Symptomatic Bipartite Medial Cuneiform Diagnosed with Two-Phase SPECT/CT: A Case Report and Literature Review

Abstract Blood-pool single-photon emission computed tomography (SPECT)/CT demonstrated marked focal hyperemia localized to the right medial cuneiform, with suspicion of an underlying bipartite variant, a finding not present on the left side. This blood-pool positivity is critically important: it directly demonstrates active vascular permeability and synovitis-like inflammation at the pseudoarticulation cleft, a pathophysiological layer that neither CT nor magnetic resonance imaging can provide under physiological weight-bearing conditions. Without the blood-pool phase, the inflammatory component of the synchondrosis activity would have remained entirely undetected.