Does bone scintigraphy show Modic changes associated with increased bone turnover?

Jyri Järvinen; Jaakko Niinimäki; Jaro Karppinen; Reijo Takalo; Marianne Haapea; Osmo Tervonen

doi:10.1016/j.ejro.2020.100222

Does bone scintigraphy show Modic changes associated with increased bone turnover?

Eur J Radiol Open. 2020 Feb 10:7:100222. doi: 10.1016/j.ejro.2020.100222. eCollection 2020.

Authors

Jyri Järvinen^{1

2

3}, Jaakko Niinimäki^{1

2

3}, Jaro Karppinen^{2

4}, Reijo Takalo¹, Marianne Haapea^{1

2

3}, Osmo Tervonen^{1

2

3}

Affiliations

¹ Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
² Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
³ Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.
⁴ Finnish Institute of Occupational Health, Oulu, Finland.

Abstract

Purpose: Our purpose was to evaluate whether Modic changes (MC) revealed in lumbar MRI are associated with increased tracer uptake shown in bone scintigraphy. To our knowledge, this has not previously been studied.

Methods: We included patients with MC shown in lumbar MRI and bone scintigraphy performed within six months before or after MRI. Exclusion criteria included metastasis and other specific lesions in the area of interest such as discitis, tumors or fractures. We compared the level and type of MC to the degree of tracer uptake shown in bone scintigraphy. Tracer uptake was assessed both visually and quantitatively. We calculated the lesion-to-normal-bone ratios between the MC area with increased tracer uptake and the vertebra with normal tracer uptake. We used linear mixed models in statistical analyses.

Results: Our study sample consisted of 93 patients (aged 37-86) with 299 MC (28 Type 1 (M1), 50 mixed Type 1/2 (M1/2), 3 mixed Type 1/3 (M1/3), 211 Type 2 (M2), 6 mixed Type 2/3 (M2/3), and 1 Type 3 (M3)). Of all the MC, 26 (93 %) M1, 34 (64 %) in the combined M1/2 and M1/3 group, and 11 (5 %) in the combined M2, M2/3 and M3 group showed increased tracer uptake. The mean lesion-to-normal-bone ratio was higher for lesions with a Type 1 component (M1, M1/2 and M1/3) than for other types, at 1.55 (SD 0.16) for M1; 1.44 (SD 0.21) for combined M1/2 and M1/3; and 1.28 (SD 0.11) for combined M2, M2/3 and M3; p = 0.001).

Conclusion: In most cases, MC with a Type 1 component showed increased tracer uptake in bone scintigraphy. This indicates that bone turnover is accelerated in the M1 area.

Keywords: 99mTc, 99mTechnetium; 99mTc-HDP, 99m Technetium-labeled hydroxymethylene diphosphonate; Bone scintigraphy; Bone turnover; ICC, intraclass correlation coefficients; LBP, low back pain; M1, Type 1 Modic change; M1/2, Type 1/2 mixed Modic change; M1/3, Type 1/3 mixed Modic change; M2, Type 2 Modic change; M2/3, Type 2/3 mixed Modic change; M3, Type 3 Modic change; MC, Modic changes; MRI, magnetic resonance imaging; Magnetic resonance imaging; Modic changes; SPECT, single photon emission computed tomography; κ, Cohen’s kappa.