The role of nuclear medicine in the diagnosis of spondylodiscitis.

BACKGROUND: The diagnosis of spondylodiscitis can be difficult, because the patients history, subjective symptoms and physical findings are often inconclusive, particularly in the early stages.

AIM: To perform an overview on the role of nuclear medicine procedures with single photon emission tomography (SPET) and positron emission tomography (PET) tracers in the diagnosis of spondylodiscitis.

MATERIALS AND METHODS: A literature review about bone scintigraphy, Gallium-67-citrate scintigraphy, labeled leukocytes scintigraphy and PET was performed. Main findings of the literature were reported.

RESULTS: Bone scintigraphy is a sensitive and widely available nuclear medicine technique, but it is characterized by low specificity. Gallium-67-citrate scintigraphy is often used as a complement to bone scintigraphy to enhance the specificity of the study and to detect extra-osseous sites of infection. Labeled leukocytes scintigraphy is not a useful method in the diagnosis of spondylodiscitis. Fluorine-18-fluorodeoxyglucose positron emission tomography is a sensitive method and could potentially be useful in the diagnosis of spondylodiscitis and in the evaluation of treatment response. Nevertheless, scientific literature about this topic is still limited.

CONCLUSIONS: Overall, nuclear medicine procedures play a useful role in the diagnosis of spondylodiscitis identifying functional abnormalities which precede morphological changes. Therefore, nuclear medicine procedures may complement or integrate morphological imaging findings in patients with suspected spondylodiscitis.