The Incremental Value of SPECT/CT in Characterizing Solitary Spine Lesions

Abstract

The purpose of this study was to investigate the incremental value and diagnostic impact of SPECT/CT in patients who had a solitary spinal lesion on a bone scan. Methods: A prospective study was performed on 80 patients (50 with known cancer) who underwent 99m Tc-methylene diphosphonate whole-body planar bone scintigraphy and had a solitary spinal lesion. These lesions were then further evaluated using SPECT/CT. Results: Lesions were localized to the vertebral body in 38 patients (47.5%), pedicle in 15 (18.8%), facet joint in 15 (18.8%), transverse process in 2 (2.5%), spinous process in 2 (2.5%), lamina in 3 (3.8%), and end plates in 5 (6.2%). Although the specificity of planar bone scans was excellent (100%), sensitivity was only 6.1% but increased to 78.8% after the addition of SPECT/CT. The results provide evidence of a substantial incremental increase in diagnostic accuracy using SPECT/CT over planar imaging alone for patients in whom a solitary spinal lesion is noted. Conclusion: The addition of SPECT/CT significantly reduced the number of false-negative results and increased the number of true-positive results. SPECT/CT also reduced the number of equivocal reports. A definitive diagnosis was given for most patients, indicating improved diagnostic confidence with the addition of SPECT/CT, compared with planar imaging alone, in patients with solitary spinal lesions.

Hybrid spect-CT for characterization of isolated vertebral lesions seen on bone scintigraphy: comparison with planar scintigraphy, spect and CT

“…These systems allow the field of view of the CT scan to be adapted to line up with the SPECT findings. Some studies have evaluated the efficacy of 99mTc-MDP hybrid SPECT-CT for spinal lesions (12,13). However, none of these studies compared SPECT-CT with CT alone, which is more widely available and requires less time.…”

SPECT/CT imaging in breast cancer - current status and challenges

“…For solitary lesions in the spine, SPECT/CT increases the sensitivity of bone metastases detection from 6% using planar scan, to 79% (ref. 26 ). Further improvement is documented when determining the nature of the lesions in the skull using SPECT/ CT (in 100%) (ref.…”

“…SPECT/CT is also able to determine the benign character of different bone lesions: spine hemagiomas 31 , Schmorl's nodes 32 , pelvic fractures 33 . In case of isolated lesions of the spine, Iqbal 26 established a benign diagnosis in 80% of patients using SPECT/CTthese were cases of osteomyelitis, post-traumatic changes, spondylolysis, spondylolisthesis, and osteoarthritis of facet joints.…”

The usefulness of SPECT/CT in characterization of skeletal and soft tissue lesions — report of two cases

“…Lesions which affect body and pedicle or are photo-deficient are more likely to be malignant. Lesions affecting facet joints, costovertebral joints or two adjacent vertebrae are more likely to be benign [1][2][3].…”