Abstract
PurposeTo demonstrate the usefulness of positron emission tomography (PET)/computed tomography (CT) bone scans for gaining insight into healing bone status earlier than CT or X-ray alone.MethodsForty-one prospective patients being treated with a Taylor Spatial Frame were recruited. We registered data obtained from successive static CT scans for each patient, to align the broken bone. Radionuclide uptake was calculated over a spherical volume of interest (VOI). For all voxels in the VOI, histograms and cumulative distribution functions of the CT and PET data were used to assess the type and progress of new bone growth and radionuclide uptake. The radionuclide uptake difference per day between the PET/CT scans was displayed in a scatter plot. Superimposing CT and PET slice data and observing the spatiotemporal uptake of 18F− in the region of healing bone by a time-sequenced movie allowed qualitative evaluation.ResultsNumerical evaluation, particularly the shape and distribution of Hounsfield Units and radionuclide uptake in the graphs, combined with visual evaluation and the movies enabled the identification of six patients needing intervention as well as those not requiring intervention. Every revised patient proceeded to a successful treatment conclusion.ConclusionNumerical and visual evaluation based on all the voxels in the VOI may aid the orthopedic surgeon to assess a patient’s progression to recovery. By identifying slow or insufficient progress at an early stage and observing the uptake of 18F− in specific regions of bone, it might be possible to shorten the recovery time and avoid unnecessary late complications.
Highlights
The Ilizarov-derived circular Taylor Spatial FrameTM (TSF; Smith & Nephew, Memphis, TN, USA) [1, 2] has the ability to correct deformity in six dimensions and has added possibilities to treat difficult fractures and osteotomies [3]
After initial treatment with an intramedullary nail, he presented with an infected pseudarthrosis and a TSF was attached to his tibia
Hsu et al [23] as well as Mathavan et al [24] found that positron emission tomography (PET)/Computed tomography (CT) was valuable in the evaluation of fracture healing in a rat model
Summary
The Ilizarov-derived circular Taylor Spatial FrameTM (TSF; Smith & Nephew, Memphis, TN, USA) [1, 2] has the ability to correct deformity in six dimensions and has added possibilities to treat difficult fractures and osteotomies [3]. Computed tomography (CT), planar X-ray imaging, and clinical examinations are presently used to evaluate bone healing. These techniques are currently unable to predict the healing potential either preoperatively or during treatment. As 18F− is rapidly taken up by bone, healing bone, there is a high bone-to-background contrast [4], making it an excellent bone-imaging agent. Values in the range of 200–600 HU were considered to represent cancellous/trabecular or healing bone while cortical (strong) bone is > 600 HU [8, 9]. If identification of patients with a high risk of delayed or nonunion could be done early, even preoperatively, it might be possible to avoid late revisions which lead to prolonged treatments and unnecessary late amputations
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