Suspected Spine Infection Radiography Spine Area of Interest Radiographs are insensitive during the early course of spine infection [3]. In the subacute or chronic phase of infection, radiographs can be helpful in the follow-up evaluation of the posttreatment spine because serial radiographic studies may show new abnormalities such as implant loosening or alteration in spinal alignment that might be caused by infection [10]. 3-Phase Bone Scan A 3-phase bone scan with Tc-99m-MDP has variable moderate-to-high sensitivity (81.4%) and low specificity (40.7%) for spine infection [31]. Gallium Scan Whole Body Ga-67 scintigraphy combined with SPECT can be used to evaluate suspected spine infection in patients who have undergone recent spine interventions. Ga-67 is less sensitive (73%) but more specific (61%) than skeletal scintigraphy [31]. A dual Ga-67 and Tc-99m-MDP study can increase the overall specificity of the examination to 81% with a sensitivity of 73% [3,10,31,36]. This combined study can be used to assess the postoperative or postprocedure spine in cases of suspected spine infection when MRI imaging findings are equivocal [3,10]. WBC Scan and Sulfur Colloid Scan Complete Spine A labeled leukocyte and sulfur colloid study is limited in the evaluation of spine infection because areas of infection often demonstrate decreased or absent radionuclide uptake [31]. FDG-PET/CT Whole Body FDG-PET with CT has seen increasing application for the assessment of suspected spine infection in select cases as a complementary examination [10,31]. Increased FDG uptake is seen at sites of infection with an elevated SUVmax value. FDG-PET/CT can be used in the evaluation of the postsurgical or postprocedure spine for suspected infection when the MRI examination is inconclusive. Initial studies with FDG-PET/CT have shown the utility of this study in the initial evaluation of potentially infected spinal implants in selected patients [40].
Suspected Spine Infection PCAs. Suspected Spine Infection Radiography Spine Area of Interest Radiographs are insensitive during the early course of spine infection [3]. In the subacute or chronic phase of infection, radiographs can be helpful in the follow-up evaluation of the posttreatment spine because serial radiographic studies may show new abnormalities such as implant loosening or alteration in spinal alignment that might be caused by infection [10]. 3-Phase Bone Scan A 3-phase bone scan with Tc-99m-MDP has variable moderate-to-high sensitivity (81.4%) and low specificity (40.7%) for spine infection [31]. Gallium Scan Whole Body Ga-67 scintigraphy combined with SPECT can be used to evaluate suspected spine infection in patients who have undergone recent spine interventions. Ga-67 is less sensitive (73%) but more specific (61%) than skeletal scintigraphy [31]. A dual Ga-67 and Tc-99m-MDP study can increase the overall specificity of the examination to 81% with a sensitivity of 73% [3,10,31,36]. This combined study can be used to assess the postoperative or postprocedure spine in cases of suspected spine infection when MRI imaging findings are equivocal [3,10]. WBC Scan and Sulfur Colloid Scan Complete Spine A labeled leukocyte and sulfur colloid study is limited in the evaluation of spine infection because areas of infection often demonstrate decreased or absent radionuclide uptake [31]. FDG-PET/CT Whole Body FDG-PET with CT has seen increasing application for the assessment of suspected spine infection in select cases as a complementary examination [10,31]. Increased FDG uptake is seen at sites of infection with an elevated SUVmax value. FDG-PET/CT can be used in the evaluation of the postsurgical or postprocedure spine for suspected infection when the MRI examination is inconclusive. Initial studies with FDG-PET/CT have shown the utility of this study in the initial evaluation of potentially infected spinal implants in selected patients [40].