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Facet joints are the important articular pillars of the spine. Several pathologies can occur in and around the facet joint, including extra ossicles, traumatic dislocation, osteoarthritis, synovial cyst, axial spondyloarthritis, rheumatoid arthritis, calcium pyrophosphate deposition disease, septic arthritis, and malignant and benign neoplasms. Imaging is the mainstay to detect and characterize these diseases. In this review, we discuss the anatomy and function of facet joints, imaging techniques, and the imaging findings of several facet joint diseases. This information may be helpful to radiologists to make the correct diagnosis and optimize the management of patients with facet joint diseases.

This study aimed to determine the most important perfusion score in patient selection for coronary angiography (CA) by quantitatively evaluating myocardial perfusion scintigraphy (MPS).Patients who underwent MPS single-photon emission computerized tomography/computed tomograph imaging in our clinic between December 2017 and January 2019, without coronary artery disease (CAD) history, followed by CA were included in the study. CA was considered positive when there is a stenosis of 70% or more in at least one coronary vessel. The summed stress score, rest score, and differential score; total perfusion deficit (TPD); and the defect's extent obtained from non-attenuation-corrected (NC) and attenuation-corrected (AC) images of 80 patients were evaluated using the Mann-Whitney U test. A p value of0.05 was considered significant. Receiver operating characteristic (ROC) analysis was performed.The scores obtained from NC and AC images showed a significant difference between the two groups for all scores except for the extent and TPD scores at rest from AC images. The applied ROC curves' highest diagnostic value was determined as the TPD score at stress (TPDS) obtained from NC images (area under the curve: 0.880, 95% confidence interval, 0.807-0.952, p0.001). The cut-off value obtained for the TPDS from the ROC curve was found to be 5.5.The scores obtained from NC images have more power to detect CAD than those obtained from AC images. Patients with no prior CAD history with TPDS score higher than 5 in MPS should be referred for CA with priority.Bu çalışmada miyokard perfüzyon sintigrafisinin (MPS) kantitatif değerlendirilmesiyle koroner anjiyografi (KAG) yapılacak hastalarının seçiminde en önemli perfüzyon skorunun belirlenmesi amaçlandı.Aralık 2017-Ocak 2019 tarihleri arasında kliniğimizde MPS tek foton emisyon tomografisi/bilgisayarlı tomografi (SPECT/BT) görüntüleme uygulanan ve daha önce koroner arter hastalığı (KAH) tanısı bulunmayan ve MPS sonrası KAG yapılan hastalar çalışmaya dahil edildi. KAG sonucunda en az bir koroner damarda %70 veya daha fazla darlık izlenen hastalar koroner arter darlığı (KAD) açısından pozitif kabul edildi. Seksen hastanın atenüasyon düzeltilmemiş (NC) ve SPECT/BT ile atenüasyon düzeltilmiş (AC) görüntülerden elde edilen toplam stres skoru, toplam rest skoru, toplam perfüzyon bozukluğu ve extent puanları Mann-Whitney U testi ile değerlendirildi. P0,05 değeri anlamlı kabul edildi. Alıcı işlem karakteristikleri (ROC) analizi yapıldı.NC ve AC görüntülerinden elde edilen skorlar, ExtentRac ve TPDRac dışındaki tüm skorlar için iki grup arasında anlamlı fark görüldü. ROC eğrilerindeki en yüksek tanı değeri NC görüntülerinden elde edilen TPDS değeri olarak belirlendi (eğrinin altında kalan alan: 0,880, %95 güven aralığı, 0,807-0,952, p0,001). TPDS için ROC eğrisinden elde edilen kesim değeri 5,5 olarak bulundu.NC görüntülerden elde edilen skorların AC görüntülerden elde edilen skorlara göre daha fazla KAD saptama gücü vardır. Daha önceden bilinen KAH olmayan ve MPS’de TPDS skoru 5’in üzerinde olan hastalar KAG’ye öncelikli olarak yönlendirilmelidir.

Background. Diseases of the musculoskeletal system (MSS), in particular diseases of joints, are a leading factor for reducing the work ability of the population all around the world. The early diagnosis and treatment for them is a high priority task for clinical medicine. Modern nuclear medicine methods can significantly increase the possibilities in differential diagnostics, optimize treatment and improve the prognosis of diseases of the musculoskeletal system (MOP). Purpose – to study and generalize the world experience of application of modern methods of osteoscintigraphy (OSG) for diagnostics of joints diseases, to define possibilities and prospects of various scintigraphic acquisitions for investigation patients with MSS pathology. Materials and methods. Full-text publications in the databases Scopus, Web of Science Core Collection, PubMed (mostly 2015–2021), international standard guidelines for the diagnosis of MSS pathology and monographs for radionuclide examination methods and hybrid imaging technologies in oncology, orthopedics and traumatology. Results. We received the main approaches for radiological diagnostics of pathological changes in joints and the abilities of osteoscintigraphy. We defined the main principles and analyzed the possibilities and advantages of different nuclear medicine protocols: conventional planar examination of the whole body, 3-phase OSG, single-photon emission computed tomography (SPECT) and combined technology with X-ray computed tomography (SPECT/CT). Indications for the use of OSG in various pathological changes of ORA have been determined. We considered different patterns of radiation imaging according to the pathogenesis of various pathological processes – systemic arthritis, diseases of the joints of the spine, upper and lower extremities. The possibilities of different radiological methods for diagnosing and application of different modes of OSG depending on the pathogenesis and localization of lesions were analyzed and compared. Conclusions. Performing 3-phase OSG and tomographic modes (SPECT, SPECT/CT) significantly increases the efficiency of the method for the diagnostics, determination of process activity, staging and prevalence of joint pathology, as well as for monitoring the treatment results. The method detects active metabolic processes at an early stage in the vascular, soft tissue and bone phases and determines the condition of the joints of the whole body without additional radiation exposure., Актуальність. Захворювання кістково-м’язової системи, зокрема суглобів, є головним фактором зниження працездатності населення в усьому світі, тому рання їх діагностика і лікування – це пріоритетний напрямок розвитку клінічної медицини. Сучасні методи ядерної медицини дозволяють значно підвищити можливості диференційної діагностики, оптимізувати лікування та покращити прогноз захворювань опорно-рухового апарату (ОРА). Мета роботи – дослідити та узагальнити світовий досвід застосування сучасних методів остеосцинтиграфії (ОСГ) для діагностики захворювань суглобів, визначити можливості і перспективи застосування різних сцинтиграфічних режимів для ведення пацієнтів з патологією ОРА. Матеріали і методи. Повнотекстові публікації, розміщені у базах даних Scopus, Web of Science Core Collection, PubMed (переважно 2015–2021 рр.), міжнародні стандартні настанови для діагностики патології ОРА і монографії, присвячені радіонуклідним методам обстеження та гібридним технологіям візуалізації в онкології, ортопедії і травматології. Результати та їх обговорення. У роботі розглянуто основні підходи до променевої діагностики патологічних змін суглобів та місце у ній остеосцинтиграфії. Визначено основні принципи, проаналізовано можливості та переваги різних протоколів її проведення: конвенційного планарного дослідження всього тіла, трифазової ОСГ, однофотонно-емісійної комп’ютерної томографії (ОФЕКТ) та суміщеної технології з рентгенівською комп’ютерною томографією (ОФЕКТ/КТ). Визначено показання до застосування ОСГ при різних патологічних змінах ОРА. Розглянуто аспекти променевої візуалізації відповідно до патогенезу різних патологічних процесів – системних артритах, захворюваннях суглобів хребта, верхніх та нижніх кінцівок. Проаналізовано і порівняно можливості різних променевих методів діагностики та застосування різних режимів ОСГ залежно від патогенезу і локалізації уражень. Висновки. Виконання ОСГ в трифазовому і томографічних (ОФЕКТ, ОФЕКТ/КТ) режимах значно підвищує ефективність методу для діагностики, визначення активності, стадії і поширеності патології суглобів, а також для моніторингу результатів їх лікування. Метод виявляє активні метаболічні процеси на ранній стадії у судинну, м’якотканинну та кісткову фази та визначає стан суглобів усього тіла без додаткового променевого навантаження.

In [In SPECT/CT phantom measurements (NaI cameras, N = 2; CZT, N = 1), peak contrast recovery (CRpeak) was derived from sphere inserts or myocardial insert (cardiac phantom; signal-to-background ratio [SBR], 10:1 or 5:1). In 25 positive and 38 negative patients (reference: endomyocardial biopsy or clinical diagnosis), Perugini scores and heart-to-contralateral (H/CL) count ratios were derived from planar images 1 hour and 3 hour p.i.In phantom measurements, accuracy of myocardial CRpeak at SBR 10:1 (H-mode, 0.95-0.99) and reproducibility at 5:1 (H-mode, 1.02-1.14) was comparable for H-mode and L-mode. However, L-mode showed higher variability of background counts and sphere CRpeak throughout the field of view than H-mode. In patients, sensitivity/specificity were ≥ 95% for H/CL ratios at both time points and visual scoring 3 hour. At 1 hour, visual scores showed specificity of 89% and reduced reader's confidence.Early DPD images provided no additional value for visual scoring or H/CL ratios. In SPECT/CT, H-mode is preferred over L-mode, especially if quantification is applied apart from the myocardium.ANTECEDENTES: En la gammagrafía con [ 99mTc]-DPD para amiloidosis cardiaca ATTR, se recomienda la adquisición de imágenes planares a las 3h p.i y SPECT/CT en modo L. Este estudio investigó si las imágenes planares más tempranas (1h p.i.) tienen beneficios y si la adquisición del SPECT/CT debería preferirse en modo H (ángulo de detección de 180 °) o en modo L (90 °). MéTODOS: En las mediciones con el fantoma del SPECT/CT (cámaras de NaI, n= 2; CZT, n=1), la recuperación pico de contraste (CRpico) se derivó de inserciones de esfera o de inserciones miocárdicas (fantoma cardiaco; relación señal-fondo [SBR], 10:1 o 5: 1). En 25 pacientes positivos y 38 negativos (referencia: biopsia endomiocárdica o diagnóstico clínico), el score de Perugini y la relación de cuentas corazón-contralateral (H/CL) se derivaron de imágenes planares a 1h y 3h p.i.En mediciones con el fantoma, la precisión del CRpico miocárdico en SBR 10:1 (modo H, 0.95-0.99) y la reproducibilidad a 5:1 (modo H, 1.02-1.14) fue comparable para el modo H y el modo L. Sin embargo, el modo L mostró una mayor variabilidad de las cuentas de fondo y del CRpico de la esfera en todo el campo de visión que el modo H. En pacientes, la sensibilidad/especificidad fue ≥ 95% para las relaciones H/CL en ambos puntos de tiempo y con un score visual a las 3 h. A 1h, los scores visuales mostraron una especificidad de (89%) y disminución de la confianza del lector.Las imágenes tempranas de DPD no proporcionaron ningún valor adicional para el score visual o las relaciones H/CL. En SPECT/CT, se prefiere el modo H sobre el modo L, especialmente si la cuantificación se aplica aparte del miocardio.摘要: 背景: [99mTc]Tc-DPD闪烁显像检查心肌ATTR淀粉样变性时, 建议使用3h p.i.平面图像和L模式SPECT/CT扫描。本研究探讨了早期平面图像(1h p.i.)是否有益, 以及SPECT/CT采集是否应首选H模式(探测器角度180°)或L模式(90°)。 方法: 在SPECT/CT模体测量中(NaI相机, n=2;CZT, n=1), 峰值造影剂恢复(CRpeak)来自球体插入物或心肌插入物(心脏模体; 信号与背景比[SBR], 10:1 或5:1)。在25个阳性和38个阴性病人中(参考标准: 心内膜活检或临床诊断), Perugini分数和心脏/对侧 (H / CL)计数比率来自平面图像1 h和3 h p.i.。 结果: 在模体测量中, 心肌CRpeak的SBR准确性 10:1 (H-mode, 0.95 - 0.99)和可重复性5:1 (H-mode, 1.02 - 1.14), H模式和L 模式相当。然而, 与H模式相比, L模式在整个视野中表现出更高的背景计数和球形CRpeak变异性。在患者中, 两个时间点的H/CL比值以及3h视觉评分的敏感性/特异性均≥95%。1h时, 视觉评分特异性为89%, 阅读者的信心降低。 结论: DPD早期图像对视觉评分和H/CL比值没有额外的价值。在SPECT/CT中, H模式优于L模式, 特别是心肌之外定量时。.

Background There is a need for better diagnostic tools that identify loose total hip and knee arthroplasties. Here, we present the accuracy of different 99mTc-dicarboxypropandiphosphate ([99mTc]Tc-DPD) SPECT/CT quantification tools for the detection of loose prostheses in patients with painful hip and knee arthroplasties. Methods Quantitative reconstruction of mineral phase SPECT data was performed using Siemens xSPECT-Quant and xSPECT-Bone, with and without metal artefact reduction (iMAR) of CT-data. Quantitative data (SUVmax values) were compared to intraoperative diagnosis or clinical outcome after at least 1 year as standard of comparison. Cut-off values and accuracies were calculated using receiver operator characteristics. Accuracy of uptake quantification was compared to the accuracy of visual SPECT/CT readings, blinded for the quantitative data and clinical outcome. Results In this prospective study, 30 consecutive patients with 33 symptomatic hip and knee prostheses underwent [99mTc]Tc-DPD SPECT/CT. Ten arthroplasties were diagnosed loose and 23 stable. Mean-SUVmax was significantly higher around loose prostheses compared to stable prostheses, regardless of the quantification method (P = 0.0025–0.0001). Quantification with xSPECT-Bone-iMAR showed the highest accuracy (93.9% [95% CI 79.6–100%]) which was significantly higher compared to xSPECT-Quant-iMAR (81.8% [67.5–96.1%], P = 0.04) and xSPECT-Quant without iMAR (77.4% [62.4–92.4%], P = 0.02). Accuracies of clinical reading were non-significantly lower compared to quantitative measures (84.8% [70.6–99.1%] (senior) and 81.5% [67.5–96.1%] (trainee)). Conclusion Quantification with [99mTc]Tc-DPD xSPECT-Bone-iMAR discriminates best between loose and stable prostheses of all evaluated methods. The overall high accuracy of different quantitative measures underlines the potential of [99mTc]Tc-DPD-quantification as a biomarker and demands further prospective evaluation in a larger number of prosthesis.

Background To explore the 131I-SPECT/CT characteristics of remnant thyroid tissue (RTT) in differentiated thyroid cancer (DTC), further assess the risk factors and clinical significance. Methods 52 DTC patients after total thyroidectomy had undergone neck 131I-SPECT/CT before 131I ablation. The diagnosis of RTT was based on SPECT/CT and follow-up at least 3 months. The anatomic locations and features of SPECT/CT of RTT were assessed by reviewers. The risk factors of RTT with CT positive were analyzed by the chi-square test. Results A total of 80 lesions of RTT were diagnosed in this study, most of them were mainly located in the regions adjacent to trachea cartilage (37/80) or lamina of thyroid cartilage (17/80). On SPECT/CT of RTT, low, moderate and high uptake were respectively noted in 10, 24 and 46 lesions, definite positive, suspected positive and negative CT findings were respectively noted in 10, 21 and 49. The RTT lesions with definite positive CT findings were mainly located adjacent to lamina of thyroid cartilage (5/10). Primary thyroid tumor (P = 0.029) and T stage (P = 0.000) were the effective risk factors of CT positive RTT. Conclusions RTT has certain characteristic distribution and appearances on SPECT/CT. Most of RTT with definite CT abnormalities located adjacent to lamina of thyroid cartilage, which suggest surgeons should strengthen the careful removal in this region, especially primary thyroid tumor involving bilateral and T4 stage. This study can provide a certain value for the improvement of thyroidectomy quality in DTC patients.

IntroductionNuclear medicine parathyroid imaging is important in the identification of hyperfunctioning parathyroid glands in primary hyperparathyroidism (pHPT), but it may be also valuable before surgical treatment in secondary hyperparathyroidism (sHPT). Parathyroid radionuclide imaging with scintigraphy or positron emission tomography (PET) is a highly sensitive procedure for the assessment of the presence and number of hyperfunctioning parathyroid glands, located either at typical sites or ectopically. The treatment of pHPT is mostly directed toward minimally invasive parathyroidectomy, especially in cases with a single adenoma. In experienced hands, successful surgery depends mainly on the exact preoperative localization of one or more hyperfunctioning parathyroid adenomas. Failure to preoperatively identify the hyperfunctioning parathyroid gland challenges minimally invasive parathyroidectomy and might require bilateral open neck exploration.MethodsOver a decade has now passed since the European Association of Nuclear Medicine (EANM) issued the first edition of the guideline on parathyroid imaging, and a number of new insights and techniques have been developed since. The aim of the present document is to provide state-of-the-art guidelines for nuclear medicine physicians performing parathyroid scintigraphy, single-photon emission computed tomography/computed tomography (SPECT/CT), positron emission tomography/computed tomography (PET/CT), and positron emission tomography/magnetic resonance imaging (PET/MRI) in patients with pHPT, as well as in those with sHPT.ConclusionThese guidelines are written and authorized by the EANM to promote optimal parathyroid imaging. They will assist nuclear medicine physicians in the detection and correct localization of hyperfunctioning parathyroid lesions.

111In-leukocyte scintigraphy has generally been considered a sensitive diagnostic test for the evaluation of infectious or inflammatory processes in the abdomen due to a lack of normal physiologic bowel activity. Herein we present a case of a patient status post endovascular repair of an abdominal aortic aneurysm for which an 111In-leukocyte scan was ordered to assess for graft infection. Planar imaging revealed an abnormal focus of radiotracer activity in the right lower quadrant of the abdomen. A SPECT-CT obtained to further delineate the anatomic location of abnormal activity showed abnormal leukocyte activity localizing to the terminal ileum secondary to a micro-perforation from an ingested fishbone. This case underscores the principle that in the absence of known intra-abdominal pathology, 111In-leukocyte activity in the abdomen should always be considered abnormal, and that further evaluation with dedicated cross-sectional imaging should be performed to assist with the localization of abnormal activity.

Purpose This prospective study was aimed at assessing the ability of 99mTc-PSMA scan to detect bone metastases in prostate cancer (PCa) against 99mTc-MDP scan as a standard and assess the correlation of these modalities in PCa staging of bone involvement. Patients and methods Forty-one patients (41) with histologically confirmed PCa were scanned using both methods. Planar imaging was performed with additional regional SPECT/CT 3 to 4 hours posttracer injection. Scans were reported as positive, negative, or equivocal. In the case of positive scans, lesions were quantified by each of the 3 reporters separately. Planar and SPECT/CT images were reported together to obtain the final report on each scan. Results Our preliminary results showed no significant difference in the detection of bone metastases between the 2 scans. 99mTc-PSMA detected 52 of the 55 bone lesions detected on 99mTc-MDP. However, 99mTc-PSMA provided extra information by reporting lymph nodal metastases in 7 patients and residual disease in the prostate in 2 patients with biochemical progression after radical therapy. In 1 patient, the PSMA scan resulted in change in management with patient now on 177Lu-PSMA radioligand therapy. Equivocal findings were reported in 4 patients on 99mTc-MDP and none on 99mTc-PSMA. Conclusions 99mTc-PSMA was comparable to 99mTc-MDP in detection of bone metastases and demonstrated an additional benefit of providing information on visceral disease. 99mTc-PSMA may be a better alternative to 99mTc-MDP in staging, restaging, and assessment of patients with biochemical progression after radical therapy of PCa in a resource-limited setup like ours while also assisting to detect patients eligible for PSMA-labeled radioligand therapy.

Purpose To evaluate the diagnostic accuracy of SPECT/CT arthrography in patients with suspected aseptic prosthesis loosening following hip and knee arthroplasty. Methods A retrospective review of 63 SPECT/CT arthrogram studies (36 knees and 27 hips) between February 1, 2013, and July 1, 2018, was conducted. All patients underwent clinical and radiologic evaluation as part of their assessment for persistent pain following hip and knee arthroplasty. The detection of tracer activity along the bone-prosthetic interface on SPECT/CT suggests aseptic loosening. Operative assessment as well as clinical/radiologic follow-up at a minimum of 1 year was used as the reference standard. Results The sensitivity and specificity of SPECT/CT for detection of aseptic loosening was 6/7 (86%) and 55/56 (98%), respectively. This gives a positive predictive value (PPV) of 6/7 (86%), a negative predictive value (NPV) of 55/56 (98%), and a diagnostic accuracy of 61/63 (97%). Conclusion SPECT/CT arthrography has a high diagnostic accuracy (97%) in the evaluation of loosening of both hip and knee arthroplasties in patients with persistent post-procedural pain.

Objective 123I metaiodobenzylguanidine (MIBG) scintigraphy is a useful tool for the diagnosis of neuroblastoma (NB). MIBG uptake is correlated with norepinephrine transporter expression; hence, it is expected that high-MIBG tumors would be more highly differentiated and have a better prognosis than those with lower expression. We have introduced a method of assessing MIBG accumulation semi-quantitatively using SPECT/CT fusion images. The purpose of this study was to evaluate the relationship of 123I MIBG uptake measured by semi-quantitative values of SPECT/CT and early relapse of NB. Methods We studied the cases of 11 patients (5 males and 6 females, age 5–65 months, median age 20 months) with histopathologically proven NB between April 2010 and March 2015. The early-relapse group was defined as patients who had relapsed within 3 years after the first 123I MIBG SPECT/CT exam. Other patients were classified as the delay-relapse group. Uptake of MIBG was evaluated using the count ratio of tumor and muscles. T/Mmax and T/Mmean were defined as follows: T/Mmax = max count of tumor/max count of muscle, T/Mmean = mean count of tumor/mean count of muscle. Results The average T/Mmean values of the early-relapse group and delay-relapse group were 2.65 ± 0.58 and 7.66 ± 2.68, respectively. The T/Mmean values of the early-relapse group were significantly lower than those of delay-relapse group (p Conclusions Low 123I MIBG uptake using semi-quantitative SPECT/CT analysis was correlated with early relapse of NB.

Parathyroid scintigraphy with 99mTc-MIBI is an imaging technique used in nuclear medicine and performed in patients with suspected hyperparathyroidism (HPT). The objective of this study was to evaluate the role of this technique in patients who, along with suspected HPT, also have thyroid nodules. Retrospective analysis included a period of 8 years (2006-2013). The study included 91 patients with clinical or laboratory suspected HPT. Pathologic changes in parathyroid glands were demonstrated in 47 (70%) of 67 patients with positive scintigraphy. Pathologic changes in parathyroid glands were not evident in the remaining 20 (30%) patients. Out of nine patients with negative scintigraphy results but with suspected enlargement of the parathyroid gland examined by ultrasound, eight (89%) patients did not show pathologic changes in the parathyroid gland, whereas one (11%) patient had evident changes. Eight (54%) of 15 patients with suspected scintigraphy had positive ultrasound findings, as well as fine needle aspiration cytology (FNAC) findings with parathyroid hormone (PTH) determination in the aspirate. Seven (46%) patients had negative FNAC findings and PTH in the aspirate. The study showed scintigraphy to have high sensitivity (98%) in detecting patients with pathologic changes in the parathyroid glands. In patients with suspected HPT, scintigraphy needs to be combined with FNAC and PTH determination in the aspirate due to its low specificity of 28%.

Purpose This study was designed to review the diagnostic yield of single photon emission computed tomography-computed tomography (SPECT/CT) in children with complex foot/ankle pain. Methods We reviewed the records of 33 patients with complex foot and ankle pain referred for SPECT/CT (36 scans) performed between 1st September 2009 to 30th September 2019. All patients had foot and ankle radiographs and 18 out of 33 patients had undergone magnetic resonance imaging (MRI) prior to SPECT/CT. The diagnostic contribution of SPECT/CT was established at the time of the scan during a multi-disciplinary team meeting. Results The patients’ mean age was 13.4 years (range six to 16.5 years) and 58% were female. In total, 18 patients had undergone previous surgical treatment. SPECT/CT was found to have decisive clinical value compared with radiographs and CT/MRI in 28 out of 36 cases. In ten patients it prompted surgical management (coalition excision, arthrodesis), in seven patients it redirected conservative management, in six patients it excluded other pathology and in five patients it showed additional/unexpected focal areas of mechanical stress, thus avoiding surgery. When compared with MRI, SPECT/CT added further clinical information in 13 out of 18 cases. SPECT/CT added decisive clinical value in five out of five patients with accessory ossicles, eight out of nine patients with tarsal coalition, five out of seven patients with surgically treated Congenital Talipes Equinovarus (CTEV) and four out of five patients with neuromuscular feet. In eight out of 36 cases SPECT/CT confirmed the diagnosis without adding significant information. Conclusions SPECT/CT can identify foci of active mechanical stress at cortical bone level in children with unexplained complex foot and ankle pain, particularly in the multiply operated foot, accessory ossicles and tarsal coalitions. Level of Evidence IV

BACKGROUND: Infectious sacroiliitis (ISI) is an inflammation of one or both of the sacroiliac (SI) joints, relatively rare disorder, affecting between 1% and 2% of all patients with septic arthritis. The variety of symptom presentation makes the diagnosis quite challenging. Combination of laboratory hematological tests, together with diagnostic imaging tools, such as magnetic resonance imaging (MRI), computed tomography (CT), and bone scan (BS), as well as microbiological tests contribute the final diagnosis, which may take up to several months. CASE REPORT: We present a case of a 33-year-old male patient with a history of lower back pain with propagation of the pain in the right leg, accompanied by febrility and hematuria. Laboratory tests showed high values of C-reactive protein, high degradation products and hyperkalemia, leading to a diagnose of acute renal failure stage 3. MRI of the lower spine and pelvis revealed hetero- signal change more to the right where the spinal canal was expanded, accumulating contrast and involved the caudate and the right radix. Тhe displayed sequences were accompanied by an altered morphology of the spinal musculature, with intense accumulation of contrast in parts of the muscle. Paravertebral abscess was detected in the intercaudal and iliac muscles, along with inflammatory edema of the right SI with a suspicion of a sacroiliitis. One week after, a three phase BS showed positive accumulation in the right SI joint in all three phases. The SI index for the right SI joint was 2.09, while for the left SI joint was 1.125. The patient underwent surgical intervention for drainage of the paravertebral abscess. CONCLUSION: The condition of ISI may be sometimes very difficult to be recognized in many patients. Considering the diversity of the clinical manifestations, it is of great importance to select the right imaging modality. The nuclear medicine technique triple phase bone and the hybrid imaging SPECT/CT have been suggested to improve the sensitivity and specificity of the bone scan, providing better characterization of equivocal lesions, especially in the acute form for disease localization.

After Turkish Society of Nuclear Medicine “Cardiology Group” had first published “Nuclear Cardiology Practice Guidelines” in 2001, in line particular with the technological developments, significant changes both in the hardware, software and also in the protocols have occurred in the era of nuclear cardiology. Besides many new clinical uses in nuclear cardiology and specific developments in both single photon emission computerized tomography and positron emission tomography systems, such as specific cardiac gamma camera systems and blood flow studies, myocardial perfusion scintigraphy (MPS), which is still performed today mostly with conventional gamma camera systems, ranks first among both nuclear cardiology and also general conventional nuclear medicine procedures in almost all nuclear medicine clinics. The aim of this guideline is to assist nuclear medicine physicians in MPS studies, in terms of indications, application, imaging methods, evaluation and reporting stages. The recommendations in this guide has been prepared by “Turkish Society of Nuclear Medicine Cardiology Task Group” to ensure the standardization of the MPS applications in our country in the light of international studies and current guidelines.

Background Osteoblastoma (OB) is an intermediate lesion, which makes the accurate preoperative diagnosis very important. 99mTc-methylene diphosphonate (99mTc-MDP) bone scan and SPECT/CT imaging were evaluated for their diagnostic value in spinal OB. Methods This study was a retrospective analysis of patients with spinal OB lesions confirmed by pathology and diagnosed with bone scan and SPECT/CT for preoperative diagnosis from January 2008 to December 2018. The uptake levels of OB on planar bone scan were divided into low, medium, and high groups by visual assessment referring to the uptake of the normal rib, spine, and bladder. X-ray, CT, MRI, bone scan, and SPECT/CT imaging of the patients were analyzed for characteristics summary. Results Twenty-five patients were diagnosed for spinal OB (17 males and 8 females with a proportion of 2.1:1), and the average age was 26.8 ± 10.8 years (range 5~59). There were 8 lesions located in the cervical, 6 in the thoracic, and 11 in the lumbar vertebrae. Twenty-four lesions involved posterior elements, especially the pedicles (14/25). Symptoms were predominantly painful with a duration of 18.3 ± 13.9 months (range 0.5~60 months). The lesion size ranged from 9 to 35 mm. All the lesions were low to high uptake in the planar bone scan, and the percentages of low to high levels were 1 (4%), 8 (32%), and 16 (64%) cases. Conclusions Spinal OB mainly involved the posterior area, and elderly patients should be considered as well. SPECT/CT combined the characteristics of bone uptake and anatomical features of bone tumors, proving its one-in-all diagnostic value for spinal OB and other osteogenic tumors.

Background: Melanoma is the most lethal skin cancer with a mortality rate of 262 cases per 100.000 cases. The sentinel lymph node (SLN) is the first lymph node draining the tumor. SLN biopsy is a widely accepted procedure in the clinical setting since it provides important prognostic information, which helps patient management, and avoids the side effects of complete lymph node dissection. The rationale of identifying and removing the SLN relies on the low probability of subsequent metastatic nodes in case of a negative histological exam performed in the SLN. Discussion: Recently, new analytical approaches, based on the evaluation of scintigraphic images are also exploring the possibility to predict the metastatic involvement of the SLN. 99mTc-labeled colloids are still the most commonly used radiotracers but new promising radiotracers, such as 99mTc- Tilmanocept, are now on the market. In the last decades, single photon emission computed tomography- computerized tomography (SPECT/CT) has gained wider diffusion in clinical departments and there is large evidence about its superior diagnostic accuracy over planar lymphoscintigraphy (PL) in the detection of SLN in patients with melanoma. Scientists are also investigating new hybrid techniques combining functional and anatomical images for the depiction of SLN but further evidence about their value is needed. Conclusion: This review examined the predictive and prognostic factors of lymphoscintigraphy for metastatic involvement of SLN, the currently available and emerging radiotracers and the evidence of the additional value of SPECT/CT over PL for the identification of SLN in patients with melanoma. Finally, the review discussed the most recent technical advances in the field.

To investigate the feasibility and effectiveness of prostate‐specific membrane antigen (PSMA) imaging to make response assessment regarding novel hormone treatment and to predict the outcomes for metastatic castration‐resistant prostate cancer (mCRPC) patients. This retrospective study enrolled 68 mCRPC patients who had daily received a novel hormone agent named abiraterone. Tc‐99m PSMA single‐photon emission computed tomography (SPECT/CT) was performed at the baseline (SPECT/CT1) and after 3‐6 months of treatment (SPECT/CT2). The treatment response was determined by visual analysis based on molecular imaging PSMA (miPSMA) scores framework and was compared with conventional biochemical analysis. We chose either the hottest lesion (target A) or five of the hottest lesions (target B) to calculate the tumor/background ratio (TBR) and the maximum standardized uptake value (SUVmax) and compared their performances in predicting progression‐free survival (PFS). Changes in PSMA expression between SPECT/CT1 and SPECT/CT2 were well associated with the results of the visual analysis. The TBR and the SUVmax of both targets were significantly associated with the baseline serum PSA level (P, We found it very accurate to evaluate the effect of abiraterone on prostate cancer using PSMA molecular imaging. PSMA imaging is expected to replace traditional imaging in prostate diagnosis and treatment

Primary hyperparathyroidism (PHPT) is a common endocrine disease that occurs with multiple profiles in which no classical manifestation. Diagnosis revolves around routine measurement of serum calcium and parathyroid hormone more than in half cases. The understanding of clinical presentation, epidemiology and management tactics of patients with hyperparathyroidism has significantly changed by virtue of the use of biochemical calcium screening. The successful diagnosis and treatment are possible with the cooperation of a multidisciplinary team of endocrinologist, endocrine surgeon, radiologist, nuclear medicine physician and pathomorphologist. The only radical method of treatment is the surgical removal of abnormal parathyroid glands. In this regard, there is necessary to improve the parathyroid glands imaging algorithms. Early treatment of hyperparathyroidism allows to avoid severe damage to the bones, kidneys, heart, other organs, improving the quality of life and reducing the incidence of disability. For a systematic literature review, more than 100 articles published from 2000 to the present time were used, on following resources: PubMed, Embase, SciSearch, Scopus, Cochrane Databases, Research Gate, Google Scholar. Including recommendations from the American Association of Endocrinologists and Endocrine Surgeons (AACE/AAES), European Society of Nuclear Medicine (EANM), European Society ofEndocrinologists (ESE), Russian Association of Endocrinologists (RAE) and several other organizations. The main goal of this review is to summarize and present relevant information and a new look on preoperative imaging techniques, methods of intraoperative navigation, surgery, control quality of treatment in patients with primary hyperparathyroidism.

The presented clinical case demonstrates the hybrid imaging SPECT/CT-angiography solutions in the diagnosis of post-traumatic femoral artery pseudoaneurysm combined with arteriovenous fistula. The presented case shows the effective use of CT and radionuclide medicine which allowed detailed of blood flow and tissue perfusion of lower extremities as well as an outcome of surgical treatment to be evaluated.Authors declare lack of the conflicts of interests.

Stem cell-based therapies are a promising approach for the treatment of degenerative muscular diseases; however, clinical trials have shown inconclusive and even disappointing results so far. Noninvasive cell monitoring by medicine imaging could improve the understanding of the survival and biodistribution of cells following injection. In this study, we assessed the canine sodium iodide symporter (cNIS) reporter gene as an imaging tool to track by single-photon emission computed tomography (SPECT/CT) transduced canine myoblasts after intramuscular (IM) administrations in dogs. cNIS-expressing cells kept their myogenic capacities and showed strong 99 mTc-pertechnetate (99 mTcO4−) uptake efficiency both in vitro and in vivo. cNIS expression allowed visualization of cells by SPECT/CT along time: 4 h, 48 h, 7 days, and 30 days after IM injection; biopsies collected 30 days post administration showed myofiber’s membranes expressing cNIS. This study demonstrates that NIS can be used as a reporter to track cells in vivo in the skeletal muscle of large animals. Our results set a proof of concept of the benefits NIS-tracking tool may bring to the already challenging cell-based therapies arena in myopathies and pave the way to a more efficient translation to the clinical setting from more accurate pre-clinical results., Graphical Abstract

Purpose: The aim of this study was to investigate the gallium-67 (67Ga) single-photon emission-computed tomography (SPECT-CT) for the evaluation of head and neck, especially maximum standardised uptake value (SUVmax) in lesions, and in the parotid and submandibular glands. Material and methods: Fourteen patients with head and neck lesions who underwent SPECT-CT at 72 hours after injection of 67Ga were included in this study. The 67Ga SPECT-CT parameters SUVmax were compared between the parotid glands and submandibular glands. Statistical analyses for the SUVmax were performed by Mann-Whitney U test. A p value lower than 0.05 was considered as statistically significant. Results: Of all 14 patients, 67Ga SPECT-CT was positive for two cases (one malignant lymphoma and one osteomye­litis). The SUVmax for malignant lymphoma and osteomyelitis were 11.21 and 10.95, respectively. Furthermore, SUVmax for parotid glands and submandibular glands of all patients were 4.86 ± 1.89 and 4.64 ± 1.64, respectively (p = 0.694). Conclusions: This study investigated the 67Ga SPECT-CT for the evaluation of head and neck, especially SUVmax of lesions, and the parotid and submandibular glands. 67Ga SPECT-CT may be an effective technique for the evaluation of maxillofacial lesions.

© 2022 by Turkish Society of Nuclear Medicine Molecular Imaging and Radionuclide Therapy published by Galenos Yayınevi.Caudal regression syndrome (CRS) or sacral agenesis is a rarely seen malformation with a varying degree of structural abnormalities, including multiorgan system dysfunctions, reported with higher incidence among children of mothers with diabetes, as in this case. Spinal anomalies can range from coccyx hemiagenesis to the total absence of lower lumbar vertebrae and sacrum in most severe cases. Herein, we have presented a 9-year-old patient with CRS who had renal failure. Technetium-99m dimercaptosuccinic acid renal scintigraphy revealed bilaterally non-functioning kidneys with no renal cortical uptake. Renal anomalies in CRS with vertebral, anorectal, cardiac, trachea-esophageal, renal, and limb anomalies association include one-sided renal agenesis, multicystic dysplastic kidneys, and ureter duplications. Kaudal regresyon sendromu (KRS) veya sakral agenezi, çoklu organ sistemlerini etkileyen, yapısal anomaliler ile seyreden ve olgumuzda olduğu gibi diyabetik annelerin çocukları arasında daha yüksek sıklıkta görülen nadir bir malformasyondur. Vertebral anomaliler koksiksin kısmi agenezisinden ağır olgularda sakral ve/veya lomber vertebraların total agenezisine kadar değişebilmektedir. Burada, teknesyum-99m DMSA böbrek sintigrafisinde bilateral kortikal aktivite tutulumu izlenmeyen, non-fonksiyonel böbrekler saptanan KRS tanılı 9 yaşında bir pediatrik vaka sunulmaktadır. Tek taraflı renal agenezi, multisistik displastik böbrekler ve toplayıcı sistem duplikasyonları gibi renal anomaliler KRS ile vertebral, anorektal, kardiyak, trakeoözafagial, renal ve ekstremite anomalileri birlikteliğinde görülebilmektedir.

Purpose: The purpose of this study was to investigate the feasibility of Single-Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) image-based radiomics in differentiating bone metastases from benign bone lesions in patients with tumors.Methods: A total of 192 lesions from 132 patients (134 in the training group, 58 in the validation group) diagnosed with vertebral bone metastases or benign bone lesions were enrolled. All images were evaluated and diagnosed independently by two physicians with more than 20 years of diagnostic experience for qualitative classification, the images were imported into MaZda software in Bitmap (BMP) format for feature extraction. All radiomics features were selected by least absolute shrinkage and selection operator (LASSO) regression and 10-fold cross-validation algorithms after the process of normalization and correlation analysis. Based on these selected features, two models were established: The CT model and SPECT model (radiomics features were derived from CT and SPECT images, respectively). In addition, a combination model (ComModel) combined CT and SPECT features was developed in order to better evaluate the predictive performance of radiomics models. Subsequently, the diagnostic performance between each model was separately evaluated by a confusion matrix.Results: There were 12, 13, and 18 features contained within the CT, SPECT, and ComModel, respectively. The constructed radiomics models based on SPECT/CT images to discriminate between bone metastases and benign bone lesions not only had high diagnostic efficacy in the training group (AUC of 0.894, 0.914, 0.951 for CT model, SPECT model, and ComModel, respectively), but also performed well in the validation group (AUC; 0.844, 0.871, 0.926). The AUC value of the human experts was 0.849 and 0.839 in the training and validation groups, respectively. Furthermore, both SPECT model and ComModel show higher classification performance than human experts in the training group (P = 0.021 and P = 0.001, respectively) and the validation group (P = 0.037 and P = 0.007, respectively). All models showed better diagnostic accuracy than human experts in the training group and the validation group.Conclusion: Radiomics derived from SPECT/CT images could effectively discriminate between bone metastases and benign bone lesions. This technique may be a new non-invasive way to help prevent unnecessary delays in diagnosis and a potential contribution in disease staging and treatment planning.

Pulmonary hypertension (PH) is a life‐threatening disorder, which originates from various aetiologies. Ventilation–perfusion (V/Q) scanning is commonly used to evaluate the differential diagnosis of PH. Meanwhile, previous studies have shown that single‐photon emission computed tomography (SPECT)/CT imaging can provide a more detailed analysis for the assessment of pulmonary blood flow. However, there is insufficient evidence supporting the merits of V/Q SPECT/CT image data in detecting pulmonary vascular disease. Here, we report a case of pulmonary arterial hypertension with localized accumulation and peculiar distribution just below the pleura on V/Q SPECT/CT. Our finding is unique, and it suggests that V/Q SPECT/CT image data might be useful to detect blood flow not only in cases of pulmonary embolism, but also in the more commonly encountered PH., We report a case of pulmonary arterial hypertension with localized accumulation and peculiar distribution just below the pleura on ventilation–perfusion (V/Q) single‐photon emission computed tomography (SPECT)/CT. Our finding is unique, and it suggests that V/Q SPECT/CT image data might be useful to detect blood flow not only in cases of pulmonary embolism, but also in the more commonly encountered pulmonary hypertension.

(1) Background: To comparatively analyze the uptake of hepatocellular carcinoma (HCC) on pre-therapeutic imaging modalities, the arterial phase multi-detector computed tomography (MDCT), the parenchymal phase C-arm computed tomography (CACT), the Technetium99m-macroaggregates of human serum albumin single-photon emission computed tomography/computed tomography (SPECT/CT), and the correlation to the post-therapeutic Yttrium90 positron emission tomography/computed tomography (PET/CT) in patients with selective internal radiation therapy (SIRT). (2) Methods: Between September 2013 and December 2016, 104 SIRT procedures were performed at our institution in 74 patients with HCC not suitable for curative surgery or ablation. Twenty-two patients underwent an identical sequence of pre-therapeutic MDCT, CACT, SPECT/CT, and post-therapeutic PET/CT with a standardized diagnostic and therapeutic protocol. In these 22 patients, 25 SIRT procedures were evaluated. The uptake of the HCC was assessed using tumor-background ratio (TBR). Therefore, regions of interest were placed on the tumor and the adjacent liver tissue on MDCT (TBRMDCT), CACT (TBRCACT), SPECT/CT (TBRSPECT/CT), and PET/CT (TBRPET/CT). Comparisons were made with the Friedman test and the Nemenyi post-hoc test. Correlations were analyzed using Spearman’s Rho and the Benjamini–Hochberg method. The level of significance was p &lt, 0.05. (3) Results: TBR on MDCT (1.4 ± 0.3) was significantly smaller than on CACT (1.9 ± 0.6) and both were significantly smaller compared to SPECT/CT (4.6 ± 2.0) (pFriedman-Test &lt, 0.001, pTBRMDCT/TBRCACT = 0.012, pTBRMDCT/TBRSPECT/CT &lt, 0.001, pTBRCACT/TBRSPECT/CT &lt, 0.001). There was no significant correlation of TBR on MDCT with PET/CT (rTBRMDCT/TBRPET/CT = 0.116, p = 0.534). In contrast, TBR on CACT correlated to TBR on SPECT/CT (rTBRCACT/TBRSPECT/CT = 0.489, p = 0.004) and tended to correlate to TBR on PET/CT (rTBRCACT/TBRPET/CT =0.365, p = 0.043). TBR on SPECT/CT correlated to TBR on PET/CT (rTBRSPECT/CT/TBRPET/CT= 0.706, p &lt, 0.001) (4) Conclusion: The uptake assessment on CACT was in agreement with SPECT/CT and might be consistent with PET/CT. In contrast, MDCT was not comparable to CACT and SPECT/CT, and had no correlation with PET/CT due to the different application techniques. This emphasizes the value of the CACT, which has the potential to improve the dosimetric assessment of the tumor and liver uptake for SIRT.

PurposeVideofluoroscopic swallowing study (VFSS) is currently the most widely used clinical examination method for diagnosis of oesophageal fistula, but it has many limitations. Therefore, we evaluated radionuclide salivagram single-photon emission computed tomography (SPECT/CT) as a new method of oesophageal fistula diagnosis.MethodsWe retrospectively evaluated the data of 11 patients (10 men and 1 woman, aged 41 to 70 years, with an average age of 58.6 years) who had clinically suspected oesophageal fistula from January 2019 to October 2020. They underwent radionuclide salivagram SPECT/CT and VFSS examinations, and we analysed and compared the results of the two examinations.ResultsA total of 11 patients were included in this study. Ten underwent both salivagram and VFSS examinations. One patient was unable to swallow the contrast agent; therefore, only salivagram was performed, and we excluded this patient from the VFSS analysis. A total of 11 patients underwent salivagram examinations, of which 6 were positive and 5 were negative. A total of 10 patients were tested by VFSS, of which 6 results were positive and 4 were negative.ConclusionRadionuclide salivagram SPECT/CT and VFSS are complementary, which can greatly improve the clinical diagnosis and prognosis of oesophageal fistula. When the patient cannot perform the VFSS, or the clinical symptoms are inconsistent with the VFSS imaging findings, the salivagram is an ideal test method.

Paget's disease is a chronic benign bone disease characterized by excessive and abnormal bone remodeling. Monostotic Paget's disease accounts for only 20% of the cases, and the monostotic form involving the vertebra with the Mickey Mouse sign is very rare. Herein, we report a case of suspected bony metastasis in the second lumbar vertebra that was diagnosed as Paget's disease because of the Mickey Mouse sign on bone scintigraphy, and the diagnosis was confirmed by biopsy. Therefore, bone scintigraphy may provide a positive contribution to the diagnosis, and may help to avoid unnecessary biopsy in cases with specific signs and patterns.Paget, aşırı ve anormal kemik yapımı ve yıkımı ile karakterize kronik, iyi huylu bir kemik hastalığıdır. Monostotik Paget hastalığı, sadece olguların %20’sini oluşturmakla kalmaz; Mickey Mouse bulgusu olan, vertebra tutulumu ile giden monostotik formu daha da nadirdir. Sunduğumuz olguda, ikinci lumbar vertebrada metastaz şüphesi ile araştırılan hastada; kemik sintigrafisinde Mickey Mouse işareti görülmesi üzerine Paget hastalığı tanısı kondu ve tanı biyopsiyle doğrulandı. Bu olguda görülmektedir ki; kemik sintigrafisi tanıya olumlu katkıda bulunur ve belirli belirti ve paternler görülmesi sayesinde gereksiz biyopsileri önleyebilir.

Background Computed tomography (CT) scans are routinely performed in positron emission tomography (PET) and single photon emission computed tomography (SPECT) examinations globally, yet few surveys have been conducted to gather national diagnostic reference level (NDRL) data for CT radiation doses in positron emission tomography/computed tomography (PET/CT) and single photon emission computed tomography/computed tomography (SPECT/CT). In this first Nordic-wide study of CT doses in hybrid imaging, Nordic NDRL CT doses are suggested for PET/CT and SPECT/CT examinations specific to the clinical purpose of CT, and the scope for optimisation is evaluated. Data on hybrid imaging CT exposures and clinical purpose of CT were gathered for 5 PET/CT and 8 SPECT/CT examinations via designed booklet. For each included dataset for a given facility and scanner type, the computed tomography dose index by volume (CTDIvol) and dose length product (DLP) was interpolated for a 75-kg person (referred to as CTDIvol,75kg and DLP75kg). Suggested NDRL (75th percentile) and achievable doses (50th percentile) were determined for CTDIvol,75kg and DLP75kg according to clinical purpose of CT. Differences in maximum and minimum doses (derived for a 75-kg patient) between facilities were also calculated for each examination and clinical purpose. Results Data were processed from 83 scanners from 43 facilities. Data were sufficient to suggest Nordic NDRL CT doses for the following: PET/CT oncology (localisation/characterisation, 15 systems); infection/inflammation (localisation/characterisation, 13 systems); brain (attenuation correction (AC) only, 11 systems); cardiac PET/CT and SPECT/CT (AC only, 30 systems); SPECT/CT lung (localisation/characterisation, 12 systems); bone (localisation/characterisation, 30 systems); and parathyroid (localisation/characterisation, 13 systems). Great variations in dose were seen for all aforementioned examinations. Greatest differences in DLP75kg for each examination, specific to clinical purpose, were as follows: SPECT/CT lung AC only (27.4); PET/CT and SPECT/CT cardiac AC only (19.6); infection/inflammation AC only (18.1); PET/CT brain localisation/characterisation (16.8); SPECT/CT bone localisation/characterisation (10.0); PET/CT oncology AC only (9.0); and SPECT/CT parathyroid localisation/characterisation (7.8). Conclusions Suggested Nordic NDRL CT doses are presented according to clinical purpose of CT for PET/CT oncology, infection/inflammation, brain, PET/CT and SPECT/CT cardiac, and SPECT/CT lung, bone, and parathyroid. The large variation in doses suggests great scope for optimisation in all 8 examinations.

The aim of our retrospective study was to evaluate the contribution of single photon emission computed tomography/computed tomography (SPECT/CT) to three phase bone scintigraphy/SPECT for the assessment of osteomyelitis (OM) and patient’s management.Eighty-five patients who were suspected as having OM were included in this study. Tc-99m MDP three phase bone scintigraphy and SPECT/CT were performed to the region of suspected OM. SPECT/CT findings were compared with the findings of planar images/SPECT. Both planar bone scan/SPECT and SPECT/CT findings were divided into two groups: With OM and without OM. In all patients, scintigraphic diagnosis was confirmed by clinical follow up, laboratory findings, microscopic-bacteriological examinations, radiological, surgical, and pathological findings.SPECT/CT changed the diagnosis and treatment planning in 14/85 (16.5%) patients. SPECT/CT was significantly superior to planar scan/SPECT imaging for determining OM (kappa value was 0.626 for planar scan/SPECT, 0.929 for SPECT/CT). SPECT/CT was statistically more successful in detection of chronic OM, and useful in differentiating chronic OM from acute OM (kappa value was 0.541 for planar scan/SPECT, 0.944 for SPECT/CT).SPECT/CT increases accuracy of the diagnosis in the evaluation of OM when it is compared to three phase bone scintigraphy/SPECT. SPECT/CT can change the diagnosis and management of the patients.Retrospektif çalışmamızda osteomiyelitin (OM) değerlendirilmesinde ve hasta yönetiminde tek foton emisyon bilgisayarlı tomografi/bilgisayarlı tomografi (SPECT/BT) üç fazlı kemik sintigrafisi/SPECT’ye katkısı araştırıldı.OM’den şüphelenilen 85 hasta çalışmaya dahil edildi. OM şüphesi bulunan bölgeye Tc-99m MDP üç fazlı kemik sintigrafisi ve SPECT/BT yapıldı. SPECT/BT bulguları planar görüntü/SPECT bulguları ile karşılaştırıldı. Planar kemik sintigrafisi/SPECT ve SPECT/BT bulguları iki gruba ayrıldı: OM olmayanlar ve OM olanlar. Tüm hastalarda sintigrafik tanı, klinik takip, laboratuvar, mikroskobik-bakteriyolojik inceleme, radyoloji, cerrahi ve patoloji ile doğrulanmıştır.SPECT/BT, 14/85 (%16,5) hastada tanı ve tedavi planlamasını değiştirdi. SPECT/BT, OM’nin belirlenmesinde planar görüntüler/SPECT görüntülemeye göre anlamlı derecede üstün bulundu (kappa değeri planar tarama/SPECT için 0,626, SPECT/BT için 0,929). SPECT/BT, kronik OM’nin saptanmasında istatistiksel olarak daha başarılıydı ve akut OM’den kronik OM’nin ayırt edilmesinde faydalı idi (kappa değeri planar tarama/SPECT için 0,541, SPECT/BT için 0,944).SPECT/BT, üç fazlı kemik sintigrafisi/SPECT ile karşılaştırıldığında OM değerlendirilmesinde tanı doğruluğunu arttırmaktadır. SPECT/BT hastaların teşhis ve yönetimini değiştirebilir.