Diagnosing spinal osteomyelitis: A comparison of bone and Ga-67 scintigraphy and magnetic resonance imaging

Charito Love, Mahendra Patel, Baron S. Lonner, Maria B. Tomas, Christopher J. Palestro

Research output: Contribution to journalArticle

112 Citations (Scopus)

Abstract

Purpose: The objective of this investigation was to compare the accuracies of bone and Ga-67 scintigraphy and magnetic resonance imaging (MRI) for diagnosing spinal osteomyelitis and to determine the optimal radionuclide approach to this disorder. Methods: Twenty-two patients, with 24 sites of possible spinal osteomyelitis, who underwent three-phase bone scintigraphy with SPECT, Ga-67 scintigraphy with SPECT, and MRI with and without contrast were included in this retrospective review. Bone scans were interpreted as three-phase studies, delayed planar images alone, delayed planar plus SPECT, and SPECT alone (to identify uptake patterns). Sequential bone/Ga-67 images were interpreted as planar and as SPECT studies. Planar and SPECT Ga-67 images were also interpreted alone. Precontrast MRI studies were used to identify osteomyelitis, whereas postcontrast images were used to identify soft tissue infection. Results: Eleven sites of spinal osteomyelitis were identified. Tracer uptake in two contiguous vertebrae, as noted on SPECT, was the most accurate bone scan criterion for detecting spinal osteomyelitis (71%). SPECT bone/Ga-67 was significantly more accurate (92%) than both planar bone/Ga-67 (75%) and bone SPECT (P = 0.15 and P = 0.2, respectively). SPECT Ga-67 was as accurate as SPECT bone/Ga-67 and as sensitive as MRI (91%); the radionuclide study was slightly but not significantly more specific (92% vs. 77%) than MRI. Of 11 sites of extraosseous infection, 10 were identified on MRI, 9 on SPECT Ga-67, 7 on planar Ga-67, and none on bone scintigraphy. Conclusions: Spinal osteomyelitis and accompanying soft tissue infection can be diagnosed accurately with a single radionuclide procedure: SPECT Ga-67. This procedure can be used as a reliable alternative when MRI cannot be performed and as an adjunct in patients in whom the diagnosis is uncertain.

Original languageEnglish (US)
Pages (from-to)963-977
Number of pages15
JournalClinical Nuclear Medicine
Volume25
Issue number12
DOIs
StatePublished - 2000
Externally publishedYes

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Osteomyelitis
Single-Photon Emission-Computed Tomography
Radionuclide Imaging
Magnetic Resonance Imaging
Bone and Bones
Radioisotopes
Soft Tissue Infections
Spine

Keywords

  • Ga-67
  • Magnetic Resonance Imaging
  • Osteomyelitis
  • SPECT

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Diagnosing spinal osteomyelitis : A comparison of bone and Ga-67 scintigraphy and magnetic resonance imaging. / Love, Charito; Patel, Mahendra; Lonner, Baron S.; Tomas, Maria B.; Palestro, Christopher J.

In: Clinical Nuclear Medicine, Vol. 25, No. 12, 2000, p. 963-977.

Research output: Contribution to journalArticle

Love, Charito ; Patel, Mahendra ; Lonner, Baron S. ; Tomas, Maria B. ; Palestro, Christopher J. / Diagnosing spinal osteomyelitis : A comparison of bone and Ga-67 scintigraphy and magnetic resonance imaging. In: Clinical Nuclear Medicine. 2000 ; Vol. 25, No. 12. pp. 963-977.
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abstract = "Purpose: The objective of this investigation was to compare the accuracies of bone and Ga-67 scintigraphy and magnetic resonance imaging (MRI) for diagnosing spinal osteomyelitis and to determine the optimal radionuclide approach to this disorder. Methods: Twenty-two patients, with 24 sites of possible spinal osteomyelitis, who underwent three-phase bone scintigraphy with SPECT, Ga-67 scintigraphy with SPECT, and MRI with and without contrast were included in this retrospective review. Bone scans were interpreted as three-phase studies, delayed planar images alone, delayed planar plus SPECT, and SPECT alone (to identify uptake patterns). Sequential bone/Ga-67 images were interpreted as planar and as SPECT studies. Planar and SPECT Ga-67 images were also interpreted alone. Precontrast MRI studies were used to identify osteomyelitis, whereas postcontrast images were used to identify soft tissue infection. Results: Eleven sites of spinal osteomyelitis were identified. Tracer uptake in two contiguous vertebrae, as noted on SPECT, was the most accurate bone scan criterion for detecting spinal osteomyelitis (71{\%}). SPECT bone/Ga-67 was significantly more accurate (92{\%}) than both planar bone/Ga-67 (75{\%}) and bone SPECT (P = 0.15 and P = 0.2, respectively). SPECT Ga-67 was as accurate as SPECT bone/Ga-67 and as sensitive as MRI (91{\%}); the radionuclide study was slightly but not significantly more specific (92{\%} vs. 77{\%}) than MRI. Of 11 sites of extraosseous infection, 10 were identified on MRI, 9 on SPECT Ga-67, 7 on planar Ga-67, and none on bone scintigraphy. Conclusions: Spinal osteomyelitis and accompanying soft tissue infection can be diagnosed accurately with a single radionuclide procedure: SPECT Ga-67. This procedure can be used as a reliable alternative when MRI cannot be performed and as an adjunct in patients in whom the diagnosis is uncertain.",
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