title: Co-registration of isotope bone scan with CT scan and MRI in the investigation of spinal pathology.
abstract: Image fusion software enables technetium(99m)-methylene diphosphonate (Tc(99m)-MDP) bone scan images to be co-registered with CT scan or MRI, allowing greater anatomical discrimination. We examined the role of bone scan images co-registered with CT scan or MRI in the investigation of patients presenting with axial spinal pain and/or limb pain. One hundred and thirty-nine consecutive patients were examined, and thereafter investigated with CT scan, MRI, and/or dynamic plain films. At this point diagnosis (pathology type and anatomical site) and treatment intention were declared. The co-registered Tc(99m)-MDP bone scan images were then studied, after which diagnosis (pathology type and anatomical site) and treatment intention were re-declared. This data were then analysed to determine whether the addition of co-registered bone scan images resulted in any change in diagnosis or treatment intention. The most significant change in diagnosis was pathology type (10%). Anatomical site changed markedly without overlap of the pre and post-isotope fields in 5%, and with overlap in 10%. Treatment intention had a major change in 3.6% and minor change in 8.6%. In the two groups where there was (i) no obvious pathology after full pre-isotope investigation, or (ii) a spinal fusion under suspicion, addition of the bone scan information led to a major change in the pathology and/or anatomical localisation in 18% and 19%, respectively. The addition of co-registered Tc(99m)-MDP bone scan images offers significant diagnostic assistance, particularly in the difficult diagnostic groups where a failed spinal fusion may be the suspected pain generator, or when no pain generator can otherwise be found.
authors.affiliation: Neuroscience Clinical Institute, Epworth Hospital, Melbourne, VIC, Australia.
authors.forename: Graeme A
authors.initials: GA
authors.lastname: Brazenor
authors.affiliation: Neuroscience Clinical Institute, Epworth Hospital, Melbourne, VIC, Australia. Electronic address: gmalham@bigpond.net.au.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Malham
authors.affiliation: Nuclear Medicine Department, Primary Healthcare Imaging, Epworth Hospital, Melbourne, VIC, Australia.
authors.forename: Zita E
authors.initials: ZE
authors.lastname: Ballok
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011446:Prospective Studies; D011877:Radionuclide Imaging; D013131:Spine / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D013669:Technetium Tc 99m Medronate; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
chemical_list: D013669:Technetium Tc 99m Medronate
keywords: Bone scan; CT scan; Diagnosis; MR; Pathology; Spine; Treatment