Metabolic disturbances identified by SPECT-CT in patients with a clinical diagnosis of sacroiliac joint incompetence

Abstract

Purpose To establish the sensitivity and specificity of cross-sectional scintigraphy [single photon emission computed tomography (SPECT)] combined with computed X-ray tomography (CT) in the detection of sacroiliac joint (SIJ) mechanical dysfunction and evaluate reproducibility of reporting. Methods Patients with pelvic girdle pain either on the basis of peri-partum SIJ dysfunction or trauma were included. These patients were imaged with bone scintigraphy with hybrid imaging with SPECT/CT. Results The study group comprised 100 patients (72 females, 28 males). Trauma accounted for 52 % and the remainder were patients with peri-partum pain. Average age was 43 years and average length of history was [2 years. The major finding was increased uptake in the upper SIJ and posterior soft-tissues/ligaments. Hybrid imaging had a sensitivity of 95 % and specificity of 99 %. Positive predictive value was 99 % and negative predictive value 94 %. Power of the test was 1.0. Reproducibility of the test was good with kappa values of 0.85. ConclusionHybrid imaging with SPECT/CT reproducibly demonstrates metabolic alterations around the SIJ in patients with SIJ dysfunction, which we have termed SIJ incompetence. The condition is more common than previously recognised and frequently occurs after trauma, which has not been reported previously.

What's Old Is New Again: The Sacroiliac Joint as a Cause of Lateralizing Low Back Pain

“…Analysis with the Student t test yielded a mean difference of 59 counts (95% CI, 42–89 counts). The specific SPECT/CT criteria for the diagnosis of SIJ incompetence have been validated in previous work ( 9 ).…”

“…Patients were imaged using standardized protocols published in detail elsewhere ( 9 ). Following the intravenous injection of 900-1000 MBq of 99m-Tc hydroxydiphosphonate (HDP), blood-pool images of the anterior and posterior pelvis were obtained.…”

“…These patients can be identified by a specialized battery of physical tests that have been established as the diagnostic reference standard on the basis of good evidence ( 8 ). We have developed and validated a bone scintigraphic technique with the use of single-photon emission CT (SPECT) with fused CT images (SPECT/CT) to identify this condition ( 9 ). The major cause of the dysfunction in this series was trauma, largely related to either discrete or repetitive sporting trauma.…”

“…We hypothesize that these findings agree with and provide physical imaging evidence to support the integrated model of SIJ function proposed by Lee and Vleeming ( 10 ). Accurate diagnosis will provide significant clinical improvement with targeted therapy in 80% of cases ( 9 , 11 ).…”

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“…The roots of L3 to S1 and branches of the superior gluteal nerve (L5-S2) supply the anterior aspect of the SIJ [8]. We have developed an imaging test for SIJ dysfunction utilizing bone scintigraphy and X-ray computed tomography that demonstrates metabolic alterations in both the affected joint and the posterior SIJ ligaments [9]. It supports the assertion that posterior ligamentous pathology makes a significant nociceptive contribution to the condition, hence the importance of the nerve supply to the posterior SIJ ligaments.…”