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SPECT/CT in lower back pain

James Howard NM nuclear medicine skeletal SPECT/CT spine

SPECT/CT can be performed to help evaluate potential causes of lower back pain. It can be used as a problem-solver where other imaging techniques have not provided a diagnosis, or to answer a specific question such as localisation of a site of primary pain generation. Single photon emission computed tomography (SPECT) has a better contrast resolution than planar imaging and when combined with CT gives accurate anatomical localisation of tracer uptake. The most commonly used tracer in routine clinical practice is Tc99m-MDP which demonstrates areas of osteoblastic activity and thus is useful to assess sites of healing fractures, bone turnover and spondylosis. Typically, delayed planar scintigraphy is performed first and then selected SPECT/CT to an area of abnormal uptake or as requested by the referring clinician. In this article we will discuss some of the common, non-tumour findings that can be encountered.

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