In those cases in which a contrast- enhanced CT is to be performed, it is not necessary or useful to perform a noncontrast-enhanced CT first, because this latter examination does not add more diagnostic information. The sensitivity and specificity of CT for spine infection is 79% and 100%, respectively [33]. CT has low sensitivity (6%) for the identification of epidural abscess Suspected Spine Infection [33]. CT is often utilized to evaluate suspected spine infection when MRI is equivocal [3]. It is also of value in presurgical planning for patients with suspected infection-related spine instability, cord compression, as well as follow-up evaluation of the instrumented spine [30]. CT is often used to facilitate percutaneous image-guided spine biopsy [52,57]. Radiography Spine Area of Interest Radiography can be used as part of the initial evaluation in patients with suspected spine infection. Radiographs may not show any abnormalities during the early course of spine infection [3]. Imaging findings such as disc space narrowing, vertebral endplate erosion, and gross paraspinal soft tissue changes that can be seen on radiography lag behind the clinical course of spine infection by at least 2 to 8 weeks [3,10,31]. Nevertheless, the possible presence of one or more of these findings may increase the clinical suspicion for infection and may help guide subsequent imaging management. Radiographs, however, provide an overall view of the status and alignment of the vertebral column and can be used to assess for spinal instability [8]. 3-Phase Bone Scan Complete Spine A 3-phase bone scan with Tc-99m-methylene diphosphonate (MDP) has variable moderate-to-high sensitivity (81.4%) and low specificity (40.7%) for spine infection [31]. The advantages of skeletal scintigraphy include that it can be performed and completed in 1 day. Because of the imaging time required for a 3-phase bone scan, it tends to be utilized in select situations [3].
Suspected Spine Infection PCAs. In those cases in which a contrast- enhanced CT is to be performed, it is not necessary or useful to perform a noncontrast-enhanced CT first, because this latter examination does not add more diagnostic information. The sensitivity and specificity of CT for spine infection is 79% and 100%, respectively [33]. CT has low sensitivity (6%) for the identification of epidural abscess Suspected Spine Infection [33]. CT is often utilized to evaluate suspected spine infection when MRI is equivocal [3]. It is also of value in presurgical planning for patients with suspected infection-related spine instability, cord compression, as well as follow-up evaluation of the instrumented spine [30]. CT is often used to facilitate percutaneous image-guided spine biopsy [52,57]. Radiography Spine Area of Interest Radiography can be used as part of the initial evaluation in patients with suspected spine infection. Radiographs may not show any abnormalities during the early course of spine infection [3]. Imaging findings such as disc space narrowing, vertebral endplate erosion, and gross paraspinal soft tissue changes that can be seen on radiography lag behind the clinical course of spine infection by at least 2 to 8 weeks [3,10,31]. Nevertheless, the possible presence of one or more of these findings may increase the clinical suspicion for infection and may help guide subsequent imaging management. Radiographs, however, provide an overall view of the status and alignment of the vertebral column and can be used to assess for spinal instability [8]. 3-Phase Bone Scan Complete Spine A 3-phase bone scan with Tc-99m-methylene diphosphonate (MDP) has variable moderate-to-high sensitivity (81.4%) and low specificity (40.7%) for spine infection [31]. The advantages of skeletal scintigraphy include that it can be performed and completed in 1 day. Because of the imaging time required for a 3-phase bone scan, it tends to be utilized in select situations [3].