Validation of topographic hybrid SPECT-CT scan in patients with and without non-specific chronic low back pain. a prospective comparative study.

Publication date: Available online 8 May 2017
Source:The Spine Journal
Author(s): Erik Van de Kelft, Gino Verleye, An-Sofie Van de Kelft, Koen Melis, Johan Van Goethem
Background/contextThe evidence for the treatment for non-specific chronic low back pain (ns CLBP) is very weak. Besides the complexity of the pain experience, a good biological marker or tool enabling identification of a pain generator is lacking. Hybrid imaging, combining Single Photon Emission Computerized Tomography (SPECT) with Computerized Tomography (CT)-scan, has been proposed as useful in the diagnostic workup of CLBP patients.PurposeTo evaluate the sensitivity of SPECT-CT in patients with ns CLBP (group I) as compared to patients without CLBP (Group II).Study designA prospective comparative studyPatient sampleTwo hundred patients were enrolled, 96 in group I and 104 in group II.Outcome measuresOnly the physiological measurement of the incidence of hotspots was performed.The hotspots were rated as: 0 = normal; 1 = slightly coloured (no hot spot on whole body bone scan and 2 = clear hot spot (can be identified on the whole-body bone scan and confirmed on SPECT). To analyse the inter-observer agreement when using this scoring system, a second independent reading was performed for 50 randomly chosen records.MethodsTwo hundred patients divided in two groups, were referred to the department of Medical & Molecular Imaging for a topographic SPECT-CT.The first group consisted of patients with ns CLBP, diagnosed by the neurosurgeon. The control group consisted of patients referred for SPECT-CT for non-spinal conditions. Hotspots were assessed for all patients.A second independent reading, blinded for the results of the first reader, was performed on 25 randomly selected patients in each group.This study was investigator initiated, no funding was received. None of the authors or their proxies have a potential conflict of interest.ResultsThe odds of finding a normal image in the control group are 2.05 times higher compared to group I. The sensitivity score equals 2.37, meaning that the probability of detecting a hot spot (levels 1 or 2) is more than 2 times higher in group I. Focusing on level 2 hot spots only, this score rises to 7.02, indicative for a high sensitivity.ConclusionsSPECT-CT might have potential in the diagnostic workup of ns CLBP patients, due to its higher sensitivity when compared to other advanced medical imaging modalities.



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