TY - JOUR
T1 - 99mTc-MDP SPECT/CT of the spine and sacrum at a multispecialty institution
T2 - Clinical use, findings, and impact on patient management
AU - Lehman, Vance T.
AU - Murphy, Robert C.
AU - Maus, Timothy P.
PY - 2013/11/1
Y1 - 2013/11/1
N2 - OBJECTIVE: The use of technetium-99m methylene diphosphonate single-photon emission tomography/computed tomography (Tc-MDP SPECT/CT) of the spine and sacrum has increased over the past years; however, there is little information about the optimal clinical role and true clinical impact of this modality. METHODS: All 99mmc-MDP SPECT/CT examinations of the spine and sacrum performed at our large multispecialty institution between 1 January 2008 and 12 April 2012 were identified. The indications, findings, clinical context, and impact on patient management were identified through a retrospective chart review. RESULTS: Of the 212 99mTc-MDP SPECT/CT examinations of the spine and sacrum identified, 191 (90%) were for pain evaluation, 14 (7%) were to assess infection, and seven (3%) were to evaluate a potential malignancy. The most common specific indication was evaluation of facet joint pain in 70/191 (37%) patients, and the most common finding was facet joint activity in 106/212 (50%) patients. Several findings were reported, although facet joint activity was the most frequent. The other findings included costovertebral joint activity, pars interarticularis defects, an osteoid osteoma, a lumbosacral pseudoarticulation, and a postoperative pseudoarthrosis. A resultant change in clinical management was documented in 168/212 (79%) patients. Ninety-two of the 212 (44%) patients had undergone an MRI of the same region for any indication within ±6 months. CONCLUSION: 99mTc-MDP SPECT/CT of the spine and sacrum is most frequently used for the diagnosis and management of pain. It helps identify several potential pain generators, is often used in patients who have a near-contemporaneous MRI, and has an impact on the procedural and/or conservative management in most patients. In addition, several areas in need of future research to establish the optimal clinical role of this modality were identified.
AB - OBJECTIVE: The use of technetium-99m methylene diphosphonate single-photon emission tomography/computed tomography (Tc-MDP SPECT/CT) of the spine and sacrum has increased over the past years; however, there is little information about the optimal clinical role and true clinical impact of this modality. METHODS: All 99mmc-MDP SPECT/CT examinations of the spine and sacrum performed at our large multispecialty institution between 1 January 2008 and 12 April 2012 were identified. The indications, findings, clinical context, and impact on patient management were identified through a retrospective chart review. RESULTS: Of the 212 99mTc-MDP SPECT/CT examinations of the spine and sacrum identified, 191 (90%) were for pain evaluation, 14 (7%) were to assess infection, and seven (3%) were to evaluate a potential malignancy. The most common specific indication was evaluation of facet joint pain in 70/191 (37%) patients, and the most common finding was facet joint activity in 106/212 (50%) patients. Several findings were reported, although facet joint activity was the most frequent. The other findings included costovertebral joint activity, pars interarticularis defects, an osteoid osteoma, a lumbosacral pseudoarticulation, and a postoperative pseudoarthrosis. A resultant change in clinical management was documented in 168/212 (79%) patients. Ninety-two of the 212 (44%) patients had undergone an MRI of the same region for any indication within ±6 months. CONCLUSION: 99mTc-MDP SPECT/CT of the spine and sacrum is most frequently used for the diagnosis and management of pain. It helps identify several potential pain generators, is often used in patients who have a near-contemporaneous MRI, and has an impact on the procedural and/or conservative management in most patients. In addition, several areas in need of future research to establish the optimal clinical role of this modality were identified.
KW - SPECT/CT
KW - costotransverse joint
KW - costovertebral joint
KW - facet joint
KW - novel imaging technology
KW - outcomes
KW - pars interarticularis
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U2 - 10.1097/MNM.0b013e328364bfa6
DO - 10.1097/MNM.0b013e328364bfa6
M3 - Article
C2 - 23942325
AN - SCOPUS:84885018435
SN - 0143-3636
VL - 34
SP - 1097
EP - 1106
JO - Nuclear medicine communications
JF - Nuclear medicine communications
IS - 11
ER -