The role of single photon emission computed tomography in bone scintigraphy

The increasing availability for routine nuclear medicine studies of single photon emission computed tomography (SPECT) reflects the realisation of its ability to improve lesional detection and the assessment of location. This is achieved by removing unwanted surrounding radioactivity and thus delineating with greater clarity deeper areas of preferential accumulation. By removing the super-imposition of structures, SPECT offers considerable potential for improved diagnostic accuracy in suspected bone and joint disease. Time and cost, however, necessitate a selective use of the technique. The maximum advantages arise from studies of the head, spine, skull and knees. The role of SPECT does, in some instances, lie in providing increased sensitivity in the detection of focal uptake while in others it complements alternative imaging modalities by identifying the functional status of an abnormality and thus may demonstrate its clinical significance. Since such information may be obtained by planar scintigraphy using techniques such as pinhole collimation, continuing evaluation is essential to ascertain the precise indications for SPECT imaging.