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Chiropractic Research Review

A Clinician’s Primer on Single Photon Emission Computed Tomography

Bone scintigraphy, or radiography using radioisotopes, is a highly sensitive technique for locating skeletal problems. The uptake of bone in the body relies on functional changes (e.g. regional blood flow), which can be tracked by following the movement of radioactive isotopes.

Bone loss or disease can be detected with scintigraphy one-and-a-half years prior to radiographic evidence of structural changes in bone. Although this diagnostic method is highly sensitive, it has poor resolution and specificity.

Single photon emission computed tomography (SPECT) is a tool for bone scanning that increases contrast resolution and spatial localization of graphs, and is very valuable for determining spinal pathology, according to the authors. They write that SPECT used in conjunction with bone scintigraphy is useful for evaluating patients with chronic low back pain (LBP). SPECT has been especially valuable at determining facet syndrome as a cause of LBP.

Further uses of SPECT:

1. assessment of osteoporosis;
2. predicting results of surgery;
3. early diagnosis of sacroiliitis;
4. investigating metastatic and pathologic disease;
5. diagnosing meniscal tears;
6. evaluating temporomandibular joint (TMJ) dysfunction; and
7. detecting abnormalities at the skull base.

"There is now clear evidence that SPECT adds to the diagnostic utility of bone scans, especially in the lumbar spine," the authors write. They conclude that use of SPECT can improve the accuracy of interpretations of conditions, and effectively complements other cross-sectional imaging techniques.

Note: This is a great article to read as an overview to this topic. Clinicians unfamiliar with SPECT will find the article easy to read and clinically relevant. The full-text article is available for free at http://imaging.birjournals. org/cgi/content/full/13/3/149.

Cook GJR, Fogelman I. Bone single photon emission computed tomography. Imaging 2001:13(3), pp. 149-154.

Chiropractic Research Review

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