In the circumstance of determining the presence of calcifications, limited images could be obtained through the area of interest. Bone Scan Whole Body with SPECT or SPECT/CT Complete Spine Tc-99m bone scan may be a useful tool in children with back pain and no specific neurologic findings on physical examination [4]. However, a retrospective study evaluating bone scan as a screening tool found that primary malignancies of the spine were missed in 3 out of 142 patients, although only planar bone scans were obtained in this study [20]. Although bone scan with SPECT can be very sensitive to bone pathology such as spondylolysis [19], potentially significant causes of back pain could be missed using only this modality [8,20]. SPECT/CT is not addressed in this discussion because it is not widely available. Myelography and Postmyelography CT Spine Because of the invasiveness of the procedure, myelography and postmyelography CT of the whole spine are considered in the setting of an abnormal neurologic examination only if MRI is contraindicated or will have significantly limited diagnostic yield because of spinal hardware. Variant 4: Child. Back pain with 1 or more of the following clinical red flags: constant pain, night pain, radicular pain, pain lasting >4 weeks, abnormal neurologic examination. Positive radiographs. MRI Spine MRI is sensitive for the imaging evaluation of soft-tissue and bony abnormalities associated with pediatric back pain, including paraspinous soft-tissue pathology, disc disease, marrow edema, and intraspinal masses that may be suggested on radiographs of the spine [8,24-26,32]. Two large prospective studies have used MRI in an algorithm for evaluation of pediatric back pain in a total of 348 patients [1,5]. These studies found that MRI had high diagnostic accuracy in identifying and delineating the etiology of pediatric back pain; however, if a specific diagnosis was determined using spine radiographs, MRI was not performed.
Back Pain Child PCAs. In the circumstance of determining the presence of calcifications, limited images could be obtained through the area of interest. Bone Scan Whole Body with SPECT or SPECT/CT Complete Spine Tc-99m bone scan may be a useful tool in children with back pain and no specific neurologic findings on physical examination [4]. However, a retrospective study evaluating bone scan as a screening tool found that primary malignancies of the spine were missed in 3 out of 142 patients, although only planar bone scans were obtained in this study [20]. Although bone scan with SPECT can be very sensitive to bone pathology such as spondylolysis [19], potentially significant causes of back pain could be missed using only this modality [8,20]. SPECT/CT is not addressed in this discussion because it is not widely available. Myelography and Postmyelography CT Spine Because of the invasiveness of the procedure, myelography and postmyelography CT of the whole spine are considered in the setting of an abnormal neurologic examination only if MRI is contraindicated or will have significantly limited diagnostic yield because of spinal hardware. Variant 4: Child. Back pain with 1 or more of the following clinical red flags: constant pain, night pain, radicular pain, pain lasting >4 weeks, abnormal neurologic examination. Positive radiographs. MRI Spine MRI is sensitive for the imaging evaluation of soft-tissue and bony abnormalities associated with pediatric back pain, including paraspinous soft-tissue pathology, disc disease, marrow edema, and intraspinal masses that may be suggested on radiographs of the spine [8,24-26,32]. Two large prospective studies have used MRI in an algorithm for evaluation of pediatric back pain in a total of 348 patients [1,5]. These studies found that MRI had high diagnostic accuracy in identifying and delineating the etiology of pediatric back pain; however, if a specific diagnosis was determined using spine radiographs, MRI was not performed.