High Uptake Detection for Spinal Degenerative Changes: A Comparison Between Bone Scintigraphy and Single Photon Emission Computed Tomography Combined With High-Resolution Computed Tomography.

Background: Nuclear imaging modalities are increasingly advancing spinal diagnostics. This study evaluates the prevalence of high uptake in bone scan and single photon emission computed tomography combined with high-resolution computed tomography (SPECT/CT) in the spine and sacroiliac joint (SIJ) and compares the diagnostic performance of BS to SPECT/CT in detecting metabolic activity linked to neck and back pain.

Objective: The primary objective was to assess the sensitivity, specificity, and diagnostic accuracy of BSs compared with SPECT/CT for spine and SIJ evaluation.

Methods: This retrospective study evaluated data from patients with spinal complaints who underwent spine-focused SPECT/CT alongside whole-body BS at a tertiary institution.

Results: A total of 110 patients were included, with 48 cervical spine, 34 thoracic spine, and 91 lumbar spine and SIJ SPECT/CT scans. For the cervical spine, BS sensitivity, specificity, and accuracy were 41.5%, 100%, and 50%, respectively. For the thoracic spine, these values were 50.0%, 100%, and 73.5%, respectively. For the lumbar spine, they were 72.9%, 100%, and 79.1%. For the SIJ, sensitivity, specificity, and accuracy were 38.2%, 96.5%, and 74.7%, respectively.

Conclusions: Bone scans demonstrated reasonable sensitivity and high specificity, particularly for lumbar spine and SIJ evaluation, making them a useful screening tool in resource-constrained settings. However, SPECT/CT showed superior performance in detecting osteometabolic activity and provided more detailed functional and structural insights for diagnosing and managing degenerative spinal conditions.

Clinical relevance: This study highlights the potential complementary role of bone scans in spinal diagnostics.

Level of evidence: 3: