Bone SPECT-CT Research Articles

Quantitative Assessment of Treatment Response in Metastatic Breast Cancer Patients by SPECT-CT Bone Imaging-Getting Closer to PET-CT.

Cancer represents the major cause of death mainly through its ability to spread to other organs, highlighting the importance of metastatic disease diagnosis and accurate follow up for treatment management purposes. Although until recently the main method for imaging interpretation was represented by qualitative methods, quantitative analysis of SPECT-CT data represents a viable, objective option. Seventy-five breast cancer patients presenting metastatic bone disease underwent at least two Bone SPECT-CT studies using [99mTc]-HDP between November 2019 to October 2022. Our findings show a good positive relationship between the qualitative methods of imaging interpretation and quantitative analysis, with a correlation coefficient of 0.608 between qualitative whole body scintigraphy and quantitative SPECT-CT, and a correlation coefficient of 0.711 between the qualitative and quantitative interpretation of SPECT-CT data; nevertheless, there is a need for accurate, objective and reproducible methods for imaging interpretation, especially for research purposes. Quantitative evaluation of the SPECT-CT data has the potential to be the first choice of imaging interpretation for patient follow up and treatment response evaluation, especially for research purposes, because of its objectivity and expression of uptake changes in absolute units.

The modified Dunn procedure can be performed safely in stable slipped capital femoral epiphysis but does not alter avascular necrosis rates in unstable cases: a large single-centre cohort study.

Purpose:The modified Dunn procedure for slipped capital femoral epiphysis (SCFE) remains controversial. We reviewed our series over ten years to report our learning curve, experience with intraoperative monitoring of femoral head perfusion and its correlation with postoperative Single-photon emission computed tomography (SPECT-CT) bone scan and femoral head collapse in stable and unstable SCFE.Methods:We retrospectively assessed 217 consecutive modified Dunn procedures performed between 2008 and 2018. In all, 178 had a minimum of one-year follow-up (mean 2.7 years (1 to 9.2)) including 107 stable and 71 unstable SCFE. Postoperative viability was assessed with a three-phase Tc99 bone scan and SPECT-CT. From 2011, femoral head perfusion monitoring was performed intraoperatively using a Codman Intracranial Pressure transducer and the capsulotomy was modified.Results:With intraoperative monitoring, the rate of non-viable femoral heads in stable SCFE decreased from 21.1% to 0% (p < 0.001). In unstable SCFE, the rate remained unchanged from 35.7% to 29.8% (p = 0.669). The positive predictive value (PPV) of pulsatile monitoring for no collapse was 100% in stable and 89.1% in unstable SCFE. Pulsatile monitoring and viable SPECT-CT bone scan gave a 100% PPV for all cases. A non-viable scan defines those hips at risk of collapse since 100% of stable and 68.2% of unstable hips with non-viable bone scans went on to collapse.Conclusion:Our protocol enables safe performance of this complex procedure in stable SCFE with intraoperative monitoring being a reliable asset. The avascular necrosis rate for unstable SCFE remained unchanged and further research into its best management is required.Level of evidence:Level III

Comparison of bone SPECT/CT and MRI in detection of pain generator in ankle and foot pain: a retrospective diagnostic study.

To study the sensitivity and specificity of MRI and bone SPECT-CT in detecting the pain generator in ankle and foot pain with diagnostic dilemma. Retrospectively data of patients with ankle or foot pain who underwent both MRI and Bone SPECT-CT were analyzed. The lesions and probable pain generator sites were reported as per MRI and bone SPECT-CT findings. These lesions were correlated clinically, managed accordingly and followed up. The patients who had significant improvement in response to the treatment provided were considered to have been diagnosed accurately. The foot and ankle disability index (FADI) was used to evaluate the patient's pre- and postintervention condition. The study included 37 patients retrospectively (18 women and 19 men). The lesions were classified into soft tissue lesions (ligaments/tendons), joint lesions (arthritis) and bony lesions (fractures/osteomyelitis/osteochondral lesions). Overall, MRI had sensitivity, specificity, positive predictive value and negative predictive value of 82, 31, 74 and 42%, respectively, and SPECT-CT had sensitivity, specificity, positive predictive value and negative predictive value of 84, 60, 84 and 60%, respectively. The mean FADI score pretreatment for all patients was 61.5 (SD = 13.8) and posttreatment 88.4 (SD = 13.01) showing significant improvement in the score (P < 0.05), suggesting that the final diagnosis of these patients was accurate. Overall, management change due to bone SPECT-CT over MRI was seen in 26% of patients. Bone SPECT-CT has incremental value over MRI in the diagnosis of pain generator in foot and ankle pain. The overall specificity of bone SPECT-CT is higher than MRI in detection of pain generators. Bone SPECT-CT performed better than MRI in detection of culprit pathology in the bone, whereas MRI is better in soft tissue lesions. There are only a few published literature with direct comparison of bone SPECT-CT scintigraphy and MRI in detection of foot and ankle pain generator. This study directly compares diagnostic utility of bone SPECT-CT scintigraphy and MRI in foot and ankle pain. In the present study, the bone SPECT-CT performed better than MRI in detection of culprit pathology in the bone, whereas MRI is better in soft tissue lesions.

Tumor Induced Osteomalacia - Long Term Medical Treatment When Surgery Is Risky

Introduction: Tumor induced osteomalacia (TIO) is a rare paraneoplastic syndrome characterized by bone pain, muscle weakness and fractures caused by production of a phosphaturic factor by rare mesenchymal bone or soft tissue tumors that causes isolated renal phosphate loss and osteomalacia. Low phosphate (iP), high bone alkaline phosphatase (BAP), and normal or low 125 dihydroxy D, are salient biochemical findings. Fibroblast derived growth factor (FGF 23) may be high or inappropriately normal. Gallium-68 Dotatate (DoT) imaging has become the imaging method of choice. Long term medical management may be required when removal of the tumor is risky or not feasable. Case Report: 65 yr old woman with carcinoid tumor of the right lung and a bony lesion in the T3 vertebral body diagnosed with TIO. She was initially screened for osteoporosis after traumatic rib fractures. Bone scan and SPECT-CT revealed numerous foci of increased uptake. She had elevated alkaline phosphatase 186 IU/L (0–140) and PTH 83 pg/ml (15–65) with a low phosphate 1.5 mg/dl (2.5–4.5), along with normal FGF23 level 102 RU/ml Ref Range < + 180 RU/ml. DoT and PET CT imaging for TIO evaluation showed a foci of increased uptake right lower lobe of her lung, and “osseous metastatic disease” in the right scapula, vertebral body, iliac, and pubic ramus. Sclerosis of T3 vertebral body was noted in the area of intense Gallium Dotatate uptake. Transbronchial excision of the lesion showed a well differentiated neuroendocrine carcinoma. Chromogranin A and 24 hour urine for 5HIAA were normal. She responded well to medical therapy with oral phosphate, calcium and calcitriol. Follow up, DoT and FDG PET showed persistent intense uptake in the sclerotic lesion on T3 vertebral body, while the rest of the hot spots resolved. Sclerotic T3 lesion is likely the primary lesion that is responsible for the TIO. Neuroendocrine tumor of the lung may be a mere association. Biopsy of the T3 lesion was not feasible and excision was considered risky to the patient. Discussion: Our case illustrates that awareness is the key to early diagnosis of TIO. FGF 23 in some TIO cases may be inappropriately normal in commercial assays and even in research labs. Measurement of fibronectin 1 (FN1) and FGF receptor 1 fusion gene which is noted in up to 60% of tumors are not commercially available. While DoT and PET CT are imaging modality of choice, CT and MRI may be useful to define the anatomy of the lesion. Long term medical management may be necessary when removal of primary lesion is not possible or risky. Most tumors are benign while some may prove to be malignant.

Bone single-photon emission computed tomography-CT peak standardized uptake value for chronic osteomyelitis, osteoradionecrosis and medication-related osteonecrosis of the jaw.

Recently, standardized uptake value (SUV) has been applied for the evaluation of SPECT-CT. This study was performed to investigate the bone SPECT-CT peak SUV for chronic osteomyelitis, osteoradionecrosis and medication-related osteonecrosis of the jaw (MRONJ). Sixty-five patients with jaw lesions (12 chronic osteomyelitis, 12 osteoradionecrosis and 41 MRONJ) underwent SPECT-CT after injection of technetium-99m hydroxymethylene diphosphonate. The peak SUV was compared for the chronic osteomyelitis with osteoradionecrosis and MRONJ using GI-BONE software. Statistical analyses for the peak SUV were performed by one-way repeated measures analysis of variance with Tukey's HSD test. A P-value lower than 0.05 was considered as statistically significant. Peak SUV for chronic osteomyelitis (15.6±4.4) was significantly higher than those for osteoradionecrosis (6.7±2.1, P=0.000) and MRONJ (10.7±6.1, P=0.019). The SPECT-CT peak SUV using GI-BONE software can be useful for the evaluation of jaw lesions, such as chronic osteomyelitis, osteoradionecrosis and MRONJ.

Bone metabolism of the jaw in response to bisphosphonate: a quantitative analysis of bone scintigraphy images.

We examined the changes in the bone metabolism of the jaw in response to BP treatment, and we used bone SPECT-CT to analyze the site-specific bone metabolism between the jaw and other sites of bone. We compared the changes in the bone metabolism of each part of bone in response to BP treatment by performing a quantitative analysis of bone scintigraphy images between patients treated with low-dose BP for osteoporosis (LBP group; n = 17), those treated with high-dose BP for metastatic bone tumor (HBP group; n = 11), and patients with other oral disease who required bone scintigraphy, with no history of BP treatment (control group; n = 40). The study endpoint was the mean standardized uptake value (SUV) of the uptake of Tc-99m methylene diphosphonate (MDP) in each group. The mean SUVs of the HBP group were significantly lower at the axial bone of the cervical vertebra, thoracic vertebra, sternum, and rib compared to those of the LBP and control groups. The LBP group's mean SUV was significantly higher at the temporal bone, the anodontia part of the alveolar bone in maxilla, the vital teeth part of alveolar bone in the mandible, and the temporomandibular joint. There was no significant difference among the three groups at the mandibular angle and mandibular ramus. Our analyses revealed that the bone metabolism of the jaw and temporal bone in the BP-treated patients was enhanced, and no suppression of bone remodeling in the jaw by BP was observed.

Feasibility Study and Preliminary Results of Prognostic Value of Bone SPECT-CT Quantitative Indices for the Response Assessment of Bone Metastatic Prostate Carcinoma to Abiraterone.

Objective: We assessed the prognostic value of quantitative indices extracted from bone SPECT-CT to evaluate the response of bone metastatic castrate-resistant prostate cancer (BmCRPC) to abiraterone.Methods: Consecutive patients with BmCRPC initiating treatment with abiraterone from March 2014 to March 2015 were prospectively included. Three 2-bed SPECT-CT [at baseline [M0], after 3 months [M3], and 6 months [M6] of treatment], were planned (Symbia Intevo®, Siemens). SPECT data were reconstructed using an Ordered Subset Conjugate Gradient Minimization (OSCGM) algorithm allowing SUV quantification. SUVmax and SUVpeak of the highest uptake lesion were measured in each SPECT-CT. Total Neoplastic Osteoblastic Metabolic Volume (NOMV) was assessed. PSA level was recorded at baseline, M3, and M6 of treatment. Overall survival (OS), progression-free survival (PFS), and disease-specific survival (DSS) were calculated.Results: Nineteen patients aged 71.1 ± 7.7 years were included. Low M0 SUVmax was significantly predictive of longer OS (p = 0.04). Low NOMV at M0 were significantly predictive of longer PFS (p = 0.02). Patients with increase of at least 12.5% of the SUVpeak of the highest uptake lesion between M0 and M3 (ΔSUVpeakM0M3) had a significantly longer OS (p = 0.03). Patients with increase (or decrease lesser than 25%) of ΔSUVpeakM0M3 had a significantly longer DSS (p = 0.01). Patients with increase of NOMV of at least 45% between M0 and M6 had a significantly shorter PFS (p < 0.001). Variations of NOMV between M0 and M6 were significantly correlated with PSA variations between M0 and M6 (rs = 0.73, p = 0.02).Conclusions: Quantitative bone SPECT-CT appears to be a promising tool of BmCRPC assessment. Early flare-up phenomenon seems to predict longer OS.

Clinical interest of quantitative bone SPECT-CT in the preoperative assessment of knee osteoarthritis

The aim of the study was to evaluate the interest of quantitative bone SPECT-CT in the preoperative assessment of knee osteoarthritis (OA) before unicompartmental knee arthroplasty (UKA).Patients eligible for UKA were prospectively included in 2 centers and underwent a preoperative SPECT-CT. Images were reconstructed with an OSEM, an OSCGM (allowing SUV quantification) and an enhanced OSCGM (containing uptakes to bones) algorithms. Visual analysis and quantification (SUVmax) were performed for each compartment (medial compartment [MC], lateral compartment [LC], and patellofemoral compartment [PFC]). Clinical data were preoperatively assessed. The gold standard was the per-operative OA staging (International Cartilage Repair Society [ICRS] scale). Spearman's correlation coefficient was used for correlations. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and accuracy of SPECT-CT were assessed.One hundred three patients (50 women, 53 men, mean age = 64.5 ± 10.3 y/o, 120 preoperative knees) were analyzed. There was no correlation between SUVmax and clinical data. There was a correlation between ICRS staging and SUVmax with both OSCGM (MC [rs = 0.25], LC [rs = 0.51], and PFC [rs = 0.27]), and enhanced OSCGM, except in the PFC (MC [rs = 0.22], LC [rs = 0.62], and PFC [rs = 0.03]). The Se, Sp, PPV, NPV, and accuracy of SPECT-CT were, respectively, 0.99, 0.67, 0.98, 0.80, 0.97 for the MC; 0.50, 0.85, 0.42, 0.89, 0.79 for the LC; and 0.23, 0.86, 0.50, 0.64, 0.62 for the PFC.Bone SPECT-CT SUVmax is correlated with per-operative OA staging. Despite the low sensitivity of SPECT-CT in the LC, its high specificity in the LC should prompt the surgeon to be vigilant before UKA surgery.

99mTc MDP SPECT-CT–Based Modified Mirels Classification for Evaluation of Risk of Fracture in Skeletal Metastasis

Mirels' scoring system quantifies the risk of sustaining a pathologic fracture in osseous metastases of weight bearing long bones. Conventional Mirels' scoring is based on radiographs. Our pilot study proposes Tc MDP bone SPECT-CT based modified Mirels' scoring system and its comparison with conventional Mirels' scoring. Cortical lysis was noted in 8(24%) by SPECT-CT versus 2 (6.3%) on X-rays. Additional SPECT-CT parameters were; circumferential involvement [1/4 (31%), 1/2 (3%), 3/4 (37.5%), 4/4 (28%)] and extra-osseous soft tissue [3%]. Our pilot study suggests the potential role of SPECT-CT in predicting risk of fracture in osseous metastases.

A large heterotopic ossification in a 25 years old laparotomy scar.

Heterotopic ossification (HO) is a benign condition when bone develops in tissues that do not usually ossify. The etiology is not fully understood but the condition can appear in variable locations, sizes and morphology in the body. We describe a large HO in a scar, discovered 25 years after a laparotomy of the upper abdomen. The calcification led to mechanical complaints and resection gave resolution of symptoms. HOs can be incidental findings on plain radiographs. CT-scan can show typical mature peripheral mineralization with central lucency. If symptomatic, resection must be performed after maturation. Maturation can be examined with activity-oriented imaging as 3-phase bone scan or SPECT-CT.

Bone SPECT–CT: An additional diagnostic tool for undiagnosed wrist pain

Diagnosis of wrist pain can be difficult to determine with clinical examination and conventional imaging techniques alone. Bone SPECT-CT (single-photon emission tomography with computerized tomography) is a hybrid imaging technique that overlays functional bone scintigraphy in tomographic/3D mode with conventional CT. Data from the two modalities are complementary; areas of abnormal bone metabolism can be localized with anatomical precision, hitherto lacking in conventional bone scans, while structural information from the CT scan further embellishes the diagnostic information. Over the last 6 years, one surgeon (David Evans) has used bone SPECT and later bone SPECT-CT as an additional line of investigation. This is a series of 21 consecutive patients with wrist pain that could not be diagnostically resolved with the usual combination of history, examination, and conventional imaging, and therefore underwent bone SPECT-CT. Clinical and imaging findings, management, and outcomes of these cases are discussed to explore the potential role of this hybrid functional modality in hand and wrist surgical practice.

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 technetium99m-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.

Low Bone Density In Sickle Cell Disease Is a Risk Factor in The Development Of Avascular Necrosis

Introduction Sickle cell disease (SCD) is a highly prevalent disorder in the world, specifically in the region of Kuwait. A wide population suffers from sickle cell anaemia. It has been known that bone involvement is one of the most common clinical manifestations of sickle cell disease, both in the acute setting such as painful vaso-occlusive crises, and as a chronic, progressive process such as osteoporosis ,osteopenia and avascular necrosis (AVN), which can develop due to the low bone mass and the deterioration of the micro architecture of bone tissue. In this ongoing project, we used the radionuclide imaging technique for bone and bone marrow scintigraphy and dual-energy x-ray absorptiometry (DEXA). We attempted a correlation between low bone density and the bone infarct for SCD, and identified if low bone density is a risk factor for the severity and development of osteonecrosis in an at-risk population of sickle cell patients. Patients and Methods A total of 13 sickle cell patients participated in this correlation study; 5 males and 8 females, ages ranged from 16 to 55 years with a mean age of 35.5 years. To meet the participant selection criteria, patients were selected if they were never prescribed bisphosphonates or any type of medicine used to help strengthen bones weakened by osteoporosis, nor exposed to any other AVN risk factors other than SCD. Subjects were subjected to a scintigraphy (3-phase bone SPECT-CT, bone marrow) and bone mineral density scan (BMD). All subjects consented to the study approved by the ethics committee. Bone scintigraphy was performed by Tc-99m MDP, HDP 20mCi / 70kg intravenous injection. Bone Marrow Scintigraphy was performed by Tc-99m sulfur or tin colloid, 10-15 mCi / 70 kg I.V, Bone with Bone marrow scintigraphy imaging is required to assess bone marrow infarction and infection. BMD dual-energy x-ray absorptiometry (DEXA) was also performed to indicate the reliably changes in bone mineral content of the lumbar spine and proximal femur. Statistical analysis involved descriptive statistics and chi-square test. Results According to the WHO criteria used; low bone density was found in 9/13 (69%) while normal bone density was found in 4/13 patients (31 %). Based upon the application of a chi-square test, all those subjects 9/9 having a low bone density were showing AVN in several severity and multiple sites of the skeleton; it was found that there is an association between low bone density and incidents of AVN. However, it is of importance to note that 2/4 (50%) of the normal bone density patients were found to have AVN. Conclusion The preliminary conclusion discern from this ongoing project suggest that low bone mineral density in SCD could be considered a risk factor contributing to the development of AVN. We hypothesise that the severity of AVN develops due to the low bone mass and the deterioration of the micro architecture of bone tissue. The results have shown that low bone density is highly associated with osteonecrosis. Further case studies are needed to confirm or disprove these findings. The findings of this project could inspire new protocols required for effective management of this disease. Our findings could also potentially point out and diagnose new clinical cases, which would normally not be clinically suspected. We also speculate that increasing bone density of this patient population may decrease the severity and incidents of AVN. References 1-Sch2-nog JB, Duits AJ, Muskiet FA, ten Cate H, Rojer RA, Brandjes DP. Sickle cell disease; a general overview. Neth J Med. 2004 Nov;62(10):364-74. Review. PubMed citation 2-Digiovanni, Cw; Patel, A; Calfee, R; Nickisch, F (Apr 2007). “Osteonecrosis in the foot”. The Journal of the American Academy of Orthopaedic Surgeons 15 (4): 208–17. ISSN 1067-151X. PMID 17426292. 3-eMedicine Specialties &gt; Avascular NecrosisAuthor: Jeanne K Tofferi, MD, MPH, FACP; Coauthor: William Gilliland, MD, MPHE, FACP, FACR. Updated: Dec 17, 2009 4-Baksi, Dp (May 1983). “Treatment of post-traumatic avascular necrosis of the femoral head by multiple drilling and muscle-pedicle bone grafting. Preliminary report”. The Journal of bone and joint surgery. British volume 65 (3): 268–73. ISSN 0301-620X. PMID 6341373. Disclosures: No relevant conflicts of interest to declare.

AB0544 The usefulness of bone spect-ct imaging with volume of interest analysis in early axial spondyloarthritis

BackgroundImaging is an important tool in diagnosing axial spondylo-arthritis (SpA). In contrast to magnetic resonance imaging, conventional bone scintigraphy has not been so helpful for early detection of axial SpA....

Prevalence of Stress Reaction in the Pars Interarticularis in Pediatric Patients With New-Onset Lower Back Pain

Spondylolysis is a defect of the pars interarticularis and is most commonly encountered in the lower lumbar spine of pediatric patients. Stress reaction of the pars interarticularis was regarded as an early stage of this pathological diagnosis in which no obvious anatomical change is detected. Both SPECT with (99m)Tc MDP and CT of the lumbar spine have been used to evaluate the patients with low back pain. The purpose of this study was to determine the prevalence of stress reaction in pars interarticularis in pediatric patients presenting new-onset back pain using both bone SPECT and CT. The records and images of 63 consecutive pediatric patients (mean age, 13.2 years) with new onset of back pain, who received both (99m)Tc MDP bone scintigraphy with SPECT of the lumbar spine and lumbar thin-slice CT were retrospectively analyzed. The results of bone SPECT and CT were retrospectively compared. Among the cohort of 63 patients who had both bone SPECT and thin-slice CT of the lumbar spine, there was a total of 56 positive SPECT results indicating stress injuries in the pars interarticularis. Spondylolysis was shown on both bone SPECT and thin-slice CT in 45 patients. In 11 patients, stress reaction was shown. In 7 patients, no abnormality was detected by either SPECT or thin-slice CT. Our result showed that a significant portion (19.6%, 11 of 56) of the stress injuries in the pars interarticularis will be CT-negative stress reaction in pediatric patients with new-onset back pain.

Abnormal Appearance of Spinal Hemangioma Mimicking Metastasis in Bone Scintigraphy and SPECT-CT: Case Report

Study design: Case reports of abnormal appearance of hemangioma in thoracolumbar spine in bone scintigraphy. Objective: To report an unusual presentation of spinal hemangioma mimicking metastasis in bone scintigraphy and SPECT-CT. Summary of back ground data: Spinal hemangiomas are usually incidental findings. Most of them are asymptomatic and bone scintigraphy will be normal in majority of them. In the back ground of an underlying malignancy, an abnormal hot spot in bone scan always arouse a high suspicion of bone metastasis. Methods: Two middle aged ladies, treated for carcinoma cervix and carcinoma breast respectively, were undergoing regular follow ups. One patient had complaints of back pain on and off and her bone scan showed abnormal increase in tracer uptake in L1 vertebra suspicious of metastasis. Second lady had suspected intra abdominal metastatic disease and her bone scan showed abnormal increase in tracer uptake in thoracolumbar spine mimicking metastasis. Results: Both patients underwent further detailed evaluations and MRI study of spine was reported as hemangioma and PET-CT ruled out the possibilities of recurrent or metastatic malignancy. During further follow up, both patients were disease free. Conclusion: Hemangioma of spine appearing as a hot spot in bone scan is rare. In the back ground of a malignancy, a ‘hot’ lesion can be studied better with metabolic imaging with PET – CT which could dispel the suspicion of a metastatic focus quite clearly. MRI could also give a diagnostic clue.

Utilidad de la SPECT-TAC ósea en la vertebroplastia percutánea

Percutaneous vertebroplasty is a minimally invasive procedure that has shown excellent results in the treatment of back pain due to acute-subacute vertebral fracture. The bone scintigraphy shows the increase of metabolic exchange in the fracture. The new hybrid SPECT-CT equipment combines bone SPECT images with Computed Tomography (CT), making it possible to obtain more combined, functional and anatomical information. We present 5 selected patients studied by bone SPECT-CT in whom fused images made it possible to obtain a more precise localization of the pain origin, and thus assess other possible causes of the vertebral pain or even reassess the vertebroplasty indication.

Bone SPECT in an Osteoid Osteoma of Transverse Process of First Lumbar Vertebra

The transverse processes of the spine are unusual locations for osteoid osteomas. Bone SPECT and spiral CT scans were crucial for localizing an osteoid osteoma in the right transverse process of L1 in a patient with lower back pain. Surgical removal of the tumor was performed.

Gorham's Disease of the Skull Demonstrated by Bone SPECT-CT

We present a case of Gorham's disease of the skull by using (superscript 99m)Tc-MDP bone SPECT-CT to demonstrate simultaneously a large defect of the skull corresponding to the photon-deficient area in the left parietal skull. An important advantage of the combined SPECT-CT is that it can be acquired without moving the patient, and thus this imaging modality is virtually a fusion image(s). This patient illustrated this advantage of structural skull defect by CT to match physiological ”cold” skull lesion by bone scintigraphy.