Co-registration of isotope bone scan with CT scan and MRI in the investigation of spinal pathology |
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| Affiliation: | 1. Neuroscience Clinical Institute, Epworth Hospital, Melbourne, VIC, Australia;2. Nuclear Medicine Department, Primary Healthcare Imaging, Epworth Hospital, Melbourne, VIC, Australia;1. Department of Neurosurgery, University of California San Francisco, 505 Parnassus Avenue, M 779, San Francisco, CA 94143-0112, USA;2. Department of Radiation Oncology, University of California San Francisco, CA, USA;1. Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School, University of Sydney, Missenden Road, Camperdown, Sydney, NSW 2050, Australia;2. Miranda Neurology, Miranda, NSW, Australia;3. Brain & Mind Research Institute, Camperdown, NSW, Australia;1. Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0112, USA;2. Department of Pathology, University of California at San Francisco, San Francisco, CA, USA;3. Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA;1. Cell Biology Section, Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Building 35, Room 2C-911, 9000 Rockville Pike, Bethesda, MD 20892-3738, USA;2. Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA;3. Immunology and Microbial Pathogenesis Program, Weill Cornell Graduate School of Medical Sciences, New York, NY, USA;1. Department of Neurology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 271 Cheonbo-ro, Uijeongbu 480-717, Republic of Korea;2. Department of Nuclear Medicine, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea |
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| Abstract: | Image fusion software enables technetium99m-methylene diphosphonate (Tc99m-MDP) bone scan images to be co-registered with CT scan or MRI, allowing greater anatomical discrimination. We examined the role of bone scan images co-registered with CT scan or MRI in the investigation of patients presenting with axial spinal pain and/or limb pain. One hundred and thirty-nine consecutive patients were examined, and thereafter investigated with CT scan, MRI, and/or dynamic plain films. At this point diagnosis (pathology type and anatomical site) and treatment intention were declared. The co-registered Tc99m-MDP bone scan images were then studied, after which diagnosis (pathology type and anatomical site) and treatment intention were re-declared. This data were then analysed to determine whether the addition of co-registered bone scan images resulted in any change in diagnosis or treatment intention. The most significant change in diagnosis was pathology type (10%). Anatomical site changed markedly without overlap of the pre and post-isotope fields in 5%, and with overlap in 10%. Treatment intention had a major change in 3.6% and minor change in 8.6%. In the two groups where there was (i) no obvious pathology after full pre-isotope investigation, or (ii) a spinal fusion under suspicion, addition of the bone scan information led to a major change in the pathology and/or anatomical localisation in 18% and 19%, respectively. The addition of co-registered Tc99m-MDP bone scan images offers significant diagnostic assistance, particularly in the difficult diagnostic groups where a failed spinal fusion may be the suspected pain generator, or when no pain generator can otherwise be found. |
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| Keywords: | Bone scan CT scan Diagnosis MR Pathology Spine Treatment |
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