Initial investigation of 18F-NaF PET/CT for identification of vertebral sites amenable to surgical revision after spinal fusion surgery

Quon, Andrew; Dodd, Robert; Iagaru, Andrei; Abreu, Marcelo Rodrigues de; Hennemann, Sérgio Afonso; Neto, Jose Maria Alves; Sprinz, Clarice

doi:10.1007/s00259-012-2196-7

Cited by 29 publications

(23 citation statements)

References 12 publications

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“…According to recent studies, 18 F-FDG PET sensitively detects active inflammation in rheumatic diseases, including synovitis in RA [12][13][14][15][16][17][18]. In contrast, 18 F-NaF PET is an increasingly used molecular imaging modality in human skeletal disorders [19][20][21][22][23]. 18 F-NaF incorporates into the bone at the site of bone formation or remodeling; there, osteoblasts and osteoclasts are activated, and 18 F ions exchange the hydroxyl ions in bone crystal to form fluorapatite.…”

Section: Introductionmentioning

confidence: 94%

¹⁸F-FDG and ¹⁸F-NaF PET/CT demonstrate coupling of inflammation and accelerated bone turnover in rheumatoid arthritis

Watanabe

Takase‐Minegishi

Ihata

et al. 2015

Modern Rheumatology

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Section: Introductionmentioning

confidence: 94%

¹⁸F-FDG and ¹⁸F-NaF PET/CT demonstrate coupling of inflammation and accelerated bone turnover in rheumatoid arthritis

Watanabe

Takase‐Minegishi

Ihata

et al. 2015

Modern Rheumatology

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“…Because patients in whom clinical findings were suggestive of loosening of lumbar fusion material and who presented with negative bone SPECT/CT findings were not included in the study by Damgaard et al, no conclusion could be drawn regarding the diagnostic accuracy of SPECT/CT for assessing loosening in their study. Finally, Quon et al performed a prospective pilot study to identify spinal sites requiring surgical revision after fusion surgery, using 18F-sodium fluoride (18F-NaF) PET/CT imaging and surgery or clinical follow-up as gold standard [12]. 18F-NaF PET/CT imaging showed sensitivity of 100 % and specificity of 85.7 % in its ability to identify spinal sites in need of surgical revision; 22 patients were studied.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of bone SPECT/CT for identifying hardware loosening in patients who underwent lumbar fusion with pedicle screws

Hudyana

Maes

Vandenberghe

et al. 2015

Eur J Nucl Med Mol Imaging

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Background The aim of this retrospective study was to evaluate the accuracy of bone SPECT (single photon emission computed tomography)/CT (computed tomography) in diagnosing loosening of fixation material in patients with recurrent or persistent back pain that underwent lumbar arthrodesis with pedicle screws using surgery and clinical follow-up as gold standard Methods A total of 48 patients (median age 49 years, range 21-81 years; 17 men) who had undergone lumbar spinal arthrodesis were included in this retrospective analysis. SPECT/ CT results were compared to the gold standard of surgical evaluation or clinical follow-up. Positive SPECT/CT results were considered true positives if findings were confirmed by surgery or if clinical and other examinations were completely consistent with the positive SPECT/CT finding. They were considered false positives if surgical evaluation did not find any loose pedicle screws or if symptoms subsided with non-surgical therapy. Negative SPECT/CT scans were considered true negatives if symptoms either improved without surgical intervention or remained stable over a minimum follow-up period of 6 months. Negative SPECT/CT scans were determined to be false negatives if surgery was still required and loosening of material was found.Results The median length of time from primary surgery to bone SPECT/CT referral was 29.5 months (range 12-192 months). Median follow-up was 18 months (range 6-57) for subjects who did not undergo surgery. Thirteen of the 48 patients were found to be positive for loosening on bone SPECT/CT. Surgical evaluation (8 patients) and clinical follow-up (5 patients) showed that bone SPECT/CT correctly predicted loosening in 9 of 13 patients, while it falsely diagnosed loosening in 4 patients. Of 35 negative bone SPECT/CT scans, 12 were surgically confirmed. In 18 patients, bone SPECT/CT revealed lesions that could provide an alternative explanation for the symptoms of pain (active facet degeneration in 14 patients, and disc and sacroiliac osteodegeneration in 7 patients and 1 patient, respectively). Overall sensitivity and specificity for the detection of loosening were 100 % and 89.7 %, respectively. The positive and negative predictive values were 69 % and 100 %, respectively. Conclusions This retrospective analysis suggests that bone SPECT/CT bone is a highly sensitive and specific tool for the exclusion of screw loosening in patients who present with recurrent low back pain after having undergone lumbar arthrodesis. In addition, it can identify other potential causes of recurrent low back pain in this patient population.

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“…Lower pitch settings usually mean better image quality, pending the patient stays still. Slimmer and younger patients could be imaged with a lower kV and mAs [16]. Higher CT energy also reduces metal artifact from spinal implants.…”

Section: Technical Informationmentioning

confidence: 99%

Pearls and Pitfalls of 18F Sodium Fluoride PET-CT Bone Imaging for Evaluation of Back Pain and Spine Pathology

Pouldar¹

2016

NMRR

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Study design: The following paper is a review article with case presentations showing how to order, perform and interpret 18F sodium fluoride PET/CT of the spine. It discusses its advantages and limitations in evaluating the orthopedic spine patient. Objective:The purpose of this article is to aid physicians and technologists in performing, analyzing, ordering, and preparing 18F sodium fluoride PET/CT in the spine surgery setting for patients suffering from back pain. Summary of background data:The evaluation of patients who have already undergone spine surgery who present with persistent pain has always been a diagnostic challenge in the orthopedic setting. While CT and MRI are conventionally used to aid diagnosis, 18F sodium fluoride PET/CT has been an undervalued tool in the setting of the complex diagnosis of back pain especially following surgical fusion. The aim of this paper is to educate radiologists, orthopedic surgeons and clinicians in use of PET/CT bone scan in the orthopedic setting. Methods:In our review article, we adopt the oncology protocol of 18F sodium fluoride PET/CT and modify it to fit the CT spine protocol. We determine which radiologic parameters are most effective in image acquisition and describe the steps involved in preparing the patient for imaging, imaging acquisition and interpretation. We illustrate this article with cases describing how 18F sodium fluoride PET/ CT can alter diagnosis and help manage difficult cases.Results: 18F sodium fluoride PET/CT is a valuable resource in the orthopedic surgeon's acumen to identify pain generators of the spine. Additionally, this article further describes the use of PET/CT in the imaging of the spine by discussing PET/CT's advantages and limitations compared to other imaging modalities, the clinical indications for when to use PET/CT, and the proper patient preparation, radiopharmaceutical preparation, imaging acquisition, data processing and physician analysis and reporting. In our experience PET/ CT bone imaging is often superior to CT alone in demonstrating potential post-surgical complications including loosening and healing changes. Conclusion: This article aids physicians and technologists in un-derstanding what is involved in performing PET/CT studies of the spine. In several cases, we described PET/CT's advantages in the orthopedic setting in identifying the pain generator of the spine. By using these guidelines, 18F sodium fluoride PET/CT and its potential benefits in the spine surgery setting can be further explored.

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Initial investigation of 18F-NaF PET/CT for identification of vertebral sites amenable to surgical revision after spinal fusion surgery

Cited by 29 publications

References 12 publications

¹⁸F-FDG and ¹⁸F-NaF PET/CT demonstrate coupling of inflammation and accelerated bone turnover in rheumatoid arthritis

¹⁸F-FDG and ¹⁸F-NaF PET/CT demonstrate coupling of inflammation and accelerated bone turnover in rheumatoid arthritis

Accuracy of bone SPECT/CT for identifying hardware loosening in patients who underwent lumbar fusion with pedicle screws

Pearls and Pitfalls of 18F Sodium Fluoride PET-CT Bone Imaging for Evaluation of Back Pain and Spine Pathology

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Initial investigation of 18F-NaF PET/CT for identification of vertebral sites amenable to surgical revision after spinal fusion surgery

Cited by 29 publications

References 12 publications

18F-FDG and 18F-NaF PET/CT demonstrate coupling of inflammation and accelerated bone turnover in rheumatoid arthritis

18F-FDG and 18F-NaF PET/CT demonstrate coupling of inflammation and accelerated bone turnover in rheumatoid arthritis

Accuracy of bone SPECT/CT for identifying hardware loosening in patients who underwent lumbar fusion with pedicle screws

Pearls and Pitfalls of 18F Sodium Fluoride PET-CT Bone Imaging for Evaluation of Back Pain and Spine Pathology

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¹⁸F-FDG and ¹⁸F-NaF PET/CT demonstrate coupling of inflammation and accelerated bone turnover in rheumatoid arthritis

¹⁸F-FDG and ¹⁸F-NaF PET/CT demonstrate coupling of inflammation and accelerated bone turnover in rheumatoid arthritis