Use of FDG-PET in differentiating benign from malignant compression fractures

Miriam A Bredella,Martin Torriani,Hugue A Ouellette,William E Palmer,Brendan Essary

doi:10.1007/s00256-008-0452-5

Miriam A Bredella, Martin Torriani + Show 3 more

Open Access

https://doi.org/10.1007/s00256-008-0452-5

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Journal: Skeletal Radiology	Publication Date: May 1, 2008
Citations: 78	License type: CC BY 4.0

Affiliation: Massachusetts General Hospital

Abstract

ObjectiveThe objective was to evaluate the use of fluorodeoxyglucose positron emission tomography (FDG-PET) in differentiating benign from malignant compression fractures.Patients and methodsIn a retrospective analysis, we identified 33 patients with 43 compression fractures who underwent FDG-PET. On FDG-PET the uptake pattern was recorded qualitatively and semiquantitatively and fractures were categorized as benign or malignant. Standardized uptake values (SUV) were obtained. MRI, CT, and biopsy results as well as clinical follow-up for 1–3 years served as standards of reference. The Student’s t test was used to determine whether there was a statistically significant difference between the SUV for benign and malignant compression fractures.ResultsThere were 14 malignant and 29 benign compression fractures, including 5 acute benign fractures. On FDG-PET, 5 benign fractures were falsely classified as malignant (false-positive). Three of these patients underwent prior treatment with bone marrow-stimulating agents. There were two false-negative results. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FDG-PET in differentiating benign from malignant compression fractures were 86%, 83%, 84%, 71%, and 92% respectively. The difference between SUV values of benign and malignant fractures was statistically significant (1.9 ± 0.97 for benign and 3.9 ± 1.52 for malignant fractures, p < 0.001). SUV of benign acute and chronic fractures were not statistically significant.ConclusionFluorodeoxyglucose positron emission tomography is useful in differentiating benign from malignant compression fractures. Therapy with bone marrow-stimulating agents can mimic malignant involvement.

Highlights

Differentiating between malignant and benign vertebral compression fractures can represent a diagnostic challenge and is difficult in elderly patients, who frequently have a history of malignancy and are predisposed to benign compression fractures from osteoporosis or treatment-related changes [1,2,3]
In contrast to magnetic resonance imaging (MRI) or Computed tomography (CT), fluorodeoxyglucose positron emission tomography (FDG-PET) can yield metabolic information that is based on increased glucose metabolism of malignant and inflammatory lesions
A retrospective search was performed using Boolean operators (Folio; Open Market, Proto, UT, USA) to identify all patients who had undergone whole-body FDG-PET at our institution from 2003 to 2006 and had the finding of a compression fracture mentioned in the PET report

Summary

Introduction

Differentiating between malignant and benign vertebral compression fractures can represent a diagnostic challenge and is difficult in elderly patients, who frequently have a history of malignancy and are predisposed to benign compression fractures from osteoporosis or treatment-related changes [1,2,3]. Differentiating between benign and malignant compression fractures has important therapeutic and prognostic implications. Computed tomography (CT) and magnetic resonance imaging (MRI) are routinely used in the evaluation of compression fractures; these imaging modalities do not always permit definite diagnosis [2,3,4,5]. In contrast to MRI or CT, fluorodeoxyglucose positron emission tomography (FDG-PET) can yield metabolic information that is based on increased glucose metabolism of malignant and inflammatory lesions.

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