title: Bone scans are reliable for the identification of lumbar disk and facet pathology.
abstract: 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 technetium(99m)-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.
authors: Neuroscience Institute, Epworth Hospital, Melbourne, Australia.
authors: Gregory M
authors: GM
authors: Malham
authors: Greg Malham Neurosurgeon, Melbourne, Australia.
authors: Rhiannon M
authors: RM
authors: Parker
authors: Nuclear Medicine Department, Primary Healthcare Imaging, Epworth Hospital, Melbourne, Australia.
authors: Zita E
authors: ZE
authors: Ballok
authors: NuVasive Australia and NZ Pty Ltd, Melbourne, Australia.
authors: Ben
authors: B
authors: Goss
authors: Department of Orthopaedic Surgery, St. George Private Hospital, University of New South Wales, Sydney, Australia.
authors: Ashish D
authors: AD
authors: Diwan
authors: Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, United States.
authors: Juan S
authors: JS
authors: Uribe
keywords: CT; bone scan; image fusion; lumbar; reliability; spine
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