SPECT or SPECT/CT Spine Area of Interest SPECT coupled with CT provides complementary information because sites of abnormal radiopharmaceutical uptake on the spine are of interest. SPECT images can be anatomically localized on the CT, and anatomic abnormalities on CT images can draw attention to subtle areas of SPECT tracer uptake. SPECT/CT has been shown to localize abnormalities in the vertebra more precisely compared with SPECT imaging alone, particularly in complicated cases, such as multiple collapsed vertebrae of different ages [57]. Studies have demonstrated a 63% to Vertebral Compression Fractures 80% agreement between SPECT/CT and MRI in detecting acute VCF [58,59]. SPECT/CT may be useful for imaging diagnosis of acute fractures [60]. FDG-PET/CT Skull Base to Mid-Thigh In the postprocedure setting, new pain may be due to infection. FDG-PET combined with morphologic CT imaging can noninvasively localize metabolic activity in areas of spinal infection. Studies on the diagnosis of vertebral osteomyelitis reported a sensitivity and specificity of 83% and 88% for FDG-PET/CT [61-63]. Vertebral osteomyelitis may present as a compression fracture [64] and may be difficult to distinguish from noninfectious, osteoporotic VCF. Vertebral osteomyelitis may be considered in the setting of severe back pain, persistent unexplained fever, elevated inflammatory markers (ie, erythrocyte sedimentation rate), or bacteremia without a known extravertebral focus of infection, particularly if the patient is immunocompromised. Variant 4: Asymptomatic VCF identified on radiographs. History of malignancy. Next imaging study. The body regions covered in this clinical scenario are the cervical, thoracic, and lumbar spine. These body regions might be evaluated separately or in combination, guided by physical examination findings, patient history, and other available information, including prior imaging.
Management of Vertebral Compression Fractures PCAs. SPECT or SPECT/CT Spine Area of Interest SPECT coupled with CT provides complementary information because sites of abnormal radiopharmaceutical uptake on the spine are of interest. SPECT images can be anatomically localized on the CT, and anatomic abnormalities on CT images can draw attention to subtle areas of SPECT tracer uptake. SPECT/CT has been shown to localize abnormalities in the vertebra more precisely compared with SPECT imaging alone, particularly in complicated cases, such as multiple collapsed vertebrae of different ages [57]. Studies have demonstrated a 63% to Vertebral Compression Fractures 80% agreement between SPECT/CT and MRI in detecting acute VCF [58,59]. SPECT/CT may be useful for imaging diagnosis of acute fractures [60]. FDG-PET/CT Skull Base to Mid-Thigh In the postprocedure setting, new pain may be due to infection. FDG-PET combined with morphologic CT imaging can noninvasively localize metabolic activity in areas of spinal infection. Studies on the diagnosis of vertebral osteomyelitis reported a sensitivity and specificity of 83% and 88% for FDG-PET/CT [61-63]. Vertebral osteomyelitis may present as a compression fracture [64] and may be difficult to distinguish from noninfectious, osteoporotic VCF. Vertebral osteomyelitis may be considered in the setting of severe back pain, persistent unexplained fever, elevated inflammatory markers (ie, erythrocyte sedimentation rate), or bacteremia without a known extravertebral focus of infection, particularly if the patient is immunocompromised. Variant 4: Asymptomatic VCF identified on radiographs. History of malignancy. Next imaging study. The body regions covered in this clinical scenario are the cervical, thoracic, and lumbar spine. These body regions might be evaluated separately or in combination, guided by physical examination findings, patient history, and other available information, including prior imaging.