Gallium Scan Whole Body Ga-67 scintigraphy combined with single-photon emission computed tomography (SPECT) can be used to evaluate suspected spine infection. Ga-67 is less sensitive (73%) but more specific (61%) than skeletal scintigraphy [31]. The disadvantages of the gallium examination include a requirement for delayed images (24 to 72 hours). [31]. A Tc-99m-MDP study can be combined with Ga-67-citrate in order to improve the overall specificity of the examination (81%) while maintaining a sensitivity of 78% [31,36]. This combined examination may be utilized in select clinical situations such as when multifocal infection is suspected [3]. WBC Scan and Sulfur Colloid Scan Complete Spine A labeled leukocyte and sulfur colloid study is limited in the evaluation of spine infection as areas of infection often demonstrate decreased or absent radionuclide uptake [31]. Suspected Spine Infection Variant 2: Suspected spine infection (such as epidural abscess or discitis osteomyelitis), with recent intervention (such as surgery with or without hardware, pain injection, or stimulator implantation). Initial imaging. The mean incidence of postoperative instrumented spine infection is approximately 2% to 3% [40]. The diagnosis of postintervention spine infection is a clinical challenge given an overlap of clinical symptoms such as neck or back pain between postoperative and spine infection patients. The identification of abnormal laboratory parameters, such as leukocytosis or elevated ESR or CRP, may increase the clinical suspicion for spine infection in the postintervention patient [8,9]. The timing of the imaging examination with respect to when the spine intervention is performed is particularly important, because expected findings such as alteration of soft tissue and osseous structures, edema, and small paraspinal fluid collections such as seromas may represent the normal sequelae of an intervention shortly (a few days to weeks) after the procedure [28,29,48,69].
Suspected Spine Infection PCAs. Gallium Scan Whole Body Ga-67 scintigraphy combined with single-photon emission computed tomography (SPECT) can be used to evaluate suspected spine infection. Ga-67 is less sensitive (73%) but more specific (61%) than skeletal scintigraphy [31]. The disadvantages of the gallium examination include a requirement for delayed images (24 to 72 hours). [31]. A Tc-99m-MDP study can be combined with Ga-67-citrate in order to improve the overall specificity of the examination (81%) while maintaining a sensitivity of 78% [31,36]. This combined examination may be utilized in select clinical situations such as when multifocal infection is suspected [3]. WBC Scan and Sulfur Colloid Scan Complete Spine A labeled leukocyte and sulfur colloid study is limited in the evaluation of spine infection as areas of infection often demonstrate decreased or absent radionuclide uptake [31]. Suspected Spine Infection Variant 2: Suspected spine infection (such as epidural abscess or discitis osteomyelitis), with recent intervention (such as surgery with or without hardware, pain injection, or stimulator implantation). Initial imaging. The mean incidence of postoperative instrumented spine infection is approximately 2% to 3% [40]. The diagnosis of postintervention spine infection is a clinical challenge given an overlap of clinical symptoms such as neck or back pain between postoperative and spine infection patients. The identification of abnormal laboratory parameters, such as leukocytosis or elevated ESR or CRP, may increase the clinical suspicion for spine infection in the postintervention patient [8,9]. The timing of the imaging examination with respect to when the spine intervention is performed is particularly important, because expected findings such as alteration of soft tissue and osseous structures, edema, and small paraspinal fluid collections such as seromas may represent the normal sequelae of an intervention shortly (a few days to weeks) after the procedure [28,29,48,69].