Scans & Imaging

MRI SCAN

This remains the gold standard for spine problems.
However, up to 85% of us show abnormal findings without back pain. Thus it is not very “specific”. Is it though very “sensitive”. As a result it is often more use for what it does not show.

One drawback to MRI is that some people are not happy being placed in a relatively confined space. Other reasons for being unable to have an MRI are having a pacemaker and having some types of metal in their body; such as fragments in their eye or brain.

These scans can be obtained through both the NHS and Private systems. Contact us for more details.

COMPUTED TOMOGRAPHY (CT) SCAN

This is good to “see” the bones with but less good with regard to the discs and other soft tissues.

It may be of value if someone is unable to have an MRI, but again it involves being placed in a fairly confined space.

X-RAYS

These tend to be the quickest and easiest images to obtain but are probably the least sensitive, certainly as far as the pain clinic goes.

However, we do use X-rays to guide us when we place needles into and around the spine but here they are being used for a different purpose.

SPECT-CT for Musculoskeletal Pain

A SPECT-CT scan is a specialised imaging test that combines two types of imaging — SPECT (Single Photon Emission Computed Tomography) and CT (Computed Tomography) — to provide detailed information about both the structure and activity of bones and joints.

Why might I need a SPECT-CT?

When you have ongoing musculoskeletal pain, it is not always possible to identify the exact source of the pain using standard X-rays, MRI or CT scans alone. A SPECT-CT can sometimes provide additional information by showing areas of increased bone activity, which may indicate where there is irritation, inflammation, stress or increased bone turnover.

This can be particularly helpful when trying to determine whether a particular joint or area of the spine is contributing to your symptoms. It may be considered when there are several possible sources of pain or when the findings on other scans do not clearly match your symptoms.

A SPECT-CT may be useful in assessing areas such as:

• The spine and facet joints
• The sacroiliac joints
• Hips, knees, ankles and feet
• Areas of previous surgery
• Stress or insufficiency injuries
• Some forms of arthritis or degenerative joint disease

Importantly, a SPECT-CT does not diagnose the cause of pain on its own. The results need to be interpreted alongside your symptoms, examination and other investigations.

What happens during a SPECT-CT?

A small amount of a radioactive tracer is injected into a vein in your arm. The tracer travels through your bloodstream and is taken up by areas of bone that are more metabolically active.

There is usually a waiting period after the injection to allow the tracer to distribute through your body. You may be asked to drink fluids and empty your bladder before the scan.

You will then lie on a scanning table while the SPECT-CT camera takes images of the relevant area. The CT component provides detailed pictures of the anatomy, while the SPECT component shows where there is increased bone activity. The two sets of images are combined to provide a more complete picture.

The scan itself is generally painless, although you will need to remain still for the images.

What can the results tell us?

A SPECT-CT may help identify areas that are biologically active and potentially contributing to your pain. This can sometimes help your Pain Team decide which areas are most appropriate for further treatment or, in selected circumstances, whether a targeted diagnostic injection may be helpful.

However, an area that appears active on SPECT-CT is not necessarily the source of your pain. Changes seen on the scan can occur as part of normal ageing and degenerative changes, so the results must always be considered in the context of your individual symptoms.

Is SPECT-CT safe?

SPECT-CT involves exposure to a small amount of radiation from both the radioactive tracer and the CT scan. The level of radiation is carefully controlled and the potential benefits of the examination are considered before the scan is recommended.

You should tell your medical team if you are pregnant or think you may be pregnant. You should also let the team know if you are breastfeeding, as you may need specific advice about the tracer.

Your nuclear medicine or radiology team will explain the procedure and answer any questions you may have before the examination.

What happens afterwards?

In most cases, you can return to your usual activities after the scan. The radioactive tracer naturally leaves the body, mainly through the urine, over time. You may be advised to drink plenty of fluids after the examination.

Your SPECT-CT images will be reviewed by an appropriately trained specialist, and the results will be considered alongside your clinical assessment and any previous imaging.

The aim of SPECT-CT is not simply to find an abnormality, but to help determine whether a particular abnormality is relevant to your pain and may help guide your treatment.