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Metabolic disturbances identified by SPECT-CT in patients with a clinical diagnosis of sacroiliac joint incompetence

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Abstract

Purpose

To establish the sensitivity and specificity of cross-sectional scintigraphy [single photon emission computed tomography (SPECT)] combined with computed X-ray tomography (CT) in the detection of sacroiliac joint (SIJ) mechanical dysfunction and evaluate reproducibility of reporting.

Methods

Patients with pelvic girdle pain either on the basis of peri-partum SIJ dysfunction or trauma were included. These patients were imaged with bone scintigraphy with hybrid imaging with SPECT/CT.

Results

The study group comprised 100 patients (72 females, 28 males). Trauma accounted for 52 % and the remainder were patients with peri-partum pain. Average age was 43 years and average length of history was >2 years. The major finding was increased uptake in the upper SIJ and posterior soft-tissues/ligaments. Hybrid imaging had a sensitivity of 95 % and specificity of 99 %. Positive predictive value was 99 % and negative predictive value 94 %. Power of the test was 1.0. Reproducibility of the test was good with kappa values of 0.85.

Conclusion

Hybrid imaging with SPECT/CT reproducibly demonstrates metabolic alterations around the SIJ in patients with SIJ dysfunction, which we have termed SIJ incompetence. The condition is more common than previously recognised and frequently occurs after trauma, which has not been reported previously.

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Conflict of interest

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Authors and Affiliations

  1. Sydney School of Medicine, University of Notre Dame, Fremantle, Australia

    Mel Cusi

  2. University of Sydney, Sydney, Australia

    Jennifer Saunders

  3. Concord Nuclear Imaging, 4 Hospital Road, Concord West, Sydney, NSW, 2138, Australia

    Hans Van der Wall

  4. Departments of Nuclear Medicine, Guys and St. Thomas’ Hospital, London, UK

    Ignac Fogelman

Authors
  1. Mel Cusi
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  2. Jennifer Saunders
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  3. Hans Van der Wall
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  4. Ignac Fogelman
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Correspondence to Hans Van der Wall.

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Cusi, M., Saunders, J., Van der Wall, H. et al. Metabolic disturbances identified by SPECT-CT in patients with a clinical diagnosis of sacroiliac joint incompetence. Eur Spine J 22, 1674–1682 (2013). https://doi.org/10.1007/s00586-013-2725-5

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  • DOI: https://doi.org/10.1007/s00586-013-2725-5

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