title: Incremental benefit of SPECT + CT bone scans over conventional planar and SPECT bone scans in vertebroplasty.
abstract: METHODS
  Planar bone scans with SPECT and SPECT + CT were performed in those patients who underwent peri-operative evaluation for vertebroplasty. The scans were evaluated separately to identify the "culprit" vertebra (e) by two readers and their results were analyzed.
  
  
  OBJECTIVE
  Use of planar and SPECT bone scan for identifying the "culprit" vertebra (e) for vertebroplasty is well established. SPECT + CT is a relatively recent imaging tool providing co-registered fused images. Theoretical advantages of SPECT + CT over conventional SPECT imaging needs to be evaluated and documented.
  
  
  BACKGROUND
  Percutaneous stabilization of collapsed vertebra by bone cement has now become a standard procedure. However, it is essential to localize the correct vertebra. Imaging modalities like CT scan provides structural or anatomical information where as bone scan (planar + SPECT images) provides more functional or physiological information. Combination of these two imaging modalities is expected to provide much more than information obtained by any one imaging modality separately. To the best our knowledge, there is no reference available in the literature adopting this approach.
  
  
  METHODS
  Two expert readers, blinded to patient history, evaluated the scans. They independently analyzed planar + SPECT only images followed by SPECT/CT fused images with the aim to identify the acutely fractured vertebra for vertebroplasty.
  
  
  RESULTS
  Interpretations changed, on average, 50% of the time as a result of the additional information provided by SPECT + CT. SPECT + CT more precisely localizes tracer abnormalities in the vertebra compared to SPECT imaging alone.
  
  
  CONCLUSIONS
  The greatest value of co-registered SPECT + CT bone scan lies in the accurate localization of affected vertebrae in complicated cases of multiple collapsed vertebrae of different ages as well as in the post-vertebroplasty setting.
authors.affiliation: Department of Radiology, Division of Nuclear Medicine, Emory University Hospital, Atlanta, Georgia, USA.
authors.forename: Kush
authors.initials: K
authors.lastname: Kumar
authors.forename: Raghuveer K
authors.initials: RK
authors.lastname: Halkar
authors.forename: Scott C
authors.initials: SC
authors.lastname: Bartley
authors.forename: David M
authors.initials: DM
authors.lastname: Schuster
keywords: Kyphosis; Tc99m-bone scan; osteoporosis; vertebroplasty
references.citation: Osteoporos Int. 1999;9(3):206-13
references.pmid: 10450408
references.citation: Radiat Med. 1998 Sep-Oct;16(5):329-34
references.pmid: 9862153
references.citation: AJNR Am J Neuroradiol. 2000 Nov-Dec;21(10):1807-12
references.pmid: 11110531
references.citation: Neurochirurgie. 1987;33(2):166-8
references.pmid: 3600949
references.citation: Eur J Nucl Med Mol Imaging. 2002 Jul;29(7):922-7
references.pmid: 12111133
references.citation: Spine (Phila Pa 1976). 2000 May 1;25(9):1070-6
references.pmid: 10788850
references.citation: Radiology. 2003 Oct;229(1):27-36
references.pmid: 14519867
references.citation: J Bone Joint Surg Am. 2003 Oct;85(10):2010-22
references.pmid: 14563813
references.citation: Med Phys. 1998 Oct;25(10):2046-53
references.pmid: 9800714
references.citation: J Bone Miner Res. 1994 Jul;9(7):977-82
references.pmid: 7942166
references.citation: Spine (Phila Pa 1976). 2002 Jun 15;27(12):1297-302
references.pmid: 12065977
references.citation: AJNR Am J Neuroradiol. 2002 Nov-Dec;23(10):1647-51
references.pmid: 12427616
references.citation: N Engl J Med. 1986 Jun 26;314(26):1676-86
references.pmid: 3520321
references.citation: Spine (Phila Pa 1976). 2001 Jul 15;26(14):1631-8
references.pmid: 11464159
references.citation: Semin Nucl Med. 1983 Apr;13(2):104-22
references.pmid: 6346492
references.citation: AJNR Am J Neuroradiol. 2003 May;24(5):1003-7
references.pmid: 12748113
references.citation: AJNR Am J Neuroradiol. 2001 Feb;22(2):373-81
references.pmid: 11156786