The role of Technetium-99m-Ethambutol scintigraphy in the management of spinal tuberculosis

Spines is a common site of extrapulmonary Mycobacterium tuberculosis infection (MTI). Spine destruction due to MTI can mimic other etiologies. Treatment of choice for spinal tuberculosis (STB) is anti-TB drugs while surgery could be needed in other causes. The gold standard for STB diagnosis is histopathology examination from biopsy tissue. Technetium-99m-ethambutol (^99mTc-EMB) scintigraphy can be used to detect and localize of TB. The aim of this study was to evaluate the role of ^99mTc-EMB scintigraphy in STB management. Retrospective study was carried out from 2006 to 2014. Subject STB were patient STB with suspected of STB and underwent ^99mTc-EMB scintigraphy. The histopathologic result was used as gold standard. Whole body planar acquisition was taken at 1 and 3 h postinjection of 370 MBq. Single-photon emission computed tomography/computed tomography acquisition was performed on suspected area. ^99mTc-EMB image were analyzed by two nuclear medicine specialist. The 93 subject STB were included in this study. Histopathologic data were available in 40/93 subject STB. Positive and negative ^99mTc-EMB scintigraphy were 32 and 8 subject STB. ^99mTc-EMB scintigraphy result STB was concordance with the histopathologic finding in 37 subject STB. Sensitivity, specificity, positive- and negative-predictive value, and accuracy of ^99mTc-EMB scintigraphy 90.91%, 71.43%, 93.75%, 62.5%, and 87.5%, respectively. This study showed that patient STB with suspected ^99mTc-EMB scintigraphy result could be directly treated with anti-TB. ^99mTc-EMB scintigraphy has significant role in the management of STB. (author)