Bone Scan Whole Body with SPECT or SPECT/CT Neck Although Tc-99m bone scan is the most commonly used technique for detecting suspected osseous metastasis, it has a high false-positive rate secondary to benign processes with increased bone turnover, such as degenerative osteoarthrosis [95]. The addition of SPECT to the acquisition protocol of bone scintigraphy improves image contrast resolution [96] and, thus, diagnostic accuracy. Furthermore, adding a CT acquisition can increase this diagnostic accuracy with anatomic localization to the SPECT images resulting in SPECT/CT [36]. Cervical Neck Pain or Cervical Radiculopathy Radiography Cervical Spine Conventional radiography still plays an important role in the diagnostic evaluation of bone metastases as pathological changes in cortical bone are detectable by plain radiograph even if they are only a few millimeters wide [97]. Radiographs can also reveal osteolytic lesions at risk for superimposed pathological fracture. However, given that these osteolytic changes may only be detectable after 50% of the bone substance has been destroyed [87], and lesions up to 1 cm may not be detectable, radiographs alone are not sufficient to exclude metastases in the setting of neck pain in a patient with known malignancy. 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]. CT Cervical Spine There is no evidence that medical imaging is diagnostic for the etiologies of cervicogenic headache; however, imaging may lend support to its diagnosis [103].
Cervical Neck Pain or Cervical Radiculopathy PCAs. Bone Scan Whole Body with SPECT or SPECT/CT Neck Although Tc-99m bone scan is the most commonly used technique for detecting suspected osseous metastasis, it has a high false-positive rate secondary to benign processes with increased bone turnover, such as degenerative osteoarthrosis [95]. The addition of SPECT to the acquisition protocol of bone scintigraphy improves image contrast resolution [96] and, thus, diagnostic accuracy. Furthermore, adding a CT acquisition can increase this diagnostic accuracy with anatomic localization to the SPECT images resulting in SPECT/CT [36]. Cervical Neck Pain or Cervical Radiculopathy Radiography Cervical Spine Conventional radiography still plays an important role in the diagnostic evaluation of bone metastases as pathological changes in cortical bone are detectable by plain radiograph even if they are only a few millimeters wide [97]. Radiographs can also reveal osteolytic lesions at risk for superimposed pathological fracture. However, given that these osteolytic changes may only be detectable after 50% of the bone substance has been destroyed [87], and lesions up to 1 cm may not be detectable, radiographs alone are not sufficient to exclude metastases in the setting of neck pain in a patient with known malignancy. 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]. CT Cervical Spine There is no evidence that medical imaging is diagnostic for the etiologies of cervicogenic headache; however, imaging may lend support to its diagnosis [103].