Hematogenous pyogenic vertebral osteomyelitis: diagnostic value of radionuclide bone imaging

Hematogenous pyogenic vertebral osteomyelitis (HPVO) continues to be a diagnostic problem for clinicians due to nonspecific presentation of the disease (1,2). We reviewed our experience of the last 10 years to determine the diagnostic usefulness of radionuclide bone studies in this disease. We found 15 patients whose primary diagnosis was HPVO. Of the 15 patients, 12 had [99mTc]MDP bone scans which were all positive. Five of the 12 patients had positive [67Ga]citrate scans and one patient with chronic active HPVO had negative 67Ga and [111In]WBC bone images. At the same time, three patients' spine x-rays and one patient's CT scan of the vertebra were normal. Additionally, in three patients spine x-rays were interpreted as consistent with degenerative joint disease that contributed to the delay of the diagnosis. We conclude that when HPVO is suspected an abnormal [99mTc]MDP bone image increases the probability of the disease, even if the x-rays and CT scans of the spine are normal. An abnormal 67Ga image following an abnormal 99mTc bone image increases the specificity of the diagnosis. Normal [99mTc]MDP and [67Ga]citrate bone images of the vertebra virtually exclude the diagnosis of HPVO.