fall or acute twisting trauma to the knee. No fracture seen on radiographs. Suspect occult fracture or internal derangement. Next study. CT Knee CT may be performed as the next imaging study for the evaluation of suspected radiographically occult knee fractures. Several studies reported CT to be superior to knee radiographs in detection and classification of fractures. In a study by Mustonen et al [12], CT showed 100% and radiographs 83% sensitivity in detection of tibial plateau fractures, and CT was superior in further characterization of fracture severity. In the setting of acute knee trauma, Mui et al [13] reported 80% sensitivity and 98% specificity of the CT examination in detecting bony avulsion fractures and a high negative predictive value for excluding ligamentous injuries, but MRI remained necessary for the preoperative detection of meniscal injury. Peltola et al [14] compared dual-energy CT examinations with MRI studies as a reference standard in 18 patients with acute knee trauma and reported dual-energy CT had 79% sensitivity and 100% specificity in detecting anterior cruciate ligament (ACL) ruptures [14]. In a study by Heffernan et al [15], 64-channel multidetector CT showed 87.5% to 100% sensitivity and 100% specificity for detection of the ACL tears. As on MRI, secondary signs, such as buckling of the posterior cruciate ligament, were also useful in their diagnosis.