Tuberculosis of the Spine on Tc-99m MDP Bone Scan: Additional Role of SPECT-CT

Dedicated multislice single-photon emission computed tomography-computed tomography (SPECT-CT) is useful for accurate anatomic localization and lesion characterization of abnormal findings on planar scintigraphy. We present a case of a 33-year-old woman with a history of low back pain. Lumbar spine radiographs demonstrated irregularity of the superior end plate of L2 with an associated compression fracture. A Tc-99m MDP bone scan was performed given her young age and the absence of a history of trauma. The whole body planar imaging revealed nonspecific findings of diffuse linear increased tracer uptake involving L2. The SPECT-CT findings were in keeping with spinal tuberculosis. This was confirmed with culture of CT-guided aspiration of a left psoas collection, which revealed heavy growth of Mycobacterium tuberculosis. This case highlights the benefits of multislice SPECT-CT imaging in the anatomic localization of increased metabolic activity and provision of additional diagnostic information. This enabled rapid diagnosis and management.