The Value of SPECT/CT in Localizing Pain Site and Prediction of Treatment Response in Patients with Chronic Low Back Pain

Lee, Inki; Budiawan, Hendra; Moon, Jee Youn; Cheon, Gi Jeong; Kim, Yong Chul; Paeng, Jin Chul; Kang, Keon Wook; Chung, June‐Key; Lee, Dong Hoon

doi:10.3346/jkms.2014.29.12.1711

Cited by 24 publications

(11 citation statements)

References 24 publications

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“…12,18 Targeted treatments based on the CT-SPECT findings have shown positive results. 10,11 We started using CT-SPECT as a diagnostic modality in 2014, and, after several successful cases, we started to incorporate it into our routine diagnostic workup for spine patients. 19 Our results show that axial pain improved in most of the surgically treated patients and suggest that CT-SPECT was correct in identifying the primary pain generator in these difficult patients, who could not be adequately diagnosed using the routine investigations.…”

Section: Discussionmentioning

confidence: 99%

Primary pain generator identification by CT-SPECT in patients with degenerative spinal disease

Tender¹,

Davidson²,

Shields³

et al. 2019

Neurosurgical Focus

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OBJECTIVEAxial spinal pain generators are difficult to identify using current diagnostic modalities. Merging CT with SPECT (CT-SPECT) scans allows for accurate identification of areas with increased osteoblastic activity, which may reflect pain generators. In this study, the authors aimed to evaluate the degree of pain improvement in patients who underwent surgery, addressing primary pain generators identified by CT-SPECT.METHODSThe authors retrospectively reviewed all patients with chronic axial spine pain who underwent diagnostic CT-SPECT at their institution and analyzed pain improvement in those who underwent surgical treatment in order to determine whether CT-SPECT correctly identified the primary pain generator.RESULTSA total of 315 patients underwent diagnostic CT-SPECT between January 2014 and August 2018. Forty-eight patients underwent either cervical or lumbar fusion; there were 26 women (16 cervical, 10 lumbar) and 22 men (9 cervical, 13 lumbar). The overall axial spinal pain, as assessed through self-reporting of visual analog scale scores at 6 months postoperatively, improved from 9.04 ± 1.4 to 4.34 ± 2.3 (p = 0.026), with cervical fusion patients improving from 8.8 ± 1.8 to 3.92 ± 2.2 (p = 0.019) and lumbar fusion patients improving from 9.35 ± 0.7 to 4.87 ± 2.3 (p = 0.008).CONCLUSIONSCT-SPECT may offer a diagnostic advantage over current imaging modalities in identifying the primary pain generator in patients with axial spinal pain.

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Section: Discussionmentioning

confidence: 99%

Primary pain generator identification by CT-SPECT in patients with degenerative spinal disease

Tender¹,

Davidson²,

Shields³

et al. 2019

Neurosurgical Focus

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“…Identifying the site of pain origin however, is often not easy and it cannot usually be determined only by anatomical imaging, because this doesn't differentiate between incidental and functionally significant findings [22,23]. However, SPECT/CT which combines functional and morphological imaging can be helpful in identifying active lesions [24,25,26].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of Bone SPECT/CT Using 99mTc-Methylene Diphosphonate in Patients with Unspecified Chest Wall Pain

et al. 2021

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Purpose We investigated the diagnostic performance of single photon emission computed tomography (SPECT)/computed tomography (CT) as a combination of functional and anatomic imaging, in patients with unspecified chest wall pain. Methods Fifty-two patients with unspecified chest wall pain and no history of recent major traumatic events or cardiac disease were included. The number and location of radioactive chest wall lesions were evaluated on both planar images and SPECT/CT. The clinical diagnosis was made based on all of the clinical and imaging data and follow-up information. Results Chest wall diseases were diagnosed in 42 patients (80.8 %). SPECT/CT showed abnormal findings in 35 (67.3 %) patients with positive predictive value (PPV) of 97.1 %. SPECT/CT revealed 56 % more lesions than planar bone scan (P = 0.002) and most of the abnormal radioactive lesions (94.6 %) showed combined morphological changes on the matched CT component. When comparing between age subgroups (< 60 y vs. ≥ 60 y), the prevalence of chest wall disease and diagnosis rate of fracture was significantly higher in the older age group. On SPECT/CT, the older age group showed higher frequency of having abnormal finding (95.8 % vs. 42.9 %, P < 0.001) and significantly more lesions were detected (a total of 189 vs. 32, P = 0.003). Conclusion SPECT/CT showed good diagnostic performance and proved to have higher sensitivity, detecting 56 % more lesions than planar bone scan. A negative result could be helpful for excluding pathologic chest wall disease. SPECT/CT might be recommended for integration in to the diagnostic workup in patients with unspecified chest wall pain, especially in patients ≥ 60 y of age, considering the high disease prevalence and the high frequency of positive results.

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“…SPECT has been used for several decades to identify bone abnormalities [ 6 ]. Recently, clinicians have started to combine the functional value of SPECT with the anatomical accuracy of CT, in order to determine the potential pain generators and treatment targets [ 7 – 9 ].…”

Section: Discussionmentioning

confidence: 99%

Primary pain generator identification by CT–SPECT in a patient with low back pain: a case report

et al. 2017

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BackgroundChronic low back pain is one of the most common conditions encountered in the middle-age population. Identifying the primary pain generator is notoriously difficult. The computed tomography–single-photon emission computed tomography (CT–SPECT) is emerging as a new diagnostic modality for this purpose.Case presentationThis 68-year-old Caucasian male presented with intractable low back pain refractory to maximal conservative treatment, including medication and extensive physical therapy. The lumbar computed tomography, magnetic resonance imaging, and flexion–extension X-rays showed advanced degenerative changes throughout the lumbar spine, but no single level significantly worse than the others. The CT–SPECT showed markedly increased uptake at the L1–2 disc level and only minimal uptake at the other levels. The patient underwent a minimally invasive lateral L1–2 fusion with near-complete resolution of his low back pain.ConclusionsThe CT–SPECT may provide a unique tool in establishing the primary pain generator in patients with degenerative spine disease.

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The Value of SPECT/CT in Localizing Pain Site and Prediction of Treatment Response in Patients with Chronic Low Back Pain

Cited by 24 publications

References 24 publications

Primary pain generator identification by CT-SPECT in patients with degenerative spinal disease

Primary pain generator identification by CT-SPECT in patients with degenerative spinal disease

Diagnostic Value of Bone SPECT/CT Using 99mTc-Methylene Diphosphonate in Patients with Unspecified Chest Wall Pain

Primary pain generator identification by CT–SPECT in a patient with low back pain: a case report

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