The use of MRI, PET/CT, and nuclear scintigraphy in the imaging of pyogenic native vertebral osteomyelitis: a systematic review and meta-analysis

Level of evidence - high (systemic review, meta-analysis)

Summary:

This study aimed to assess the diagnostic accuracy of various imaging techniques, including Magnetic Resonance Imaging (MRI), Positron Emission Tomography/Computed Tomography (PET/CT), 67Gallium, and 99mTechnetium scintigraphy, in detecting pyogenic Native Vertebral Osteomyelitis (NVO). The researchers conducted a systematic review of studies from 1970 to September 2021, comparing these imaging modalities and performed a meta-analysis using a bivariate random effect model.

Results from 20 included studies (1,123 imaging studies) showed that 67Gallium had the highest sensitivity for NVO, and its specificity improved when combined with 99mTechnetium. MRI and PET/CT demonstrated high sensitivity, with PET/CT having slightly better specificity. Specifically, the sensitivity and specificity of MRI were 90% and 72%, PET/CT were 93% and 80%, 67Gallium were 95% and 88%, 99mTechnetium were 86% and 39%, and combined 67Gallium and 99mTechnetium were 91% and 92%, respectively.

In conclusion, 67Gallium, especially when combined with 99mTechnetium, showed the highest sensitivity for NVO. Both MRI and PET/CT were highly sensitive, with PET/CT having slightly better specificity. The choice of initial imaging modality depends on the availability of resources.