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

ObjectiveThe use of technetium-99m methylene diphosphonate single-photon emission tomography/computed tomography (Tc-99m-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.MethodsAll Tc-99m-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.ResultsOf the 212 Tc-99m-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(99m)Tc-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. (C) 2013 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.