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Jeon, Yoon, Cho, Chung, and Yang: Usefulness of Fluorine-18 FDG-PET In the Diagnosis of Vertebral Pathologic Fracture
Original Research

Journal of Korean Spine Surg 2006;13(3):191-199.

Published online: 18 February 2006

DOI: https://doi.org/10.7469/JKSS.2006.13.3.191

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

Chang-Hoon Jeon, M.D., Joon-Kee Yoon, M.D.#, Jae-Hyun Cho, M.D.$, Nam-Su Chung, M.D., Young-Mo Yang, M.D.

Department of Orthopedic Surgery

#Department of Nuclear Medicine and Molecular Imaging

$Department of Diagnostic Radiology, Ajou University School of Medicine

Address reprint requests to Nam-Su Chung, M.D. Department of Orthopedic Surgery, Ajou University School of Medicine San 5 Wonchundong, Paldalku, Suwon, Kyounggido, Korea Tel: 82-31-219-5220, Fax: 82-31-219-5229, E-mail: bone@ajou.ac.kr

Copyright © 2006 Korean Society of Spine Surgery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Spine, F-18 FDG-PET, MRI, Pathologic fracture

REFERENCES

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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)
jkss-13-191f1.tif
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)
jkss-13-191f2.tif
Table 1.
Patients data
Patient t Sex Age Level MRI SUV∗ PET (1)∗∗ PET (2)∗∗∗ Bx.# F/U (mo)## Final diagnosis
01 F 66 T12,L1,2,3 tumor - pathologic pathologic +   multiple myeloma
02 M 72 T10,11 benign - pathologic benign +   spondylitis
03 F 81 T11,L1 benign - benign benign - 35 VCF###
04 F 63 T8 benign - benign benign - 12 VCF
05 M 57 C7 metastatis - pathologic pathologic +   metatasis
06 F 81 L4 benign - benign benign - 13 VFC
07 M 52 L5,S1 spondylitis - pathologic pathologic +   spondylitis
08 F 73 T12,L1 benign - benign benign - 17 VCF
09 M 71 T11,12 benign - benign benign +   VCF
10 M 52 L1,2 benign - benign benign - 10 VCF
11 F 83 T12 benign - benign benign - 18 VCF
12 F 78 L1 benign - benign benign - 10 VCF
13 M 68 L1 benign - benign benign - 14 VCF
14 F 62 L1 benign - benign benign - 25 VCF
15 F 71 T12,L1 benign - benign benign - 18 VCF
16 M 76 L3 benign - benign benign - 06 VCF
17 F 72 L1 equivocal - pathologic benign +   VCF
18 M 37 L2,3 benign - pathologic pathologic +   spondylitis
19 F 80 L2,3 metastatis - pathologic pathologic +   VCF
20 F 83 L4,5 spondylitis - benign benign - 21 spondylitis
21 F 46 L1,2,3,4,5 metastasis 5.96 pathologic pathologic - 10 metastasis
22 F 62 T4,6,7,8,9 benign 1.97 benign benign - 08 VFC
23 M 51 T8 tumor 5.23 pathologic pathologic +   multiple myeloma
24 F 63 T7 benign 3.20 benign benign - 06 VCF
25 F 61 T7 metastasis 2.71 benign benign +   VCF
26 M 67 L4,5 spondylitis 3.08 pathologic pathologic - 07 spondylitis
27 M 66 L3 benign 3.19 benign benign - 08 VCF
28 F 63 L5,S1 spondylitis 3.60 pathologic pathologic +   spondylitis
29 M 57 L5,S1 spondylitis 5.41 pathologic pathologic +   spondylitis

SUV∗ : standardized uptake value PET(1)∗∗ : PET read by nuclear medicine specialist PET(2)∗∗∗ : PET read by radiologic specialist Bx

# : histopathologic diagnosis F/U(mo)

## : clinical and radiologic follow-up duration in months VCF

### : vertebral compression fracture

Table 2.
Results
    VCF (n=18) Pathologic Fx.∗ (n=11)
MRI sensitivity 83.3% (15/18) 81.8% (9/11)
  specificity 81.8% (9/11)0 083.3% (15/18)
  accuracy 82.8% (24/29) 082.8% (24/29)
PET reader (1) sensitivity 88.9% (16/18) 90.9% (9/11)
  specificity 90.9% (10/11) 088.9% (16/18)
  accuracy 89.7% (26/29) 089.7% (26/29)
PET reader (2) sensitivity 94.4 % (17/18) 81.8% (9/11)
  specificity 81.8% (9/11)0 094.4% (17/18)
  accuracy 89.7% (26/29) 089.7% (26/29)

pathologic Fx.∗ (n=11; tumor=4, spondylitis=7)

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