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The contribution of CT to back pain patients (BPP) evaluation with SPECT/CT bone scan (BS)

¹ Nuclear Medicine Division, Mount Sinai School of Medicine, New York, New York

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Objectives: Hybrid SPECT/CT provides enhanced anatomical localization of BS lesions (LS) detected on SPECT. The aim of this study was to investigate efficacy of SPECT/CT in evaluating BPP. Additionally, we explored if CT findings on SPECT/CT have incremental value in BPP work-up.

Methods: We evaluated BS of 114 BPP (age 60 ± 24 years, 45 men) who had planar & SPECT/CT performed. Planar, SPECT & SPECT/CT were separately reviewed by 2 observers for LS presence, location & specific diagnosis (Dx) based on each scan. Confidence in these assessments was classified as uncertain, probable or certain. CT findings in 38 BPP with 80 LS done by SPECT/4-slice CT were further categorized as supportive or not supportive of SPECT/CT Dx. Final Dx was confirmed by surgical/pathological, radiological correlation, or up to 25 months follow-up.

Results: There were 240 LS detected in 114 BPP with final Dx of arthritis, degenerative disease, fracture, postoperative changes, & normal BS. SPECT/CT was more predictive of final Dx than SPECT alone as assessed by Lambda value (0.96 vs. 0.83, respectively) & uncertainty coefficient error reduction (92% vs. 73%, respectively). Although LS presence certainty in planar BS was improved by both SPECT & SPECT/CT, LS localization & overall Dx certainties were higher in SPECT/CT than SPECT alone (p < 0.001). LS presence & localization certainties, & supportive CT findings were all predictive of SPECT/CT Dx confidence. However, only LS localization certainty was significant in multivariate regression analysis (p = 0.01).

Conclusions: While detection of LS in BS is significantly enhanced by SPECT, SPECT/CT additionally clarifies exact LS location & visualizes associated CT changes. LS localization certainty appears the most important component of the superior SPECT/CT Dx confidence in BPP.

This Article Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Heiba, S. Articles by Machac, J. PubMed Articles by Heiba, S. Articles by Machac, J.