In the past, the preferred radionuclide imaging for spinal osteomyelitis was a combination of bone and gallium scans. MRA Neck The literature search did not identify any studies regarding the use of MRA in the evaluation of this clinical presentation. MRI Cervical Spine MRI with and without contrast is considered the best modality for demonstrating spinal infections, with a sensitivity of 96%, specificity of 92%, and accuracy of 94% [68,69,76]. While bone marrow edema can be detected on noncontrast examinations [68,77-79], the addition of contrast improves detection and characterization of leptomeningeal involvement or the development of an epidural or paraspinal abscess [79,80]. Bone Scan Whole Body with SPECT or SPECT/CT Neck Three-phase Tc-99m MDP scintigraphy is sensitive (90%) but not specific (78%) [76] for the identification of suspect cervical spine osteomyelitis. Radiography Cervical Spine Radiographs lack sensitivity and specificity in the setting of discitis or osteomyelitis, as 30% to 40% of the vertebral bone must be destroyed before lytic changes can be identified [81,82]. Because of the low sensitivity and specificity, particularly in early phases of spine infection, a negative cervical spine radiograph should not be considered comprehensive imaging in this scenario. Myelography Cervical Spine CT myelography has supplanted fluoroscopic myelography in most circumstances; however, there may be times when fluoroscopic myelography is also performed prior to CT imaging. The ultimate judgment regarding the appropriateness of any specific procedure, lumbar versus cervical puncture route, amount of contrast, and the extent and modality of imaging coverage must be made by the radiologist, with appropriate documentation and coding [17]. Cervical Neck Pain or Cervical Radiculopathy Variant 5: Known malignancy. New or increasing nontraumatic cervical or neck pain or radiculopathy. Initial imaging.
Cervical Neck Pain or Cervical Radiculopathy PCAs. In the past, the preferred radionuclide imaging for spinal osteomyelitis was a combination of bone and gallium scans. MRA Neck The literature search did not identify any studies regarding the use of MRA in the evaluation of this clinical presentation. MRI Cervical Spine MRI with and without contrast is considered the best modality for demonstrating spinal infections, with a sensitivity of 96%, specificity of 92%, and accuracy of 94% [68,69,76]. While bone marrow edema can be detected on noncontrast examinations [68,77-79], the addition of contrast improves detection and characterization of leptomeningeal involvement or the development of an epidural or paraspinal abscess [79,80]. Bone Scan Whole Body with SPECT or SPECT/CT Neck Three-phase Tc-99m MDP scintigraphy is sensitive (90%) but not specific (78%) [76] for the identification of suspect cervical spine osteomyelitis. Radiography Cervical Spine Radiographs lack sensitivity and specificity in the setting of discitis or osteomyelitis, as 30% to 40% of the vertebral bone must be destroyed before lytic changes can be identified [81,82]. Because of the low sensitivity and specificity, particularly in early phases of spine infection, a negative cervical spine radiograph should not be considered comprehensive imaging in this scenario. Myelography Cervical Spine CT myelography has supplanted fluoroscopic myelography in most circumstances; however, there may be times when fluoroscopic myelography is also performed prior to CT imaging. The ultimate judgment regarding the appropriateness of any specific procedure, lumbar versus cervical puncture route, amount of contrast, and the extent and modality of imaging coverage must be made by the radiologist, with appropriate documentation and coding [17]. Cervical Neck Pain or Cervical Radiculopathy Variant 5: Known malignancy. New or increasing nontraumatic cervical or neck pain or radiculopathy. Initial imaging.