Only 3 studies (104 patients in total) provided complete diagnostic accuracy data with a reference test. In addition, 7 full reports and 3 abstracts provided partial information.
Only 3 reports provided a 'gold' standard reference test and allowed the calculation of sensitivity and specificity.
1st report: 15 young patients with lower back pain of unknown source received SPECT to detect spondylolysis, spondylolisthesis, lumbar Scheuerman disease and fractures. The reference test was by the review of medical records or telephone conversation at 7 months. The true -positive rate (TPR) was 0.917 and the false- positive rate (FPR) was 0.0. It was not possible to calculate the likelihood ratio.
2nd report: 74 patients known to have a primary malignancy with no known spinal metastases were investigated, using SPECT, in order to detect benign and malignant spinal lesions. The reference test was by some combination of biopsy, autopsy, CT, magnetic resonance imaging, follow-up planar bone scan, follow-up plain films and clinical follow-up at 6 months. The TPR was 0.966, the FPR was 0.956, and the likelihood ratio of a positive test was 1.01. The pattern of positive results indicated that SPECT might be useful in distinguishing between benign and malignant lesions.
3rd report: 15 patients who had received spinal fusion were examined, using SPECT, for pseudoarthrosis. The reference test was by repeat surgery or clinical follow-up (time unspecified). The TPR was 0.778, the FPR was 0.167, and the likelihood ratio was 4.7.
The reports were not combined because they studied such different patient populations. It was not possible to estimate the accuracy of SPECT in other important populations, such as adults with no known cancer or patients with suspected osteomyelitis. No reports were found on the clinical effect or cost-effectiveness of SPECT.