title: The usefulness of bone SPECT/CT imaging with volume of interest analysis in early axial spondyloarthritis.
abstract: BACKGROUND
  The role of conventional bone scintigraphy in diagnosing early axial spondyloarthritis (SpA) is yet controversial. Single positron emission computed tomography (SPECT) plus CT is an imaging modality that adds better anatomical information to scintigraphy of the sacroiliac (SI) joint. Our aim was to investigate the usefulness of bone SPECT/CT with volume of interest (VOI) analysis in early axial SpA patients.
  
  
  METHODS
  Twenty patients (male: female ratio = 12:8; age range = 17-65 years) presenting with inflammatory back pain meeting the Amor criteria of early axial SpA were recruited from a single center in South Korea. Bone scintigraphy was performed 180 min after intravenous injection of 1110 MBq of Tc-99 m-HDP, followed by bone SPECT/CT. The ratio between the entire SI joint and sacrum (SIS ratio) was measured by both bone SPECT/CT and bone scintigraphy. Data from 13 controls were also evaluated. Receiver operating characteristic (ROC) curve was plotted for further analysis, and the correlation between the SIS ratio and SI joint grade by plain radiography was assessed.
  
  
  RESULTS
  The SIS ratio of early axial SpA patients vs. control subjects was significantly increased in bone SPECT/CT (p < 0.001). However, no significant difference was detected in bone scintigraphy. ROC curve analysis showed a significant difference in the area under curve (AUC) of bone SPECT/CT vs. bone scintigraphy (0.862 vs. 0.523, respectively; p < 0.001). With a cut-off SIS ratio of 1.50, ROC curve analysis showed a sensitivity of 80.0% and specificity of 84.6% in bone SPECT/CT. The SIS ratio measured in SPECT/CT, but not that measured in bone scintigraphy, was significantly increased with a higher grade of SI joint changes in plain radiography (p = 0.014).
  
  
  CONCLUSIONS
  Bone SPECT/CT is more useful than conventional bone scintigraphy in identifying sacroiliitis in early axial SpA patients, even with mild SI joint changes in plain radiography. By combining CT, we can accurately delineate the sacrum and SI joint uptake with our VOI method.
authors: Department of Nuclear Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea. kyi821209@naver.com.|Department of Molecular Medicine and Biopharmaceutical Sciences, WCU Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea. kyi821209@naver.com.|Cancer Research Institute, Seoul National University, Seoul, South Korea. kyi821209@naver.com.
authors: Yong-il
authors: YI
authors: Kim
authors: Department of Nuclear Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea. mandu0902@hotmail.com.
authors: Minseok
authors: M
authors: Suh
authors: Department of Nuclear Medicine, Seoul National University Hospital Boramae Medical Center, Seoul, South Korea. yk3181@snu.ac.kr.
authors: Yu Kyeong
authors: YK
authors: Kim
authors: Department of Nuclear Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea. debobkr@gmail.com.|Cancer Research Institute, Seoul National University, Seoul, South Korea. debobkr@gmail.com.
authors: Ho-Young
authors: HY
authors: Lee
authors: Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Hospital Boramae Medical Center, 425 Shin-dae-bang Dong, Dong-jak Gu, Seoul, 156-707, South Korea. kideb1@snu.ac.kr.
authors: Kichul
authors: K
authors: Shin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012446:Sacroiliac Joint / Q000000981:diagnostic imaging; D058566:Sacroiliitis / Q000000981:diagnostic imaging; D025241:Spondylarthritis / Q000000981:diagnostic imaging*; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D055815:Young Adult
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