SPECT/CT of Spondylolysis in Children and Young Adults

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after February 14, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 0.50
Procedures: 0.50
Head, Spine, and Musculoskeletal: 0.50

Magnetic Resonance Imaging: 0.50
Procedures: 0.50
Neurological: 0.50

Nuclear Medicine Technology: 2.25
Procedures: 2.25
Other Imaging Procedures: 2.25

Radiography: 0.50
Procedures: 0.50
Head, Spine and Pelvis Procedures: 0.50

Registered Radiologist Assistant: 2.25
Procedures: 2.25
Musculoskeletal and Endocrine Sections: 2.25

Outline

1. Introduction
2. Low Back Pain in Children and Adolescents
   1. Causes
   2. Workup
      1. Anterior and Posterior Planar Whole-Body Images
      2. Planar Spot Images (Optional
      3. SPECT Images
3. Imaging Findings
   1. Spondylolysis
   2. Posterior Element Abnormalities
      1. Lumbar Interspinous Bursitis
      2. Spinous Process Avulsion
      3. Facet Hypertrophy
   3. Endplate and Disk Abnormalities
      1. Endplate-Apophyseal Injuries
      2. Degenerative Disk Disease
      3. Endplate Compression Fractures
   4. Transverse Process Abnormalities
      1. Persistent Transverse Process Ossification Center
      2. Transverse Process Fractures
   5. Sacroiliac Abnormalities
      1. Transitional Vertebrae (Bertolotti Syndrome
      2. Sacral Stress Fractures
      3. Sacroiliac Joint Syndrome
   6. Other Abnormalities
      1. Diskitis and Osteomyelitis
      2. Chronic Recurrent Multifocal Osteomyelitis
      3. Benign Tumors
      4. Malignant Tumors
4. Conclusion

Objectives

Upon completion of this course, students will:

1. identify the imaging modality that is suited for assessment of low back pain in children and adults
2. be familiar with the most common structural cause of lower back pain in pediatric and adolescent populations
3. be familiar with the number of ossification centers in the vertebra
4. be familiar with more urgent imaging assessment when neurological symptoms are present
5. be familiar with the radiopharmaceutical used for bone scintigraphy
6. be familiar with accumulation of radiotracer when performing bone scintigraphy
7. be able to identify the collimator recommended for performing whole body bone scintigraphy
8. be familiar with the technique used to collect planar spot images during bone scintigraphy
9. be familiar with the advantages of SPECT/CT over the use of SPECT alone
10. be familiar with the conditions for using CT with SPECT imaging
11. be familiar with the radiation dose for imaging the pediatric spine
12. be familiar with abnormalities of the pars interarticularis
13. be familiar with the limitations of using radiography for diagnosing spondylolysis
14. be familiar with the radiotracer patterns demonstrated when nonunion occurs in the pars interarticularis
15. be familiar with Baastrup disease
16. be familiar with a benign tumor that can mimic facet hypertrophy on SPECT/CT
17. be able to identify which imaging modalities can help differentiate facet hypertrophy from osteochondroma
18. be familiar with common entities that result in endplate uptake at SPECT
19. be familiar with Schmorl nodes and limbus vertebra
20. be familiar with the location of osteoporotic compression fractures in the spine
21. be familiar with the entities causing asymmetrically increased transverse process uptake at SPECT
22. be able to identify the vertebral fractures demonstrated in the endplates at SPECT
23. be familiar with the most common level of the lumbar spine for transverse process fractures
24. be familiar with common entities that result in increased or asymmetric sacroiliac uptake at SPECT
25. be familiar with the name of the low back pain associated with transitional vertebra
26. be able to identify transverse vertebral fractures on SPECT images
27. be familiar with the radiotracer uptake when sacral stress fractures present at SPECT imaging
28. be familiar with the causes of sacroiliac joint pain
29. be familiar with the ability of skeletal scintigraphy to diagnose sacroiliac joint syndrome
30. be familiar with the limitations of radiographic procedures to diagnose acute sacroiliac joint abnormalities
31. be able to identify sacral stress fractures on SPECT images
32. be familiar with the benign bone tumors that are related to abnormal formation of osteoid or woven bone
33. be familiar with the characteristics of osteoid osteomas
34. be familiar with the malignant primary tumors of the bone
35. be familiar with the CT appearance of malignant primary bone tumors