High Uptake Detection for Spinal Degenerative Changes: A Comparison Between Bone Scintigraphy and Single Photon Emission Computed Tomography Combined With High-Resolution Computed Tomography.

Background Nuclear imaging modalities are increasingly advancing spinal diagnostics. This study evaluates the prevalence of high uptake in bone scan and single photon emission computed tomography combined with high-resolution computed tomography (SPECT/CT) in the spine and sacroiliac joint (SIJ) and compares the diagnostic performance of BS to SPECT/CT in detecting metabolic activity linked to neck and back pain. Objective The primary objective was to assess the sensitivity, specificity, and diagnostic accuracy of BSs compared with SPECT/CT for spine and SIJ evaluation. Methods This retrospective study evaluated data from patients with spinal complaints who underwent spine-focused SPECT/CT alongside whole-body BS at a tertiary institution. Results A total of 110 patients were included, with 48 cervical spine, 34 thoracic spine, and 91 lumbar spine and SIJ SPECT/CT scans. For the cervical spine, BS sensitivity, specificity, and accuracy were 41.5%, 100%, and 50%, respectively. For the thoracic spine, these values were 50.0%, 100%, and 73.5%, respectively. For the lumbar spine, they were 72.9%, 100%, and 79.1%. For the SIJ, sensitivity, specificity, and accuracy were 38.2%, 96.5%, and 74.7%, respectively. Conclusions Bone scans demonstrated reasonable sensitivity and high specificity, particularly for lumbar spine and SIJ evaluation, making them a useful screening tool in resource-constrained settings. However, SPECT/CT showed superior performance in detecting osteometabolic activity and provided more detailed functional and structural insights for diagnosing and managing degenerative spinal conditions. Clinical Relevance This study highlights the potential complementary role of bone scans in spinal diagnostics.