Figure 10.

Single photon emission CT (SPECT) in a patient with sickle-cell disease presenting with bilateral wrist pain, performed to assess vascularity of carpal bones for avascular necrosis ± evidence of degenerative changes. There is increased vascularity in the scaphoid bilaterally on the blood pool images (top left) with more marked uptake in the left scaphoid on delayed images (top right and bottom left). SPECT-CT shows preservation of the alignment and joint spaces between radio-ulna, ulna-carpal, radio-carpal and intercarpal joints but evidence of bilateral avascular necrosis of the scaphoid.