J Korean Soc Spine Surg.  2006 Sep;13(3):191-199. 10.4184/jkss.2006.13.3.191.

Usefulness of Fluorine-18 FDG-PET In the Diagnosis of Vertebral Pathologic Fracture

• Jeon CH
• Yoon JK
• Cho JH
• Chung NS
• Yang YM

• KMID: 2209641
• DOI: http://doi.org/10.4184/jkss.2006.13.3.191

Abstract

STUDY DESIGN: A prospective study of the reproducibility of F-18 FDG-PET.
OBJECTIVES
The purpose of this study was to determine whether F-18 FDG-PET had value in distinguishing between vertebral pathologic fractures and osteoporotic compression fractures. SUMMARY OF LITERATURE REVIEW: There were many reports in the literature about vertebral pathologic disease studied with F-18 FDG-PET, but few about the distinction between pathologic and benign causes in fractured vertebrae.
MATERIALS AND METHODS
Twenty-nine patients with vertebral fractures that did not result from major trauma, who were admitted to our hospital from December 2002 to May 2004, were included in this study; and all of them were evaluated with MRI and F-18 FDG-PET. Their final diagnoses were confirmed by biopsy (n=12) or clinical follow-up (n=17). There were 18 cases of vertebral compression fractures, 11 cases of pathologic fractures (4 cases of tumor lesions and 7 cases of pyogenic spondylitis). F-18 FDG-PET images of those patients were interpreted as vertebral compression fractures or pathologic fractures by one nuclear medicine specialist and one radiology specialist without any clinical or radiologic information. The sensitivity and specificity of MRI and F-18 FDG-PET for the diagnosis of vertebral pathologic fractures were calculated and compared.
RESULTS
Twenty-four (82.8 %) of 29 cases demonstrated a coincidence between MRI and F-18 FDG-PET interpretations. The sensitivity of F-18 FDG-PET for the diagnosis of vertebral pathologic fractures was 90.9 % and the specificity was 88.9 %. The sensitivity of MRI was 81.8% and the specificity was 83.3%. F-18 FDG-PET demonstrated a higher sensitivity and specificity, and these were statistically insignificant differences.
CONCLUSIONS
F-18 FDG-PET is a useful method for determining the differential diagnosis of vertebral pathologic fractures, with high sensitivity and specificity.

Keyword

Spine; F-18 FDG-PET; MRI; Pathologic fracture

MeSH Terms

Biopsy
Diagnosis*
Diagnosis, Differential
Follow-Up Studies
Fractures, Compression
Fractures, Spontaneous*
Humans
Magnetic Resonance Imaging
Nuclear Medicine
Prospective Studies
Sensitivity and Specificity
Specialization
Spine

Figure

• 

  Fig. 1. 51-year old male with T8 fracture, histopathologically diagnosed as multiple myeloma. MRI shows round-protruded posterior cortex and destructed pattern rather than fractured, F-18 PET shows multiple homogeneous uptake stronger than liver. (A: plain X-ray, B: T1WI MRI, C: T2WI MRI, D: T1WI enhanced MRI, E: PET/CT)

• 

  Fig. 2. 63-year old female with T7 fracture, clinically diagnosed as vertebral compression fracture. MRI shows fractured pattern rather than destructed with marrow edema, F-18 PET shows heterogeneous uptake weaker than liver. (A: plain X-ray, B: T1EI MRI, C: T2EI MRI, D: T1EI enhanced MRI, E: PET/CT)

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