Utility of single photon emission computed tomography/computed tomography imaging in evaluation of chronic low back pain

Bone SPECT/CT in the diagnosis and treatment decision making of axial pain

PURPOSE

To explore the usefulness of bone SPECT/CT for providing additional information to Magnetic Resonance Imaging (MRI) in patients with axial pain, and for guiding the site of spinal injections.

METHODS

We studied 194 patients with axial pain evaluated with SPECT/CT and MRI. Imaging abnormalities were classified according to location and diagnosis of pain generators. Patient outcomes after SPECT/CT guided spinal injection were evaluated during clinical follow-up. Descriptive analyses and kappa coefficient were performed for facet joint arthropathy detection and degenerative disc disease between imaging modalities.

RESULTS

MRI showed 44.3% more abnormalities than SPECT/CT (329 vs. 228). However, SPECT/CT detected 17% more patients with facet joint arthropathy compared to MRI (43.3% vs. 26.3% respectively). Imaging agreement for diagnosing degenerative disc disease was moderate (κ: 0.44; 95% CI, 0.32-0.56), but only fair for facet joint arthropathy (κ: 0.35; 95% CI, 0.28-0.42). The response to spinal injections guided by SPECT/CT imaging was assessed in 56 patients with facet joint arthropathy. Among these, 26 /56 had a history of previous spinal injections guided by physical examination. In this group, the response was effective or partially effective in 65.4% of patients and ineffective in 34.6%. After a second injection guided by SPECT/CT, the response rate increased to 88.4%, with only 11.6% remaining ineffective, resulting in an absolute benefit of 23.4%. In 30/56 patients with no prior history of spinal injections, the therapy was effective or partially effective in 93.3%, while 6.7% did not show any improvement in pain after SPECT/CT-guided spinal injections.

CONCLUSION

Bone SPECT/CT imaging complements MRI by providing valuable information to identify pain generators. In facet joint arthropathy, it improves the effectiveness of pain relief when used to guide spinal injections.

Applications of SPECT/CT in the Evaluation of Spinal Pathology: A Review

BACKGROUND

Accurate identification of pain generators in the context of low back and spine-related pain is crucial for effective treatment. This review aims to evaluate the potential usefulness of single photon emission computed tomography with computed tomography (SPECT/CT) as an imaging modality in guiding clinical decision-making.

METHODS

A broad scoping literature review was conducted to identify relevant studies evaluating the use of SPECT/CT in patients with spine-related pain. Studies were reviewed for their methodology and results.

RESULTS

SPECT/CT appears to have advantages over traditional modalities, such as magnetic resonance imaging and CT, in certain clinical scenarios. It may offer additional information to clinicians and improve the specificity of diagnosis. However, further studies are needed to fully assess its diagnostic accuracy and clinical utility.

CONCLUSIONS

SPECT/CT is a promising imaging modality in the evaluation of low back pain, particularly in cases where magnetic resonance imaging and CT are inconclusive or equivocal. However, the current level of evidence is limited, and additional research is needed to determine its overall clinical relevance.

CLINICAL RELEVANCE

SPECT/CT may have a significant impact on clinical decision-making, particularly in cases in which traditional imaging modalities fail to provide a clear diagnosis. Its ability to improve specificity could lead to more targeted and effective treatment for patients with spinal pathology.

LEVEL OF EVIDENCE: 4

SPECT/CT Scan: A New Diagnostic Tool in Pain Medicine

PURPOSE OF REVIEW

The purpose of this review is to evaluate the role of SPECT/CT in identifying facet joint arthropathy and the outcomes of interventions with SPECT/CT as an adjunct.

RECENT FINDINGS

A positive finding of facet arthropathy on SPECT/CT is associated with a higher likelihood of a unilateral procedure and a significantly more effective intervention compared with those performed on patients with facet arthropathy diagnosed only by clinical and/or radiologic examination. Surgical treatment of SPECT/CT-positive findings appears to have a good effect; however, due to limitations in the available studies, no strong conclusion can be drawn. SPECT/CT has a good correlation identifying pain generators in chronic neck and back pain. SPECT/CT-targeted facet interventions demonstrate a higher success rate, but SPECT/CT is not recommended as a first-line diagnostic tool prior to diagnostic facet interventions. More robust studies are needed to confirm the higher success of surgical treatment for SPECT/CT-positive facet arthropathy.

Intra-osseous basivertebral nerve radiofrequency ablation (BVA) for the treatment of vertebrogenic chronic low back pain

STUDY DESIGN

Prospective experimental uncontrolled trial.

BACKGROUND

Vertebrogenic pain is a frequently underestimated cause of chronic low back pain (LBP). Vertebral endplate degeneration, characterized by cortical bone damage and subchondral bone inflammatory reaction, is a significant source of LBP, the responsible of the pain transmission being the Basivertebral Nerve (BVN). Radiofrequency ablation of the BVN (BVA) leads to thermal injury of nerve tissue and interruption of the of chronic vertebrogenic pain transmission.

PURPOSE

The aim of this study is to evaluate the effectiveness, in terms of pain and disability reduction, of percutaneous (BVA) in treating patients affected by vertebrogenic chronic LBP. Moreover, as a secondary endpoint, the purpose is to assess the feasibility and safety of a percutaneous CT-guided technique.

METHODS

We performed percutaneous CT-guided BVN ablation in 56 consecutive patients presenting with vertebrogenic chronic LBP in local anesthesia using an articulating bipolar radiofrequency electrode (STAR™ Tumor Ablation System Merit). A 1-month follow-up MRI was performed to evaluate the ablation area in order to assess the target success of the procedure. A 3-month follow-up CT study was performed to evaluate bone mineral density in order to exclude structural bone abnormalities that might have been induced by the treatment. Pre- and post-procedure pain and disability levels were measured using the visual analogue scale (VAS) and Oswestry Disability Index (ODI). A 2-cm improvement threshold was set as clinical success for the VAS score and a 10-point improvement threshold was set as clinical success for the ODI score.

RESULTS

At 3- and 12-month follow-up, VAS and ODI scores decreased significantly compared to baseline. Clinical success was reached in 54/56 patients (96.5%) for pain and 54/56 patients (96.5%) for disability, exceeding significantly the MCID. CT-assisted targeting of the ablation zone was determined successful in 100% of patients. Mean operative time was 32 min. No immediate or delayed complications were detected.

CONCLUSIONS

Percutaneous CT-guided intra-osseous BVA seems to be a safe, fast, and powerful technique for pain relief in patients with vertebrogenic chronic LBP, when the selection of patients is based on a multidisciplinary approach including both conventional Diagnostic Radiology and Nuclear Medicine imaging.

Bone scans are reliable for the identification of lumbar disk and facet pathology

Study Design Surgeon survey. Objective To evaluate the reliability of bone single-photon emission computed tomography (SPECT) versus bone SPECT images co-registered with computed tomography (bone SPECT-CT) by analyzing interobserver agreement for identification of the anatomical location of technetium(99m)-labeled oxidronate uptake in the lumbar disk and/or facet joint. Methods Seven spine surgeons interpreted 20 bone scans: 10 conventional black-and-white tomograms (bone SPECT) and 10 color-graded bone SPECT-CT scans. Each surgeon was asked to identify the location of any diagnostically relevant uptake in the disk and/or facet joint between L1 and S1. Reliability was evaluated using the free-marginal kappa statistic, and the level of agreement was assessed using the Landis and Koch interpretation. Results Conventional bone SPECT scans and bone SPECT-CT scans were reliable for the identification of diagnostically relevant uptake, with bone SPECT-CT having higher reliability (kappa = 0.72) than bone SPECT alone (0.59). Bone SPECT and bone SPECT-CT were also reliable in identifying disk pathology, with kappa values of 0.72 and 0.81, respectively. However, bone SPECT-CT was more reliable (0.81) than bone SPECT (0.60) when identifying facet disease. Conclusions For the identification of disk pathology, it is reasonable to use either conventional bone SPECT or bone SPECT-CT; however, bone SPECT-CT is more reliable for facet joint pathology.

Neuroimaging chronic pain: what have we learned and where are we going?

Advances in neuroimaging have helped illuminate our understanding of how the brain works in the presence of chronic pain, which often persists with unknown etiology or after the painful stimulus has been removed and any wounds have healed. Neuroimaging has enabled us to make great progress in identifying many of the neural mechanisms that contribute to chronic pain, and to pinpoint the specific regions of the brain that are activated in the presence of chronic pain. It has provided us with a new perception of the nature of chronic pain in general, leading researchers to move toward a whole-brain approach to the study and treatment of chronic pain, and to develop novel technologies and analysis techniques, with real potential for developing new diagnostics and more effective therapies. We review the use of neuroimaging in the study of chronic pain, with particular emphasis on magnetic resonance imaging.