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The utility of SPECT-CT in identifying vertebral endplate changes for basivertebral nerve ablation: A retrospective
Eva Kubrova1, Justin Schappell2, Jeet Patel3
1Pain Medicine Department, Mayo Clinic, Jacksonville, FL, USA.
Background:
Vertebrogenic low back pain is an increasingly recognized source of chronic low back pain. Although Magnetic resonance imaging (MRI) remains the primary diagnostic tool for evaluating Modic changes (MC), its ability to confirm symptomatic pain is limited. Nuclear Medicine SPECT/CT may provide additional value by identifying metabolically active endplate pathology.
Objective:
The goal of this retrospective study is to characterize suspected correlation between MC identified on MRI with endplate radiotracer uptake on SPECT/CT and to investigate the potential utility of SPECT-CT in evaluating and treating patients with suspected vertebrogenic low back pain.
Methods:
A retrospective chart review of patients who underwent BVNA was conducted between March 2020 and July 2024. Patients with both pre-procedural MRI and SPECT/CT were identified, and a correlative descriptive analysis was performed to assess overlap of both imaging methods.
Results:
The MRI and SPECT/CT scans of 52 patients were evaluated, with Type 1 Modic changes (MC1) and Type 2 Modic changes (MC2) varying in correlation to SPECT/CT by spinal level. Most notable overlap was found when correlating positive MC1 changes; there were 80.9% patients in whom for each positive MC1, there was a positive SPECT/CT correlate. The PPV of SPECT/CT was 62.1% and the NPV was 95.2% for MC1. The PPV of SPECT/CT was 54.3% and the NPV was 89.1% for MC2. Complete (100%) MC1, MC2 and SPECT/CT level overlap was seen in 44% of patients. The Cohen's kappa measurement of agreement between the MRI and SPECT/CT was 70.1%.
Conclusion:
This study demonstrates a high MC1 and moderate MC2 correlation with increased endplate radiotracer uptake on SPECT/CT in patients selected for BVNA. These findings suggest that while SPECT/CT may complement or potentially substitute for MRI in evaluation of patients with suspected vertebrogenic low back pain, its role as a standalone alternative diagnostic tool remains uncertain.
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