Differential diagnosis between osseous metastasis and degenerative joint disease of the vertebrae by bone SPECT

To find whether or not bone SPECT can differentiate osseous metastasis from degenerative joint disease (DJD) of the vertebrae, 43 patients with increased vertebral uptake on bone scan, including 25 lesions with bone metastasis, 24 with DJD, and 4 with compression fractures due to osteoporosis, underwent bone planar scanning and SPECT. Increased accumulation in the vertebral lesions on bone SPECT transaxial images was classified into five accumulation patterns; mosaic, large hot, diffuse, peripheral and articular patterns. Mosaic, large hot and diffuse patterns were more frequently noted in patients with osseous metastasis (82%, 67% and 62%, respectively). On the other hand, 80% of the lesions with peripheral pattern and 70% of those with articular pattern were ascribed to DJD. In conclusion, bone SPECT provided much better anatomic information on the extent of 99mTc-methylene diphosphonate(MDP). Differential diagnosis between osseous metastasis and DJD of the vertebrae may be improved by bone SPECT. (author)