Although osseous destruction, as well as identifying lytic or sclerotic lesions can be detected on radiography, at least half of the bone must be eroded before there is a noticeable change on radiographs [64]. Whole-body FDG-PET/CT is typically not an initial imaging study but can be used to evaluate for widespread metastatic disease and can distinguish benign versus malignant compression fractures [65,66]. In a patient with suspected spinal infection, MRI without and with IV contrast is preferred because of its high sensitivity and specificity. MRI can localize the site of infection and assess the extent of extradural/epidural and paravertebral involvement. The addition of IV contrast with fat suppression is invaluable in identifying epidural and paraspinal abscess [65] and helps distinguish abscess from phlegmon [67]. Again, MRI allows the diagnosis of infection before bone destruction is evident on either CT or radiography. Noncontrast and contrast-enhanced MRI has the ability to demonstrate inflammatory, neoplastic, and most traumatic lesions, as well as to show anatomic detail not available on isotope studies [68]. Although less sensitive and specific than MRI for evaluation for infection or neoplasm, CT lumbar spine without IV contrast can be obtained to evaluate for associated osseous abnormalities (eg, pathologic fracture, bony destructive change). In some cases, addition of IV contrast may be useful to assess for epidural abscess in such patients [45-47]. CT myelography of the lumbar spine assesses the patency of the spinal canal/thecal sac and of the subarticular recesses and neural foramen [22]. It can be useful in patients with suspected neoplasm and neurologic deficit. This modality has the disadvantage of lumbar puncture and injection of intrathecal contrast [22]. Bone Scan Whole Body with SPECT or SPECT/CT Complete Spine SPECT or SPECT/CT is not the initial imaging study but can be used to evaluate for widespread osseous metastatic disease.
Low Back Pain PCAs. Although osseous destruction, as well as identifying lytic or sclerotic lesions can be detected on radiography, at least half of the bone must be eroded before there is a noticeable change on radiographs [64]. Whole-body FDG-PET/CT is typically not an initial imaging study but can be used to evaluate for widespread metastatic disease and can distinguish benign versus malignant compression fractures [65,66]. In a patient with suspected spinal infection, MRI without and with IV contrast is preferred because of its high sensitivity and specificity. MRI can localize the site of infection and assess the extent of extradural/epidural and paravertebral involvement. The addition of IV contrast with fat suppression is invaluable in identifying epidural and paraspinal abscess [65] and helps distinguish abscess from phlegmon [67]. Again, MRI allows the diagnosis of infection before bone destruction is evident on either CT or radiography. Noncontrast and contrast-enhanced MRI has the ability to demonstrate inflammatory, neoplastic, and most traumatic lesions, as well as to show anatomic detail not available on isotope studies [68]. Although less sensitive and specific than MRI for evaluation for infection or neoplasm, CT lumbar spine without IV contrast can be obtained to evaluate for associated osseous abnormalities (eg, pathologic fracture, bony destructive change). In some cases, addition of IV contrast may be useful to assess for epidural abscess in such patients [45-47]. CT myelography of the lumbar spine assesses the patency of the spinal canal/thecal sac and of the subarticular recesses and neural foramen [22]. It can be useful in patients with suspected neoplasm and neurologic deficit. This modality has the disadvantage of lumbar puncture and injection of intrathecal contrast [22]. Bone Scan Whole Body with SPECT or SPECT/CT Complete Spine SPECT or SPECT/CT is not the initial imaging study but can be used to evaluate for widespread osseous metastatic disease.