Bone SPECT imaging of the painful back

Bone SPECT imaging offers advantages over planar techniques based on improved contrast enhancement plus tomographic effect, with the latter allowing for precise anatomic localization of an abnormality. This is important when evaluating patients with back pain because placement of a lesion in the vertebral body, component of the vertebral arch, or disc space region significantly affects diagnostic possibilities and, in some circumstances, can effectively exclude malignancy in favor of benign disease. Such an approach to SPECT interpretation requires high-quality images capable of precise anatomic placement of a lesion and a systematic method of analysis based on recognition of normal anatomic relationships plus knowledge of the common presentations of bony abnormalities shown on SPECT scanning.