USING NUCLEAR MEDICINE IMAGING TO HELP BACK PAIN

If you are experiencing chronic low back pain, diagnosis and treatment can be a challenge. For example, the lumbar spine contains many areas that can be a cause of back pain.

An important first step for an accurate diagnosis is a thorough history and physical examination by your health care practitioner. One potential source of back pain can be the lumbar spine facet joints. If your doctor suspects this area might need to be investigated, they might order a bone scan with SPECT/CT.

HOW DOES A BONE SCAN WITH SPECT/CT HELP DIAGNOSE PAIN?

Bone scans, also known as bone scintigraphy, use a small amount of radioactive material (called a radiopharmaceutical) injected into a vein that travels through your bloodstream into your bones. A gamma camera detects the radiation emitted from your body, which is put together by a computer that creates images of the bones.

Areas that take up little or no amount of the radiopharmaceutical appear as “cold” spots and could show a lack of blood supply to the bone. Areas which take up more radiopharmaceutical show up as “hot” spots, indicating increased blood flow or bone turnover, and could point to problems like arthritis, a tumour, a fracture, or an infection.

Depending on the area of concern, a bone scan can image the entire body or pay particular attention to certain parts. It is useful in surveying areas with many small bones and joints like the spine, foot, and ankle because it can provide detailed, localized information about abnormal areas of activity. A SPECT/CT scan can also potentially guide targeted pain management procedures to treat the pain.

A SPECT/CT exam is a type of bone scan with additional imaging at the end of the exam. It’s “SPECT” imaging combined with “CT” imaging to help localize the area of abnormal activity that may be present on the planar bone scan image. For the “SPECT” part, the nuclear medicine gamma camera rotates 360 degrees around the body and forms pictures. The system can reconstruct this into an image. For the “CT” portion, a low-dose CT image is taken, similar to other CT imaging. These CT images are fused electronically with the SPECT images to get the SPECT/CT image.

WHAT HAPPENS DURING A BONE SCAN?

A bone scan involves two separate appointments booked on the same day. The first appointment will take approximately 15 minutes. During this time, the radiopharmaceutical is injected into an arm vein and travels throughout the body. You will be asked to lie on your back on the imaging bed while a gamma camera is placed over your body. The first set of images documents increased or decreased flow to the areas of concern.  Afterwards, you will be able to go about your normal daily activities until the second appointment (2-4 hours after the first).

During the second appointment, imaging will be performed without any additional injections, to document uptake in the bones. It will take approximately 30-45 minutes. You will be asked to hold as still as possible, while breathing normally – movement can blur the images and make them more difficult to interpret. The SPECT/CT imaging is performed towards the end of this second appointment.

IS A BONE SCAN SAFE?

The radiopharmaceutical is excreted from the body through your urine and will decay within the body over the 48 hours following your exam. Keeping hydrated and voiding frequently will help eliminate it from your body.

A bone scan involves a small dose of ionizing radiation from the radiopharmaceutical injected into your vein, and also from the CT scan during the CT portion of SPECT/CT imaging. CT imaging is a form of X-ray and the exposure to radiation from this scan is slightly higher than that of standard X-rays, but the associated risk is still small. Overall, the radiation exposure from a bone scan with SPECT/CT is about the equivalent of exposure to the earth’s natural background radiation over two years. In most cases, the benefits, such as the early detection of a serious illness, outweigh the small increased risk from radiation exposure.

Mayfair Diagnostics complies with policies and has procedures in place for nuclear medicine radiation safety, including a Radiation Safety Officer who ensures we follow all policies and procedures. If you are pregnant, or if there is a chance you are pregnant, we will not perform the exam. If you are breastfeeding, please inform the technologist. The exam will still be performed, but you will be advised to pump and discard breast milk, or store it for a specific period of time before using.

HOW DO I GET A BONE SCAN?

This exam is covered under your Alberta Health Care Insurance Plan and must be requested by a health care practitioner. To determine whether it is appropriate for you, your doctor will often review your medical and family history, risk factors, how long symptoms have been present, and how they affect daily activities. If this exam is indicated as a best next course of action, your doctor will provide you with a requisition and the appointment can be booked.

These exams are performed at our Castleridge, Mahogany Village, Market Mall, Mayfair Place, and Sunpark locations, please visit our services page for more information about this exam.

REFERENCES

Canadian Cancer Society (2022) “Bone Scan” www.cancer.ca. Accessed October 4, 2022.

Garcia, D., et al. (2022) “SPECT-CT as a Predictor of Pain Generators in Patients Undergoing Intra-Articular Injections for Chronic Neck and Back Pain.” World Neurosurgery, vol. 164, August 2022, e1243-e1250.

Healthwise Staff (2021) “Bone Scan.” www.myhealth.alberta.ca. Accessed October 4, 2022.

Healthwise Staff (2021) “Single Photon Emission Computed Tomography (SPECT).” www.myhealth.alberta.ca. Accessed October 4, 2022.

Maldonado, A., et al. (2019) “High resolution bone SPECT-CT in the evaluation of chronic low back pain and facet joint arthropathy. Experience in 150 patients.” Journal of Nuclear Medicine, May 2019, 60 (1) 1292.

Matesan, M., et al. (2016) “SPECT/CT bone scintigraphy to evaluate low back pain in young athletes: common and uncommon etiologies.” Journal of Orthopaedic Surgery and Research, 11 (76).

Mayo Clinic Staff (2022) “SPECT scan.” www.mayoclinic.org. Accessed October 4, 2022.