Because of the whole-body technique, bone scan can demonstrate additional osseous abnormalities as regions of increased radiotracer uptake [31,36]. Myelography and Postmyelography CT Spine This examination is not indicated in the evaluation of chronic back pain due to suspected mechanical causes and normal neurologic examination. Variant 6: Child. Back pain associated with suspected inflammation, infection, or malignancy. Radiographs Radiography of the area of clinical interest can be suggestive of inflammatory, infectious, or malignant conditions affecting the spine; however, the modality is insensitive and can easily miss subtle findings [27,28]. Discogenic infections occur in the pediatric population and manifest as mild disc-space narrowing on radiographs [7]. Lytic or sclerotic primary and metastatic tumors may be identified along with evidence of bony destruction, periosteal reaction, or a soft-tissue mass. Subtle pedicular erosion with widening of the interpedicular distance or enlargement of the neural foramina may be secondary findings due to an intraspinal tumor [8]. MRI Spine If inflammation, infection, or malignancy is suspected, MRI without and with contrast of the total spine or region of interest is indicated. A noncontrast examination may be indicated in the presence of renal dysfunction. MRI is generally accepted as the primary imaging modality for the detection and evaluation of intra- and paraspinal masses [27,28]. The ability to localize the mass in relation to adjacent neural structures is a significant advantage over other imaging modalities [8]. Infectious spondyloarthropathies also are best imaged using MRI because of its ability to evaluate for epidural extension of disease and cord compromise [8,13,29]. MRI may also be able to differentiate tuberculous from nontuberculous spondylitis [14]. Additionally, inflammatory arthropathies are well evaluated with MRI [33]. If contrast is administered, precontrast images are needed to assess enhancement.
Back Pain Child PCAs. Because of the whole-body technique, bone scan can demonstrate additional osseous abnormalities as regions of increased radiotracer uptake [31,36]. Myelography and Postmyelography CT Spine This examination is not indicated in the evaluation of chronic back pain due to suspected mechanical causes and normal neurologic examination. Variant 6: Child. Back pain associated with suspected inflammation, infection, or malignancy. Radiographs Radiography of the area of clinical interest can be suggestive of inflammatory, infectious, or malignant conditions affecting the spine; however, the modality is insensitive and can easily miss subtle findings [27,28]. Discogenic infections occur in the pediatric population and manifest as mild disc-space narrowing on radiographs [7]. Lytic or sclerotic primary and metastatic tumors may be identified along with evidence of bony destruction, periosteal reaction, or a soft-tissue mass. Subtle pedicular erosion with widening of the interpedicular distance or enlargement of the neural foramina may be secondary findings due to an intraspinal tumor [8]. MRI Spine If inflammation, infection, or malignancy is suspected, MRI without and with contrast of the total spine or region of interest is indicated. A noncontrast examination may be indicated in the presence of renal dysfunction. MRI is generally accepted as the primary imaging modality for the detection and evaluation of intra- and paraspinal masses [27,28]. The ability to localize the mass in relation to adjacent neural structures is a significant advantage over other imaging modalities [8]. Infectious spondyloarthropathies also are best imaged using MRI because of its ability to evaluate for epidural extension of disease and cord compromise [8,13,29]. MRI may also be able to differentiate tuberculous from nontuberculous spondylitis [14]. Additionally, inflammatory arthropathies are well evaluated with MRI [33]. If contrast is administered, precontrast images are needed to assess enhancement.