PT - JOURNAL ARTICLE AU - Rahul V. Parghane AU - Baljinder Singh AU - Aman Sharma AU - Harmandeep Singh AU - Paramjeet Singh AU - Anish Bhattacharya TI - Role of <sup>99m</sup>Tc-Methylene Diphosphonate SPECT/CT in the Detection of Sacroiliitis in Patients with Spondyloarthropathy: Comparison with Clinical Markers and MRI AID - 10.2967/jnmt.117.193094 DP - 2017 Dec 01 TA - Journal of Nuclear Medicine Technology PG - 280--284 VI - 45 IP - 4 4099 - http://tech.snmjournals.org/content/45/4/280.short 4100 - http://tech.snmjournals.org/content/45/4/280.full SO - J. Nucl. Med. Technol.2017 Dec 01; 45 AB - Our rationale was to evaluate the role of 99mTc-methylene diphosphonate (99mTc-MDP) SPECT/CT for the detection of sacroiliitis in spondyloarthropathies by comparing it with clinical markers and MRI findings. Methods: We prospectively included 155 patients (83 men and 72 women; mean age, 35.80 ± 12.40 y; range, 18–60 y) diagnosed with spondyloarthropathies as per the criteria of the European Spondyloarthropathy Study Group. All patients underwent clinical evaluation (using the Bath ankylosing spondylitis disease activity index [BASDAI]), measurement of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level, planar 99mTc-MDP bone scintigraphy, SPECT/CT, and MRI of the pelvic region. Using MRI as the reference criterion, the diagnostic accuracy of the clinical and scintigraphic parameters was assessed. On planar bone scintigraphy and SPECT, a score of 0, 1, or 2 was assigned when tracer uptake in the sacroiliac joint was less than, equal to, or more than that in the sacrum. A score of 2 was considered positive for the diagnosis of sacroiliitis. Results: The sensitivity, specificity, accuracy, and positive and negative predictive values of 99mTc-MDP SPECT/CT were 90.0%, 80.0%, 87.0%, 92.0%, and 75.0%, respectively. The accuracy of SPECT/CT (87%) was better than that of ESR (58.1%), CRP (32.9%), BASDAI scoring (77%), and planar bone scintigraphy (53%). Similar results were found for sensitivity and negative predictive value. Regarding specificity, SPECT/CT (80%) was lower than BASDAI scoring (88.6%) and equal to planar bone scintigraphy (80%). Regarding positive predictive value, SPECT/CT (92%) was a bit lower than BASDAI scoring (93.6%). κ-values for planar 99mTc-MDP bone scanning and SPECT/CT were 0.167 and 0.673, respectively, indicating poor agreement for planar bone scanning and good agreement for SPECT/CT. A significant (P &lt; 0.001) correlation (r = 0.659) was observed between SPECT/CT and MRI findings. Conclusion: 99mTc-MDP SPECT/CT has diagnostic accuracy comparable to that of MRI for the evaluation of sacroiliitis in spondyloarthropathies and can thus be used as an alternative when MRI is contraindicated. SPECT/CT shows better accuracy than planar bone scintigraphy, ESR, CRP, and BASDAI scoring in the diagnosis of sacroiliitis.