The role of nuclear medicine in the diagnosis of spondylodiscitis.

BACKGROUND The diagnosis of spondylodiscitis can be difficult, because the patients history, subjective symptoms and physical findings are often inconclusive, particularly in the early stages. AIM To perform an overview on the role of nuclear medicine procedures with single photon emission tomography (SPET) and positron emission tomography (PET) tracers in the diagnosis of spondylodiscitis. MATERIALS AND METHODS A literature review about bone scintigraphy, Gallium-67-citrate scintigraphy, labeled leukocytes scintigraphy and PET was performed. Main findings of the literature were reported. RESULTS Bone scintigraphy is a sensitive and widely available nuclear medicine technique, but it is characterized by low specificity. Gallium-67-citrate scintigraphy is often used as a complement to bone scintigraphy to enhance the specificity of the study and to detect extra-osseous sites of infection. Labeled leukocytes scintigraphy is not a useful method in the diagnosis of spondylodiscitis. Fluorine-18-fluorodeoxyglucose positron emission tomography is a sensitive method and could potentially be useful in the diagnosis of spondylodiscitis and in the evaluation of treatment response. Nevertheless, scientific literature about this topic is still limited. CONCLUSIONS Overall, nuclear medicine procedures play a useful role in the diagnosis of spondylodiscitis identifying functional abnormalities which precede morphological changes. Therefore, nuclear medicine procedures may complement or integrate morphological imaging findings in patients with suspected spondylodiscitis.