99mTc-MDP SPECT/CT of the spine and sacrum at a multispecialty institution: Clinical use, findings, and impact on patient management

Vance T Lehman, Robert C. Murphy, Timothy Maus

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1097-1106
Number of pages10
JournalNuclear Medicine Communications
Volume34
Issue number11
DOIs
StatePublished - Nov 2013

Fingerprint

Technetium Tc 99m Medronate
Sacrum
Spine
Zygapophyseal Joint
Osteoid Osteoma
Pain
Pseudarthrosis
Technetium
Arthralgia
Pain Management
Single Photon Emission Computed Tomography Computed Tomography
Single-Photon Emission-Computed Tomography
Tomography
Infection

Keywords

  • costotransverse joint
  • costovertebral joint
  • facet joint
  • novel imaging technology
  • outcomes
  • pars interarticularis
  • SPECT/CT

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

@article{c6ad728073784f128c92aed67729c2a2,
title = "99mTc-MDP SPECT/CT of the spine and sacrum at a multispecialty institution: Clinical use, findings, and impact on patient management",
abstract = "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.",
keywords = "costotransverse joint, costovertebral joint, facet joint, novel imaging technology, outcomes, pars interarticularis, SPECT/CT",
author = "Lehman, {Vance T} and Murphy, {Robert C.} and Timothy Maus",
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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

PY - 2013/11

Y1 - 2013/11

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 - costotransverse joint

KW - costovertebral joint

KW - facet joint

KW - novel imaging technology

KW - outcomes

KW - pars interarticularis

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