Gallium-67 scintigraphy in tuberculous and nontuberculous infectious spondylitis

Vertebral osteomyelitis is a difficult condition to diagnose clinically. A retrospective review of 21 cases of infectious spondylitis (6 tuberculous, 15 nontuberculous) confirmed the utility of 67Ga scintigraphy in imaging this process. Gallium-67 scans were positive at all sites of disease in this patient population. They anticipated the presence of spondylar infection in 23% of regions where radiographic abnormalities were originally lacking, while confirming a current and ongoing septic process at the other sites where vertebral destruction was already present on x-ray. Gallium-67 studies, as compared to the 99mTc-MDP bone scans, also provided important information as to the extent of disease by documenting the presence of eight paraspinal abscesses and the location of remote extraspinal foci of infection both in soft tissues and in bone. The relative merits of all radiologic imaging procedures are discussed. A diagnostic algorithm is also suggested.