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Peer-reviewedCC BY-NC-NDBone & joint research

The diagnostic value of quantitative 99mTc-MDP SPECT/CT fusion imaging in the differential diagnosis of spinal infections

  • Jiaxing Wang1,2
  • Jiong Wang1,2
  • Yingqin Jia3
  • Zhiyun Shi4
  • Ping Ma3
  • Hekun Liu1
  • Qian Zhao3
  • Ningkui Niu1,5
5 affiliations
  1. 1Department of Orthopedic, General Hospital of Ningxia Medical University, Yinchuan, China
  2. 2Ningxia Medical University, Yinchuan, China
  3. 3Department of Nuclear Medicine, General Hospital of Ningxia Medical University, Yinchuan, China
  4. 4Key Laboratory of Clinical Pathogenic Microorganisms, General Hospital of Ningxia Medical University, Yinchuan, China.
  5. 5Research Center for Prevention and Control of Bone and Joint Tuberculosis, General Hospital of Ningxia Medical University, Yinchuan, China
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Abstract

Aims: To investigate the value of quantitative 99mTc-labelled methylene diphosphonate (99mTc-MDP) single-photon emission CT (SPECT)/CT fusion imaging in the differential diagnosis of spinal infections.

Methods: A total of 90 patients with confirmed spinal infections, prior to any clinical treatment, underwent 99mTc-MDP SPECT/CT fusion imaging. The maximum, mean, and minimum standardized uptake values (SUVmax, SUVmean, SUVmin), bone metabolic volume (MBV), total bone uptake (TBU), and CT Hounsfield unit (HU) values were measured in both affected and normal vertebrae. Multidimensional comparisons of SPECT/CT parameters were performed, including within-subject analyses comparing affected and adjacent normal vertebrae in the same infection type, as well as inter-group comparisons across different types of spinal infections. Diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis to determine the area under the curve (AUC) and optimal cut-off values, while the linear associations between quantitative SPECT/CT parameters of affected vertebrae and laboratory biomarkers were evaluated.

Results: The median SUVmax of affected vertebrae in pyogenic spondylitis (PS) was 21.17 (IQR 17.19 to 22.01), significantly higher than that observed in spinal tuberculosis (STB) (17.57 (IQR 15.02 to 18.98)) and brucellar spondylitis (BS) (15.63 (IQR 14.28 to 16.90)). SUVmax demonstrated strong diagnostic performance in differentiating PS from BS, with an AUC of 0.852, yielding 95.0% sensitivity and 71.7% specificity at an optimal cut-off value of 18.51. Similarly, CT HU values showed moderate discriminative ability for distinguishing BS from STB, achieving an AUC of 0.741, with 80.0% sensitivity and 65.0% specificity at a cut-off of 706 HU. Furthermore, a strong positive correlation was observed between SUVmax and CT HU values across all three infection groups. In addition, SUVmax exhibited a significant positive correlation with serum inflammatory markers in patients with PS.

Conclusion: Quantitative 99mTc-MDP SPECT/CT fusion imaging enables objective assessment of spinal infection severity, thereby facilitating the differential diagnosis of distinct aetiological types of spondylitis.

Cite this article: Bone Joint Res 2026;15(11):1292–1306.

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Cite

BibTeXRIS
BibTeX
@article{wang2026diagnostic,
  title = {{The diagnostic value of quantitative 99mTc-MDP SPECT/CT fusion imaging in the differential diagnosis of spinal infections}},
  author = {Jiaxing Wang and Jiong Wang and Yingqin Jia and Zhiyun Shi and Ping Ma and Hekun Liu and Qian Zhao and Ningkui Niu},
  journal = {Bone \& joint research},
  year = {2026},
  month = nov,
  doi = {10.1302/2046-3758.1511.bjr-2025-0787.r1},
  url = {https://europepmc.org/article/PMC/PMC13723356},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - The diagnostic value of quantitative 99mTc-MDP SPECT/CT fusion imaging in the differential diagnosis of spinal infections
AU  - Jiaxing Wang
AU  - Jiong Wang
AU  - Yingqin Jia
AU  - Zhiyun Shi
AU  - Ping Ma
AU  - Hekun Liu
AU  - Qian Zhao
AU  - Ningkui Niu
PY  - 2026
DA  - 2026/11/01
JO  - Bone & joint research
DO  - 10.1302/2046-3758.1511.bjr-2025-0787.r1
UR  - https://europepmc.org/article/PMC/PMC13723356
AB  - Aims: To investigate the value of quantitative 99mTc-labelled methylene diphosphonate (99mTc-MDP) single-photon emission CT (SPECT)/CT fusion imaging in the differential diagnosis of spinal infections.  Methods: A total of 90 patients with confirmed spinal infections, prior to any clinical treatment, underwent 99mTc-MDP SPECT/CT fusion imaging. The maximum, mean, and minimum standardized uptake values (SUVmax, SUVmean, SUVmin), bone metabolic volume (MBV), total bone uptake (TBU), and CT Hounsfield unit (HU) values were measured in both affected and normal vertebrae. Multidimensional comparisons of SPECT/CT parameters were performed, including within-subject analyses comparing affected and adjacent normal vertebrae in the same infection type, as well as inter-group comparisons across different types of spinal infections. Diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis to determine the area under the curve (AUC) and optimal cut-off values, while the linear associations between quantitative SPECT/CT parameters of affected vertebrae and laboratory biomarkers were evaluated.  Results: The median SUVmax of affected vertebrae in pyogenic spondylitis (PS) was 21.17 (IQR 17.19 to 22.01), significantly higher than that observed in spinal tuberculosis (STB) (17.57 (IQR 15.02 to 18.98)) and brucellar spondylitis (BS) (15.63 (IQR 14.28 to 16.90)). SUVmax demonstrated strong diagnostic performance in differentiating PS from BS, with an AUC of 0.852, yielding 95.0% sensitivity and 71.7% specificity at an optimal cut-off value of 18.51. Similarly, CT HU values showed moderate discriminative ability for distinguishing BS from STB, achieving an AUC of 0.741, with 80.0% sensitivity and 65.0% specificity at a cut-off of 706 HU. Furthermore, a strong positive correlation was observed between SUVmax and CT HU values across all three infection groups. In addition, SUVmax exhibited a significant positive correlation with serum inflammatory markers in patients with PS.  Conclusion: Quantitative 99mTc-MDP SPECT/CT fusion imaging enables objective assessment of spinal infection severity, thereby facilitating the differential diagnosis of distinct aetiological types of spondylitis.  Cite this article: Bone Joint Res 2026;15(11):1292–1306.
SN  - 2046-3758
ER  -