Late correlative imaging findings of previous acute infective spondylitis

Purpose: To evaluate late correlative imaging findings in relation to clini cal outcome in persons with previous acute infective spondylitis, the autho rs performed bone and leukocyte scintigraphy (planar and SPECT imaging) and magnetic resonance imaging of the spine in 9 patients (2 men, 7 women; mea n age, 66 years; age range, 57 to 84 years) 3.1 years (range, 0.9 to 6.2 ye ars) after the acute disease. Methods: All images were evaluated visually. The relevant uptake on SPECT i mages was also quantitated using an adjacent normal vertebral body as the r eference area. Results: Except for one patient, all other patients had increased uptake in the affected vertebra on bone and leukocyte scintigraphy. Quantitatively d ecreased uptake was noted on magnetic resonance and computed tomographic sc ans in six of the seven patients who underwent SPECT. Typical findings were destruction of intervertebral disks and compression deformity of vertebral bodies, but there was wide interindividual variance in other findings, suc h as osteophytes, spondylolisthesis, increased vertebral fat content, and p ostoperative changes. These data show that nearly all patients with previou sly acute infective spondylitis have gross abnormal anatomic and functional imaging findings years after the acute disease, despite a good clinical ou tcome. Conclusions: The utility of bone and leukocyte scans in the diagnosis of re activated spondylitis is limited, and incidentally observed abnormal imagin g findings in asymptomatic patients with known previous spondylitis should be interpreted with caution.