title: Increased 99mTc MDP activity in the costovertebral and costotransverse joints on SPECT-CT: is it predictive of associated back pain or response to percutaneous treatment?
abstract: OBJECTIVE
  Pain related to costovertebral and costotransverse joints is likely an underrecognized and potentially important cause of thoracic back pain. On combined single-photon emission computed tomography and computed tomography (SPECT-CT), increased technetium-99m methylene diphosphonate (99mTc MDP) activity at these articulations is not uncommon. We evaluated whether this activity corresponds with thoracic back pain and whether it predicts response to percutaneous injection.
  
  
  METHODS
  All 99mTc MDP SPECT-CT spine examinations completed at our institution from March 2008 to March 2014 were retrospectively reviewed to identify those with increased 99mTc MDP activity in the costovertebral or costotransverse joints. The presence of corresponding thoracic back pain, percutaneous injection performed at the relevant joint(s), and response to injection were recorded.
  
  
  RESULTS
  A total of 724 99mTc MDP SPECT-CT examinations were identified. Increased 99mTc MDP activity at costovertebral or costotransverse joints was reported in the examinations of 55 patients (8%). Of these, 25 (45%) had corresponding thoracic back pain, and nine of 25 patients (36%) underwent percutaneous injection of the joint(s) with increased activity. At clinical follow-up two days to 12 weeks after injection, one patient (11%) had complete pain relief, two (22%) had partial pain relief, and six (67%) had no pain relief.
  
  
  CONCLUSIONS
  The findings suggest that increased activity in costovertebral and costotransverse joints on 99mTc MDP SPECT-CT is only variably associated with the presence and location of thoracic back pain; it does not predict pain response to percutaneous injection.
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA. lehman.vance@mayo.edu.
authors.forename: Jared T
authors.initials: JT
authors.lastname: Verdoorn
authors.forename: Vance T
authors.initials: VT
authors.lastname: Lehman
authors.forename: Felix E
authors.initials: FE
authors.lastname: Diehn
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Maus
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000379:methods; D000777:Anesthetics / Q000008:administration & dosage*; D001416:Back Pain / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology* / Q000378:metabolism; D004164:Diphosphonates / Q000378:metabolism*; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D007592:Joint Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds / Q000378:metabolism*; D012189:Retrospective Studies; D000072098:Single Photon Emission Computed Tomography Computed Tomography / Q000379:methods; D055815:Young Adult
chemical_list: D000777:Anesthetics; D004164:Diphosphonates; D015609:Organotechnetium Compounds; C114890:technetium 99m methylene bisphosphonate