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 CT Cervical Spine CT with and without contrast is superior to radiography for the detection of erosive changes, loss of fat planes, and paraspinal edema and fluid collections [69]. CT scanning also offers potential advantages in identifying the presence of gas within an abscess, the lack of gas within the disc space, or a sequestrum within the spinal canal [70]. CT with contrast is complementary to MRI. CT Myelography Cervical Spine The literature search did not identify any studies regarding the use of CT myelography in the evaluation of this clinical presentation. CTA Neck The literature search did not identify any studies regarding the use of CTA in the evaluation of this clinical presentation. Percutaneous Interventions The literature search did not identify any studies regarding the use of cervical facet joint, medial branch blocks, or discography as a first-line test in the evaluation of this clinical presentation. FDG-PET/CT Skull Base to Mid-Thigh PET using the tracer fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG)/CT is the scintigraphic procedure of choice for spinal osteomyelitis [71-73]. Gallium-67 Scan Whole Body Specificity may be increased by combining Tc-99m methylene diphosphonate (MDP) with gallium-67 citrate [74], and higher sensitivity and resolution can be further achieved with SPECT/CT [75]. Indium-111 WBC Scan Whole Body Indium-labeled leucocytes have a low sensitivity in spinal infections (osteomyelitis and discitis). In these clinical scenarios, leucocytes are generally not used because of a reported 40% false-negative rate, which is manifested as normal uptake or photopenia.
Cervical Neck Pain or Cervical Radiculopathy PCAs. 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 CT Cervical Spine CT with and without contrast is superior to radiography for the detection of erosive changes, loss of fat planes, and paraspinal edema and fluid collections [69]. CT scanning also offers potential advantages in identifying the presence of gas within an abscess, the lack of gas within the disc space, or a sequestrum within the spinal canal [70]. CT with contrast is complementary to MRI. CT Myelography Cervical Spine The literature search did not identify any studies regarding the use of CT myelography in the evaluation of this clinical presentation. CTA Neck The literature search did not identify any studies regarding the use of CTA in the evaluation of this clinical presentation. Percutaneous Interventions The literature search did not identify any studies regarding the use of cervical facet joint, medial branch blocks, or discography as a first-line test in the evaluation of this clinical presentation. FDG-PET/CT Skull Base to Mid-Thigh PET using the tracer fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG)/CT is the scintigraphic procedure of choice for spinal osteomyelitis [71-73]. Gallium-67 Scan Whole Body Specificity may be increased by combining Tc-99m methylene diphosphonate (MDP) with gallium-67 citrate [74], and higher sensitivity and resolution can be further achieved with SPECT/CT [75]. Indium-111 WBC Scan Whole Body Indium-labeled leucocytes have a low sensitivity in spinal infections (osteomyelitis and discitis). In these clinical scenarios, leucocytes are generally not used because of a reported 40% false-negative rate, which is manifested as normal uptake or photopenia.