POS0982\u2005DIAGNOSTIC VALUE OF SPECT/CT IN AXIAL SPONDYLOARTHRITIS AND OTHER LOW BACK PAIN

Abstract

Spondyloarthropathies (SpA) including ankylosing spondylitis are characterized by inflammatory arthritis involving the spine and peripheral joints. Bone SPECT/CT is in the spotlight as it can reflect the current level of inflammation.We aimed to investigate the diagnostic performance of bone SPECT/CT for axial SpA (axSpA) at the level of sacroiliac joints.Patients with low back pain who had undergone SPECT/CT of the SI joints were selected for inclusion in this study through a retrospective review of medical records from August 2016 and July 2018. We used semi-quantitative scoring methods for SPECT/CT. For visual scoring, a score of 0 was assigned when tracer uptake in the sacroiliac joint was less than that in the sacrum; a score of 1, when equal to that in the sacrum; and a score of 2, when greater than that in the sacrum. A score of 2 was considered positive for the diagnosis of sacroiliitis on SPECT/CT (Figure 1). The diagnosis of axSpA was retained when patients fulfilled the Assessment of SpA International Society criteria.A total of 164 patients were enrolled (34 patients with axSpA). The remaining 130 patients had non-axSpA rheumatic inflammatory disease (n=24), vertebral disk herniation (n=13), avascular necrosis (n=11), and others such as bursitis, and fracture (n=85). The mean age of aSpA (37.8±15.6 years) was lower than controls (49.8±16.4 years) (p<0.001), and axSpA (64.5 %) had more male than others (42.1 %) (p=0.024). The sensitivity, specificity, positive and negative predictive values of bone SPECT/CT for axSpA were 83.9%, 63.2%, 34.7%, and 94.4%, respectively. The bone SPECT/CT maximal score and BASDAI score has positive correlation (r=0.481, p=0.007). The bone SPECT/CT compared with MRI is marginal correlation (k=0.369, p<0.001).In patients with low back pain, the bone SPECT/CT has a high negative predictive value that can exclude AS. In addition, when contraindication in MRI the bone SPECT/CT can be an alternative test.[1]Rahul V. Parghane, Baljinder Singh, Aman Sharma, Harmandeep Singh, Paramjeet Singh, and Anish Bhattacharya. Role of 99mTc-Methylene Diphosphonate SPECT/CT in the Detection of Sacroiliitis in Patients with Spondyloarthropathy: Comparison with Clinical Markers and MRI. J Nucl Med Technol 2017; 45:280–28[2]Anuj Jain, Suruchi Jain, w A n i l A g a r w a l, Sanjay Gambhir, Chetna Shamshery, and Amita Agarwal(2015). Evaluation of Efficacy of Bone Scan With SPECT/CT in the Management of Low Back Pain. A Study Supported by Differential Diagnostic Local Anesthetic Blocks. Clin J Pain 2015;31:1054–1059[3]Yong-il Kim, Minseok Suh, Yu Kyeong Kim, Ho-Young Lee and Kichul Shin. The usefulness of bone SPECT/CT imaging with volume of interest analysis in early axial spondyloarthritis. BMC Musculoskeletal Disorders (2015) 16:9[4]Jennifer Saunders, Mel Cusi, and Hans Van der Wall. What’s Old Is New Again: The Sacroiliac Joint as a Cause of Lateralizing Low Back Pain. Tomography (2018) VOLUME 4 NUMBER 2[5]Satoshi Kato, Satoru Demura, Hidenori Matsubara, Anri Inak2, Kazuya Shinmura, Noriaki Yokogawa, Hideki Murakam1, Seigo Kinuya and Hiroyuki Tsuchiya. Utility of bone SPECT/CT to identify the primary cause of pain in elderly patients with degenerative lumbar spine disease. Journal of Orthopaedic Surgery and Research (2019) 14:185[6]Romain De Laroche, Erwan Simon, Nicolas Suignard, Thomas Williams, Marc-Pierre Henry, Philippe Robin, Ronan Abgral, David Bourhis Pierre-Yves Salaun, Frédéric Dubrana, Solène Querellou. Clinical interest of quantitative bone SPECT-CT in the preoperative assessment of knee osteoarthritis. De Laroche et al. Medicine (2018) 97:35[7]Inki Lee, Hendra Budiawan, Jee Youn Moon, Gi Jeong Cheon, Yong Chul Kim, Jin Chul Paeng, Keon Wook Kang, June-Key Chung, and Dong Soo Lee. The Value of SPECT/CT in Localizing Pain Site and Prediction of Treatment Response in Patients with Chronic Low Back Pain. J Korean Med Sci 2014; 29: 1711-1716None declared.