Early stage spine infarct accurately diagnosed by 99m Tc-HMDP bone scintigraphy performed on a combined single photon emission computed tomography/computed tomography system correlation with magnetic resonance imaging and histopathological findings.

A 53-year-old man with no significant medical, drug, or trauma history was referred for bone scintigraphy following acute lumbar pain and suspicious magnetic resonance imaging (MRI) findings. MRI examination showed anomalies (Figure 1) that, although not specific, were consistent with neoplastic bone involvement. A 99m Tc-HMDP single photon emission computed tomography (SPECT)/CT scan (Figure 2) showed a hypometabolic aspect of the whole corpus of L1, the posterior arch appearing normal. The CT part of the scan was normal, ruling out known causes of cold vertebrae such as osteolytic metastasis 1 , plasmocytoma 2 , and heman-gioma 3 . The hypothesized diagnosis was early-stage bone infarct, with an increase in tracer uptake expected to be observed at a later stage, as in avascular necrosis of the femoral head 4 . However, due to the MRI results, a surgical biopsy was performed. Pathological examination consistent with The of in the posterior part of the